|Year : 2015 | Volume
| Issue : 1 | Page : 42-47
Impact of oral health on quality of life among police personnel in Bengaluru City, India: A cross-sectional survey
Uma Shankarachari Rajagopalachari1, Manjunath P Puranik1, Laxminarayan Sonde2
1 Department of Public Health Dentistry, Government Dental College and Research Institute, Fort, Bengaluru, Karnataka, India
2 Department of Public Health Dentistry, Yenepoya Dental College, Deralakatte, Mangalore, Karnataka, India
|Date of Web Publication||19-Mar-2015|
Dr. Uma Shankarachari Rajagopalachari
Department of Public Health Dentistry, Government Dental College and Research Institute, Room No. 9, Fort, Victoria Hospital Campus, Bengaluru - 560 002, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Oral diseases though rarely life-threatening, it does influence the quality of life (QoL). It can have an impact on the functional, social and psychological well-being of an individual. Hence, there is growing interest in oral health outcomes and its impact on QoL. Objectives: To assess the impact of oral health variables on oral health-related quality of life (OHRQoL) among police personnel. Materials and Methods: A cross-sectional study was conducted among police personnel (n = 212) in the state intelligence headquarter division in Bengaluru. Oral Health Impact Profile-14 (OHIP-14) was used to measure OHRQoL. Dental caries was recorded using World Health Organization 1997 criteria, and periodontal health status was assessed using community periodontal index and loss of attachment. Oral hygiene status was evaluated using simplified oral hygiene index (OHI-S). Correlation between the oral health variables and domains of OHIP was done using the Pearsons correlation coefficient. Results: The prevalence of dental caries and periodontal disease was 43.4% and 68% respectively among the study sample. Oral hygiene status of the personnel was fair with mean score of 2.67 ± 1.4. Domains of functional limitation and physical disability of OHIP-14 significantly correlated with decayed teeth (P < 0.01). Decayed, missing, and filled teeth positively correlated with "physical pain," "physical disability" (P < 0.01), and all other domains (P < 0.05) except social disability. Conclusion: This study demonstrated a significant association between OHIP and oral health variables. The largest impact was related to decay component.
Keywords: Impact, oral health, Oral Health Impact Profile - 14, oral health-related quality of life, police, quality of life
|How to cite this article:|
Rajagopalachari US, Puranik MP, Sonde L. Impact of oral health on quality of life among police personnel in Bengaluru City, India: A cross-sectional survey. J Indian Assoc Public Health Dent 2015;13:42-7
| Introduction|| |
Any disease that could impede the daily activities may have an adverse impact on the general quality of life (QoL) of the affected individual. QoL assessment is increasingly being considered as an essential component for evaluating the outcomes of healthcare. The surgeon's general report on oral health defined oral health-related quality of life (OHRQoL) as a "multidimensional construct" that indicates people's comfort when eating, sleeping, and engaging in social interaction, their self-esteem, and their satisfaction with respect to their oral health.  It brings a new perspective to clinical care and research by shifting the focus of the clinicians from merely the oral cavity to the patient as a whole.
Although oral diseases are not life threatening, they do influence the QoL. Pain, fear, function, and esthetics affect the life quality, and with regard to oral health, chewing and eating problems are the substantial concerns. Oral diseases may adversely affect an individual's potential to live comfortably, be successful in employment, enjoy life, experience relationships, and possess a positive self-image.  The information on how people perceive the impact of oral diseases on their quality life is relevant for the development of oral health strategies that meet the specific needs of the population.
Though clinical objective indicators are preferred to assess oral health, they are not completely reliable to capture the impact of the disease at group level or population level as required in policy decisions. Epidemiological studies in dentistry are crucial to observe the population trends against several aggravating scenarios related to oral health and their adverse effects on the QoL. These studies will also assist in planning health programs to address diverse oral health needs. 
The mission of the police of a state is to help the common man, to provide him security and to create a peaceful and law abiding community with his cooperation. The place that is occupied by the police in a state is similar to the place occupied by the military in a nation. Free access to medical care at government hospitals and privileges for leave on medical grounds is provided to police personnel to ensure good general as well as oral health. Conversely, their different working environment with 24 h duty and exposure to the highest physical strain and mental stress compromise their QoL. Their odd working pattern may also interfere having timely food, sleep, rest, recreation, and family contacts. A minor ailment can impact the QoL, when the job stress adds to the problem. , Hence, the present study was conducted to assess the impact of oral health variables on OHRQoL among police personnel.
| Materials and Methods|| |
A convenient sample of police personnel in the state intelligence headquarter division of Bengaluru city, Karnataka, India formed the study sample. The personnel receive their reinforced training in this division every year along with a medical examination. Police personnel in attendance for the medical examination in the training facility who volunteered to take part in the study and gave consent for clinical examination were included. Those who were not willing were excluded from the study. Ethical clearance from the Institutional ethical committee and also permission from the authorities for the study was obtained.
The survey included a questionnaire and clinical examination of the personnel that lasted for a month. Questionnaire included demographic details like age, sex, designation, income and also information pertaining to their last visit to the dentist. The socioeconomic status was assessed using Kuppuswamy's scale.  World Health Organization (WHO) 1997 criteria and methods were used to register dental caries, community periodontal index (CPI) and loss of attachment (LoA) for assessing periodontal health.  Oral hygiene status was recorded using simplified oral hygiene index (OHI-S) developed by Greene and Vermillion. 
The short version of the Oral Health Impact Profile (OHIP) 49 profile containing 14 items (OHIP-14) was used to assess the OHRQoL.  For each of the OHIP-14 questions, subjects were asked how frequently they had experienced any impact in the preceding time interval (last 1-year) on the Likert scale (0 = never, 1 = hardly ever, 2 = occasionally, 3 = fairly often, 4 = very often). The OHIP-14 questionnaire was translated into local language and to ensure linguistic validity back translation method was used. Information about oral health problems faced by the subjects in the previous 12 months was also collected.
Data were analyzed using Statistical Package for Social Sciences, IBM Corporation, SPSS Inc., Chicago, IL, USA version-18 statistical software. Descriptive statistics with frequency mean and standard deviation was computed to characterize the participants and their responses. Significance was assessed at 5% level of significance. Individual item means for the OHIP-14 were calculated, and the means were subsequently grouped according to the sub domains. Pearson's correlation coefficient was used to assess the correlation between domains of OHIP and clinical variables.
| Results|| |
The study sample consisted of 212 subjects belonging to the age range of 24-60 years. Of these, the majority (82.5%) were males. Most of them were in the 26-50 year old category (52.4%). Of the 212 subjects, 84 were graduates (39.6%), 71 had passed 10 th grade (33.5%). Regarding their designation, most of the study participants belonged to the constable group (31.1%), while some were administrative personnel (28.8%). About 59% had not visited the dentist at all. For those who visited, the predominant reason was tooth extraction (14.6%) and restoration (12.7%) [Table 1]. All the study participants belonged to the upper middle class and upper class category.
[Table 2] depicts the distribution of responses to all OHIP-14 questions on a Likert scale. It is evident that most of them never reported having any oral problems in the last year for all the 14 items. The mean item scores ranged from 0.2 to 1.04. Of the seven domains, the highest mean scores were reported for "physical pain" (0.94 ± 1.07) followed by "psychological discomfort" (0.81 ± 1.11) and "physical disability" (0.58 ± 0.91) [Table 3].
|Table 2: Distribution of responses to individual OHIP-14 items and mean item scores among the study subjects |
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|Table 3: Mean scores of the seven domains of OHIP-14 among the study subjects |
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There was no significant difference among the mean OHIP scores across education categories (P > 0.05). Both males and females experienced the same magnitude of impact on their QoL due to oral conditions and the corresponding mean OHIP score noted were 0.50 ± 0.66 and 0.62 ± 0.63 respectively. Comparison of the mean scores of the individual OHIP-14 responses and mean OHIP showed no significant difference between the males and females (P = 0.10).
About 68% of the study, subjects had periodontal problems. Among them, 4.2% had gingival bleeding, 38.7% had calculus, 21.7% had shallow pockets of 4-5 mm, 2.8% had deep pockets. The highest numbers of individuals (38.7%) were having a CPI code 2 (mean number of sextants 2.35 ± 2.38) [Figure 1].
|Figure 1: Distribution of study subjects according to community periodontal index codes|
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Loss of attachment
The periodontal attachment loss among the study samples exhibited various conditions. Majority of them (65.2%) presented with periodontal attachment from 0 to 3 mm (code 0, mean = 4.7 ± 2), 19.3% presented with periodontal attachment from 4 to 5 mm (code 1, mean = 0.67 ± 1.3), 10.8% had LoA from 6 to 8 mm (code 2, mean = 0.42 ± 1.2) 4.2% had LoA of 9-11 mm (code 3, mean = 0.09 ± 0.5) and 0.5% had LoA level of 12 mm or more (code 4) [Table 4].
|Table 4: Mean number of sextants of CPI and LoA codes among the study subjects |
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Simplified oral hygiene index
The overall mean OHI-S of the sample was 2.67 ± 1.4 with mean debris index score being 1.4 ± 0.7 and calculus index score being 1.2 ± 0.9. The oral hygiene status of the personnel was fair.
The prevalence of dental caries was 43.4% among the sample. The mean number of decayed teeth (DT), missing teeth (MT), filled teeth, and decayed, missing, and filled teeth (DMFT) of the population were 1.10 ± 2.02, 0.53 ± 1.31, 0.37 ± 1.34, and 2 ± 3.22 respectively. The corresponding values of mean DMFT of males and females were 1.84 ± 3 and 2.70 ± 3.6. DMFT score ranging from 1 to 5 was found in 30% of the study subjects [Figure 2].
|Figure 2: Distribution of study subjects according to decayed, missing, and filled teeth scores|
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Domains of "functional limitation" and "physical disability" were found to be significantly correlated (P < 0.01) with DT. DMFT positively correlated with "physical pain" and "physical disability" domains in that order (P < 0.01), and with all other domains (P < 0.05) except social disability. Physical pain was highly correlated with MT and DMFT. Correlation of high CPI and a high LoA with all domains of OHIP-14 was statistically significant. Correlation with no statistical significance was observed between the OHI-S and the OHIP [Table 5].
|Table 5: Correlation between clinical variables and mean of sub-domains of OHIP-14 |
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| Discussion|| |
A more comprehensive assessment of the impact of oral diseases on the several dimensions of subjective well-being is feasible if OHRQoL measures are used along with traditional clinical methods of measuring oral health status.  The OHIP-14 is a 14-items questionnaire designed to measure self-reported functional limitation, discomfort, and disability attributed to oral conditions.  It is derived from an original extended version of 49-items based on a theoretical model developed by the WHO and adapted for oral health by Locker.  In this model, the consequences of oral disease are hierarchically linked from a biological level (impairment) to a behavioral level (functional limitation, discomfort, and disability) and finally to the social level (handicap). In spite of being a short-questionnaire, the OHIP-14 has been reported to show good reliability and sensitivity with adequate cross-cultural consistency. It is one of the most internationally spread OHRQoL indicators available in several languages. 
As this is the first study done among police population, results cannot be exactly compared with other studies as the study population varies, however, observations are made.
In the current study, teeth decay was significantly associated with functional limitation and physical disability of the subjects. However, it didn't show much impact on social disability. The study subjects involved more males than females, which is consistent with the fact that more men are recruited into this field than females. Studies done by Kumar et al. and Ingle et al. concluded that females had poor OHRQoL than males. Although males outnumbered females, the current study results showed that both genders perceived a similar impact, which is in line with the study by Aslund et al.
There were no discernible differences in the socioeconomic characteristics of the subjects, and none of them belonged to the lower economic strata. Although 22% of the study subjects did not complete fundamental schooling, it was noted that education did not have any effect on the OHRQoL. Previous studies by Kumar et al.  and Saub and Locker  had also reported similar finding.
Failure to complete all sections of the questionnaire by the participants is a common limitation observed in most of the OHRQoL surveys. This will have an adverse effect on generating the overall score of impact.  In this study, the response rate to the questionnaire was good, and there were no incomplete questionnaires.
Majority of the subjects reported "never" for most of the items of OHIP-14 and the possible reason could be due to social desirability bias. The bias occurs when the respondents opt for lower scores on OHIP than the usual as stated in the study by Acharya and Bhat. 
In this study, the mean scores for the OHIP-14 items ranged from 0.21 for having difficulty in chewing to 1.04 for painful aching in mouth. The reason being that the majority feel the impact of oral health only when there is pain. 
Many investigators (Locker and Miller; Locker and Slade; McGrath and Bedi) ,, have shown the association of dental caries status with OHRQoL. Though > 50% of the study subjects were caries free, a statistically significant correlation was observed between OHIP and DMFT. The decayed component was found to be associated with most of the domains of OHIP-14. It was observed that the impact was greater with DT than any other clinical variable; this was also pointed out in the study by Locker and Miller. 
Physical pain domain demonstrated the impact on QoL by the highest mean scores in this study. This can be explained by the fact that most of them visited the dentist only when they had pain. Statistically significant positive correlation was observed between all domains of OHIP and periodontal disease indicators as measured by CPI and LoA, this may reflect a significant role of periodontal disease in affecting OHRQoL, however, further studies are suggested.
The present study could be considered as the first and foremost attempt done to assess OHRQoL among the specified study population. It used clinical indicators to assess the impact. The limitation of this study is that it used a small convenience sample, hence the generalizability of the interpretation may not be possible. The low sample size could have impacted the results, particularly the predictive ability of oral health variables with regard to OHIP. However, the apparent effect is in accordance with other studies (Lawrence et al.; Sheiham). , Further studies encompassing a larger sample size of the specified population can be done, which can provide more evidence of the subjects perception about oral problems.
| Conclusion|| |
The present study demonstrated an association of OHRQoL with oral health status variables. The largest impact was related to decayed component. DT, MT, DMFT, CPI and LoA all positively correlated with the domains.
These measures have a future in OHRQoL surveys as an adjunct to identify the conditions with the most potential to compromise patient well-being and QoL. It is important to document the impact of oral health on life quality at any given point of time, to identify the variations in impact among subgroups of the population, for planning and evaluating care.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]