Journal of Indian Association of Public Health Dentistry

: 2016  |  Volume : 14  |  Issue : 4  |  Page : 397--402

Caries experience and its relationship with oral health related quality of life among orphanage children in Bengaluru City: A cross-sectional study

Rohan Pratap, Manjunath P Puranik, SR Uma 
 Department of Public Health Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India

Correspondence Address:
Rohan Pratap
Department of Public Health Dentistry, Government Dental College and Research Institute, Room No. 9, Victoria Hospital Campus, Fort, Bengaluru - 560 002, Karnataka


Introduction: Dental caries is a common disease of the childhood affecting the quality of life (QoL). Studies have focused on oral health including caries experience in underprivileged children. However, information concerning relationship between caries experience and QoL of orphanage children is scarce. Objective: To assess caries experience and its relationship with oral health-related QoL (OHRQoL) among orphanage children in Bengaluru city. Materials and Methods: A cross-sectional study was conducted among 200 orphanage children aged 7–18 years from six randomly selected orphanages in Bengaluru city. Demographic data were obtained through self-designed questionnaire while OHRQoL was assessed using prevalidated Child Oral Health Impact Profile-Short Form questionnaire (COHIP-SF). Caries experience was determined using decayed, missing, filled teeth/Decayed, Missing, Filled Teeth (dmft/DMFT) indices. Descriptive statistics and Spearman's correlation were performed using SPSS-16. P< 0.05 was considered statistically significant. Results: Among study participants, caries experience in primary and permanent dentition was 40.5% and 38%, respectively, while mean dmft and DMFT were 1.26 ± 2.00 and 0.96 ± 1.49, respectively. Mean COHIP-SF was 56.83 ± 11.10. COHIP-SF positively correlated with DMFT (rho = 0.21, P = 0.002) and negatively correlated with dmft (rho = −0.26, P = 0.001). Conclusions: Dental caries experience was similar in primary and permanent dentition among orphanage children. Higher COHIP-SF scores indicate positive OHRQoL. Dental caries significantly correlated with their OHRQoL. Innovative oral health promotion program through the help of public–private partnership could enhance their OHRQoL.

How to cite this article:
Pratap R, Puranik MP, Uma S R. Caries experience and its relationship with oral health related quality of life among orphanage children in Bengaluru City: A cross-sectional study.J Indian Assoc Public Health Dent 2016;14:397-402

How to cite this URL:
Pratap R, Puranik MP, Uma S R. Caries experience and its relationship with oral health related quality of life among orphanage children in Bengaluru City: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2021 Apr 14 ];14:397-402
Available from:

Full Text


Parents are the principal custodian and saviors of a child. However, mournfully thousands of children have to lead their lives without parents. They are either dead or being incapable of bringing up their children and such section of the society are called as “orphans.”[1] The orphans are socially and economically deprived individuals who have lost both their parents and are under age of 18 years.[1] The condition of orphanage differs from family living together as the former provides food shelter and physical security but is deprived of psychological security.[2] The vast majority of the children are placed in orphanages as a result of parental absence or abandonment and neglect.[2] They are often overlooked, sympathized, or even hidden away in the community.[3] Globally, there are approximately 153 million children who have lost either a mother or father; 17.8 million of them have lost both parents.[4] In India, a total number of orphan children are estimated to be 2.32 million.[1],[3]

Many children enter orphanages with compromised health, developmental, and psychiatric disorders, reflecting the neglect and abuse experienced.[2] They are isolated population deserving special attention to become prosperous citizens who are physically fit, mentally sound, and morally healthy with endowed skills and motivation needed by the society.[1] Moreover, healthy personality development and full unfolding of potentialities are hampered in socially handicapped children by certain elements in their social environment such as parental inadequacy, environmental deprivation, and emotional disturbances.[5] Being an orphan is one of the most important forecasters of poor oral health as these deprived children rarely get an opportunity to seek dental care.[3]

Dental caries is the most prevalent and widespread disease in children that can seriously impair quality of life (QoL), and its pattern is dependent on various socioeconomic characteristics of the children and parents.[1],[6] Oral health-related QoL (OHRQoL) is a multidimensional construct that includes a subjective evaluation of the individual's oral health and physical and psychosocial well-being.[7] It has received increased attention in the recent years, and researchers have recommended that normative clinical measures should be complemented with OHRQoL measures in treatment needs assessments along with planning oral health services.[8],[9]

Few studies have evaluated the caries experience among orphanage children, but its effect on their QoL remains to be explored. Hence, to bridge this gap, this study was conducted with an objective to assess caries experience and its relationship with OHRQoL among orphanage children in Bengaluru city.

 Materials and Methods

A cross-sectional study was conducted for a period of 3 months among orphanage children from May to July 2015 in Bengaluru city. A detailed protocol of the study was presented before the Institutional Ethical Committee, and ethical clearance was obtained. Prior permission from the administrators and directors of orphanages was obtained. Written informed consent from the caregivers and informed assent from the participants were obtained.

A pilot study was conducted among thirty children from one of the orphanages selected randomly. The caries experience was found to be 70%. Based on this, the sample size of 186 was obtained using the formula, 4PQ/L2 which was rounded to 200 to negate the nonresponse.[10]

Pre-validated Child Oral Health Impact Profile-Short Form (COHIP-SF)[11] questionnaire was subjected to cultural validation by means of back-translation method. Further, it was assessed for readability and comprehension by the participants during the pilot study. Necessary corrections were made.

The principal investigator was trained and calibrated in the Department of Public Health Dentistry in accordance with basic Oral Health Surveys purposed by the WHO (2013).[12] Training and calibration sessions on recording of decayed, missing, filled teeth/Decayed, Missing, Filled Teeth (dmft/DMFT) included theoretical aspects followed by clinical examinations of ten participants with a wide range of level of disease conditions from the outpatient department. The procedure was repeated on the same participants on successive days to determine consistency. The intraexaminer reliability was 0.80.

List of orphanages in Bengaluru city was obtained from the internet, and from this list, three aided and three unaided orphanages were selected randomly. Participants aged 7–18 years residing in orphanages were included in the study. Uncooperative children and those with detrimental systemic disorders or conditions which make oral health assessment difficult were excluded from the study. Study participants were selected using simple random sampling among eligible participants.

The data were collected at their respective orphanages using a self-designed questionnaire by a single investigator and recorded with the help of trained assistant. Demographic profile, medical and dental history, oral hygiene practices, and diet history of the study participants were collected. Caries assessment was done using the WHO criteria (2013) to determine dmft/DMFT. Children were examined on an ordinary chair in a well-ventilated hall using natural light. OHRQoL was measured using COHIP-SF 19 questionnaire.

The questionnaire consisted of 19 items divided into three domains: oral health (five items), functional well-being (four items), and socioemotional well-being (10 items), which was rated on a five-point scale ranging from never to almost all the time and scored from 0 to 4 as follows: never (0), almost never (1), sometimes (2), fairly often (3), and almost all the time (4). Participants were asked choose their response reflecting these conditions in the past 3 months. Participants took approximately 5–10 min to fill the questionnaire and it was collected immediately.

Frequency for each domain was calculated after assigning weights for each option considering positive and negative questions. Scoring of the negatively worded items was reversed. Descriptive statistics with frequency mean and standard deviation were computed using Statistical Package for Social Sciences (SPSS) version 16 (are IBM statistics, Chicago). Spearman's correlation tests were used to find out correlation between COHIP-SF and dental caries. Statistical significance was set at 5% (P < 0.05).


A total of 200 orphanage children participated in the study and the response was 100%. The age of the study participants ranged from 7 to 18 years (mean age: 11.70 ± 2.88 years). Gender wise 57% were males and 43% were females. Majority of the participants were Hindus (90%) followed by Christians (7.5%) and Muslims (2.5%). Eighty-six percent of them resided in orphanages for <5 years. None of the study participants selected in the study was suffering from any debilitating medical conditions.

Only 9% of the study participants had visited a dentist before with discolored teeth being the major complaint. Almost three-fourth (71.5%) of the study participants thought they did not need any dental treatment as most of them believed that they have good oral health.

Majority of the study participants used toothbrush (92.5%) and toothpaste (100%) to clean their teeth once daily (91.5%) using horizontal method (77%) before meals (90%) and changed brush after 4–6 months (71.5%). Only 4% of them were using other oral hygiene aids. Most of the participants consumed mixed diet (85.5%), received corporation water (83%), and rice was the staple diet (63.5%).

Caries experiences in primary and permanent dentition were 40.5% and 38.0%, respectively. Caries experience in primary dentition among males was more than two folds (50.8%) when compared to females (23.2%). Whereas in permanent dentition, females had higher caries experience (46%) as compared to males (31%). Mean dmft of the study participants in primary dentition was 1.26 ± 2.00 with mean dt of 1.23 ± 1.98, whereas in permanent dentition, mean DMFT was 0.96 ± 1.49 with mean DT being 0.93 ± 1.47 [Table 1].{Table 1}

Regarding oral health, about their experience of pain, discolored teeth, crooked teeth or spaces, bad breath, and bleeding gums in last 3 months, majority of the participants chose either “never” or “almost never.” Mean score ranged from 2.35 ± 1.60 to 2.59 ± 1.49.

In terms of functional well-being such as difficulty in eating food, sleeping, saying words, and keeping teeth clean, majority of the participants responded “never.” The mean score ranged from 3.11 ± 1.30 to 3.58 ± 0.91.

With respect to their socioemotional well-being (been happy or sad, worried, avoided smiling, felt that they look different, being worried what other thinks, being teased or bullied, missed schools, and not wanted to speak out loud in class due to teeth, mouth, or face), majority of the participants responded as “never,” whereas when ask about whether they are confident and look attractive majority responded “all the time.” The mean score ranged from 2.73 ± 1.99 to 3.44 ± 0.94.

The mean COHIP-SF scores for oral health, functional well-being, and socieoemotional well-being domain were 12.53 ± 4.73, 13.28 ± 3.46, and 32.02 ± 6.58, respectively. The overall mean score was −56.8 ± 11.10 [Table 2].{Table 2}

Negative but weak statistical correlation was observed between dmft and COHIP-SF (rho = −0.26, P = 0.001), whereas weak but positive statistical correlation was observed between DMFT and COHIP-SF (rho = 0.17, P = 0.016). Oral health domain negatively correlated with dmft (rho = −0.26, P = 0.001) and positively correlated with DMFT (rho = 0.21, P = 0.002). No significant correlation was observed between other domains and dmft/DMFT [Table 3].{Table 3}


Healthy personality development and full unfolding of potentialities of socially handicapped children such as orphans are hampered by certain elements such as parental inadequacy, environmental deprivation, and emotional disturbances. Most of the orphanages lack proper living space and facility for the proper upbringing of children.[5] They are dependent on caregivers for many basic requirements. More disturbing, however, is evidence that their health care is often neglected.[2] Children in orphanage do not receive adequate preventive health care and many significant problems go undetected, or, if diagnosed, are not evaluated and treated.[2] This cross-sectional study assessed caries experience and its relationship with OHRQoL among orphanage children in Bengaluru city.

Studies in literature have considered varied age groups from 4 to 18 years. In many cases, it is possible that the orphanage children might not know their true age and they take the age which is given to them by their caregivers. In the current study, participants were aged between 7 and 18 years with the mean age being 11.70 ± 2.88 years which is almost similar to a study,[1] and lower than three studies [2],[5],[13] reported in literature. Males were predominant (57%) when compared to females (43%) in this study which is similar to two studies,[1],[14] whereas other studies had a female predominance.[2],[5],[15],[16] Majority of the study participants were Hindus. Similar proportions were observed in other studies in India [3] reflecting ethnical pattern in India. None of the study participants had any significant medical history. Eighty-six percent of the study participants in the present study were residing in orphanage for <5 years which is similar to the finding in a study.[1] In two studies,[2],[3] 40% of the participants were residing for <5 years.

Perceptions about dental care vary across socioeconomic and cultural groups and could determine their self-care as well as dental visits. Similar to the studies reported in literature,[2],[5],[14] majority of the study participants did not perceive the need for any dental treatment. Most of them believed they have good oral health. In line with their perceptions, this study found lesser proportion of the participants visiting the dentist. On the contrary, a study [3] where less than half of the study participants (46%) perceived good oral health, higher proportions of dental visits were reported.

Orphanages provide food, shelter, and meet the basic needs of the inmates with the help of sponsors and NGOs. Life in an orphanage is somewhat different from the normal peers living with family in terms of their daily schedules, food habits, and certain practices. Oral hygiene aids are provided by the caregivers. Most of the study participants used toothbrush and toothpaste to clean teeth. This is almost similar to the studies reported in literature.[2],[5],[16] However, in one study,[1] only 45.9% of the participants were using toothbrush and toothpaste. Rice is a staple diet in South India which was reflected in this study.

In the current study, dental caries experience was similar in primary and permanent dentition. Males had higher caries experience in primary dentition, whereas females had higher caries experience in permanent teeth. Mean caries experience in primary dentition (dmft) was 1.26 ± 2.00 which is intermediate when compared to studies in the literature.[1],[14] The mean dt, mt, and ft was lower than a study.[13] In one study,[1] dt was higher and ft was similar to the current study. Mean caries experience in permanent dentition was lower as compared to some studies.[1],[2],[5],[6],[14]

Several validated instruments currently exist to measure children's OHRQoL (COHRQoL). The COHIP is the first COHRQoL instrument to incorporate both positive and negative health impacts. Higher COHIP scores reflect more positive OHRQoL. This has the potential to measure more than the absence of a condition but can measure positive attributes or enhanced well-being (e.g., confidence) as a result of care. In addition, a short form (19 items) of the COHIP has been validated which is used in this study.[11] Most of the current study participants chose the option “never” or “almost never” for the items in these three domains.

Regarding oral health domain, the impact of oral diseases such as pain, discoloration, crooked teeth, bad breath, and bleeding gums was less in the last 3 months. This aspect is reflected in the proportion as well as the means for individual items and overall domain. Correlation analysis showed weak and negative significant correlation between dmft and oral health domain, whereas weak but positive correlation with DMFT. This may be explained on the basis of pain threshold of these children and stage of the disease. Pain threshold increases with age.[17] Children with younger age have less pain threshold; thus, they complain more often than older children. Hence, this domain correlated in a different direction with dmft and DMFT.[18] Moreover, as the enamel and dentin are thin in primary teeth, caries spreads faster and can lead to pain which was observed in younger participants.

Similarly, participants' functional well-being and socioemotional well-being were least affected due to oral diseases as most of the participants responded negatively. One possible reason could be that the disease might not have progressed to such a stage which would have compromised their functions and affected social and emotional aspects of life. Another reason could be that all the items in the scale chosen might not be sensitive enough to extract the impact of caries on these individuals. Moreover, this scale measures impacts in the last 3 months which might not be sufficient enough to scale the effect of caries on these individuals.

There are a few limitations inherent in this study. First of all, the cross-sectional design does not suggest causality. Second, the social desirability bias is associated with questionnaire study. Moreover, the QoL scale chosen might not have reflected the true results.

In a resource-limited country like India, incorporation of oral health orientation program in the school education can contribute in improving the oral health of underprivileged children. There is a need for frequent dental health checkup programs in schools and orphanages to improve oral health. Training and educational programs on “oral health and its maintenance” should be conducted for primary caregivers and teaching and supporting staff of orphanages. Oral health education and screening programs should be conducted on a regular basis for this deprived group of society by dental health professionals. In a cross-sectional study like this, the cause of dental caries cannot be easily determined. Longitudinal studies are recommended in the future to study the influence of oral health knowledge, attitude, and practices on oral health status.


Dental caries experience was similar in primary and permanent dentition. Overall study participants had good OHRQoL. Significant but weak correlation was found between dental caries experience and OHRQoL.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1Khare V, Koshy A, Rani P, Srilatha S, Kapse SC, Agrawal A. Prevalence of dental caries and treatment needs among the orphan children and adolescents of Udaipur district, Rajasthan, India. J Contemp Dent Pract 2012;13:182-7.
2Shanbhog R, Godhi BS, Nandlal B, Kumar SS, Raju V, Rashmi S. Clinical consequences of untreated dental caries evaluated using PUFA index in orphanage children from India. J Int Oral Health 2013;5:1-9.
3Hans R, Thomas S, Dagli R, Bhateja GA, Sharma A, Singh A. Oral health knowledge, attitude and practices of children and adolescents of orphanages in Jodhpur city, Rajasthan, India. J Clin Diagn Res 2014;8:ZC22-5.
4United States Government. Fifth Annual Report to Congress on PL 109-95. World's Vulnerable Children; 2010. Available from: [Last accessed on 2015 Oct 27].
5Shanbhog R, Raju V, Nandlal B. Correlation of oral health status of socially handicapped children with their oral heath knowledge, attitude, and practices from India. J Nat Sci Biol Med 2014;5:101-7.
6Kumar S, Goyal A, Tadakamadla J, Tibdewal H, Duraiswamy P, Kulkarni S. Oral health related quality of life among children with parents and those with no parents. Community Dent Health 2011;28:227-31.
7Sischo L, Broder HL. Oral health-related quality of life: What, why, how, and future implications. J Dent Res 2011;90:1264-70.
8Gherunpong S, Sheiham A, Tsakos G. A sociodental approach to assessing children's oral health needs: Integrating an oral health-related quality of life (OHRQoL) measure into oral health service planning. Bull World Health Organ 2006;84:36-42.
9Tsakos G. Combining normative and psychosocial perceptions for assessing orthodontic treatment needs. J Dent Educ 2008;72:876-85.
10Suresh K, Chandrashekara S. Sample size estimation and power analysis for clinical research studies. J Hum Reprod Sci 2012;5:7-13.
11Genderson MW, Sischo L, Markowitz K, Fine D, Broder HL. An overview of children's oral health-related quality of life assessment: From scale development to measuring outcomes. Caries Res 2013;47 Suppl 1:13-21.
12WHO. Oral Health Surveys. Basic Methods. 5th ed. Geneva: WHO; 2013.
13Virk P, Jain RL, Pathak A, Sharma U, Rajput JS. Inter-relationship of intelligence-quotient and self-concept with dental caries amongst socially handicapped orphan children. J Indian Soc Pedod Prev Dent 2012;30:127-32.
14Al-Jobair AM, Al-Sadhan SA, Al-Faifi AA, Andijani RI. Medical and dental health status of orphan children in central Saudi Arabia. Saudi Med J 2013;34:531-6.
15Gaur A, Sujan SG, Katna V. The oral health status of institutionalized children that is, Juvenile home and orphanage home run by Gujarat state Government, in Vadodara city with that of normal school children. J Indian Soc Pedod Prev Dent 2014;32:231-7.
16Ojahanon PI, Akionbare O, Umoh AO. The oral hygiene status of institution dwelling orphans in Benin City, Nigeria. Niger J Clin Pract 2013;16:41-4.
17Yezierski RP. The effects of age on pain sensitivity: Preclinical studies. Pain Med 2012;13 Suppl 2:S27-36.
18Saxena I, Kumar M, Barath AS, Verma A, Garg S, Kumar M. Effect of age on response to experimental pain in normal Indian males. J Clin Diagn Res 2015;9:CC05-8.