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ORIGINAL ARTICLE
Year : 2023 | Volume
: 22
| Issue : 2 | Page : 224-228
Comparison of oral health-related quality of life and its association with the periodontal status among the adults: A questionnaire-based study
Henston DSouza1, Jagadish Prasad Rajguru2, Shivangi Gupta3, CD Mouneshkumar4, Basanta Kumar Choudhury5, Karishma6
1 Specialist Endodontist, PHCC, Doha, Qatar
2 Department of Oral Pathology and Forensic Odontology, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
3 Department of Periodontics and Implantology, MMDSR Deemed to be University, Mullana, Ambala, Haryana, India
4 Reader, Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Krishna Institute of Medical Sciences, Deemed University, Karad, Maharashtra, India
5 Department of Oral Medicine and Radiology IDS, Sum Hospital, Soa University, K-8,Kalinganagar, Bhubaneswar, Odisha, India
6 Senior Resident, Department of Dentistry, AIIMS, Patna, Bihar, India
Correspondence Address:
Shivangi Gupta
Department of Periodontics and Implantology, Mullana, Ambala, Haryana
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/aam.aam_54_22
Abstract
Background: Oral health-related quality of life (OHRQoL) is used for evaluating needs of people, their health problems, their level of satisfaction, and various effects of any intervention which have been provided for recording of various nonclinical aspects of oral health. Aim: The objective of the study was to compare OHRQoL and its association with periodontal health among adult population. Materials and Methods: This prospective and cross-sectional study was conducted on 300 respondents who were diagnosed with periodontitis. 14-item containing Oral Health Impact Profile 14 (OHIP-14) questionnaire was used for study analysis. A single observer made clinical examinations. Mann–Whitney “U” and Kruskal–Wallis statistical tests were used for comparing the OHIP-14 scores. Statistically significance was set at P < 0.05. Results: Majority of study participants were of female gender (62.0%). A significant association was observed between loss of attachment and OHIP14 scores (P = 0.003). Conclusion: Poor periodontal health may affect the OHRQoL.
Abstract in French Résumé
Contexte: La qualité de vie liée à la santé bucco-dentaire (OHRQoL) est utilisée pour évaluer les besoins des personnes, leurs problèmes de santé, leur niveau de satisfaction, et divers effets de toute intervention qui a été fournie pour l'enregistrement de divers aspects non cliniques de la santé bucco-dentaire. But: L'objectif de l'étude était de comparer la OHRQoL et son association avec la santé parodontale parmi la population adulte. Matériels et méthodes: ce Une étude prospective et transversale a été menée auprès de 300 répondants ayant reçu un diagnostic de parodontite. 14 articles contenant Orale Le questionnaire Health Impact Profile 14 (OHIP-14) a été utilisé pour l'analyse de l'étude. Un seul observateur a fait des examens cliniques. Man–Les tests statistiques Whitney “ U “ et Kruskal–Wallis ont été utilisés pour comparer les scores OHIP-14. La signification statistique a été fixée à P < 0,05. Résultats: La majorité des participants à l'étude étaient de sexe féminin (62,0 %). Une association significative a été observée entre la perte d'attachement et scores OHIP14 (P = 0,003). Conclusion: Une mauvaise santé parodontale peut affecter l'OHRQoL.
Mots-clés: Adultes, Oral Health Impact Profile 14, qualité de vie liée à la santé buccodentaire, parodontite, questionnaire
Keywords: Adults, Oral Health Impact Profile 14, oral health-related quality of life, periodontitis, questionnaire
Introduction 
Oral health may be defined as being completely free of oral diseases, i.e., “state of freedom from any oral and/or facial pain, cancer of oral cavity and/or throat, any types of oral infection and ulcers, periodontal diseases, dental caries, and loss of teeth among other diseases or disorders which can cause limitation in any person's capacity for biting, mastication, or chewing, while smiling, during speech, and psycho-social well-being.”[1]
Oral health affects an individual both physical as well as psychologically. It has been found to be influencing overall growth, enjoying life, physical appearances, ability to speak, ability for proper mastication, ability to taste food, socializing, and feeling of wellbeing. Furthermore, there may be various psychosocial effects of different oral diseases which may result in significant effect on an individual's quality of life. Therefore, in an effort in focusing over assessment of health as well as quality of various issues which affect life, the terminology “health-related quality of life” is at present used widely.[2] Periodontal diseases are major public health concern all over the world.[3]
There is a significant increase in overall burden of periodontal diseases in the previous decades.
Oral health-related quality of life (OHRQoL) in short, is multidimensional construct which is corresponding to impact exerted by oral health and diseases over any individual's day to day functions, general well-being and on over-all quality of life.[4] Approximately all measurements of OHRQoL are based on Locker's conceptualization of impact of various oral diseases which are based on the World Health Organization's (WHO) model concerning oral and general health.[5] According to this model, states that there are five consequences of oral diseases: (a) impairment, (b) limitation in functions, (c) pain or discomfort (d) functional disability, and (e) handicap. This model additionally proposes that all the domains are subsequently interrelated to an impairment or any structural defect likewise occurrence of dental caries that may lead toward any limitation in functions such as any difficulty in mastication alongside pain as well as any discomfort in physical and/or psychological well-being leading to any disability or limitations in daily activities. Locker's model acts as a framework for understanding of oral health when compared as a scientific model that can assume that there is an interrelationship between poor oral health and impairment in quality of life.[6]
Oral Health Impact Profile 14 (OHIP-14) is a validated tool for measurement of or OH-QRoL. It was developed by Slade in 1997. This questionnaire contains 2 items for seven dimensions which consist of (a) limitation in function, (b) pain of physical nature, (c) discomfort of psychological origin, (d) physical disabilities, (e) psychological form of disability, (f) lack of social interactiveness, and (g) any form of handicap.[7],[8]
A distinct advantage of this measure is that all study statements have been derived from representative study/patient group. Using these tools, any social results of these oral diseases which are considered important by the patients can be better explored using sophisticated indicators as well as measures of oral health. These measure have been used in various studies that can influence oral health all over the world.[9]
Factors such as age, sex, socioeconomic status, and cultural values have demonstrated a strong connection with health-related quality of life. This concept of OHRQoL has multidimensional views which can reflect comfort as well as levels of satisfaction in respect to health of oral cavity that is during eating, while sleeping, when doing routine work, and even, when one is interacting with public.[10]
Chronic periodontitis is an immunologically mediated disease of inflammatory origin. The primary cause for periodontal disease is the formation of specific biofilm complexes comprised of numerous bacteria which form part of any oral biofilm.[11] Periodontal disease may result in loss of attachment loss as well as alveolar bone among susceptible subjects. Formation of pockets and recession of gingiva are main clinical characteristic features.
Chronic periodontal diseases have been found to affect 65% of entire Indian population and have been considered as a significant reason of concern for various oral health-related problems in our country.[12]
Thus, the aim of this study was to compare OHRQoL and its association with periodontal health status among adult population.
Materials and Methods This hospital-based prospective and cross-sectional study was conducted on 300 patients who were diagnosed with periodontal disease. All the study respondents were asked questions by making SE of a prevalidated study questionnaire-OHIP-14. OHIP-14 is 14-itemed questionnaire that included in total seven domains which show impact over oral health such as-limitations in functions, physical form of pain, psychological effects, any physical or psychological disability, social behavior, and any handicap which is based up on Locker's adaptation of WHO classification of diseases' impairment and disability handicap (proposed by Lockerin 1988).[9]
The Oral Health Impact Profile-14 scale comprises of a total of 14 items
Trouble in pronunciation of wordsWorsening in taste sensationPain sensation in oral cavityUncomfortable feeling while consuming foodFeeling tensed and or stressedFeeling of self-consciousnessUnsatisfactory and incomplete dietConstant interruption of mealsDifficult in relaxingFeeling of embarrassmentFeeling constantly irritableDifficulty in performing routine choresLess satisfied with their livesComplete inability during functioning.The frequencies of experiencing each of the impact which were felt for a period of past 12 months were reported by study subjects using a five-point scale:
Never (Score = 0)Hardly ever (Score = 1)Occasionally (Score = 2)Fairly often (Score = 3)Very often (Score = 4).In present study, the total numbers of questions in each of the domain was reduced to two. The Likert's format for response (4 = very often; 3 = often; 2 = occasionally used; 1 = hardly used; and 0 = never used) was used. The frequency of impact was calculated by adding overall reported negative effects (for example, very often, or often or occasional) in all the 14 statements.
Ethical approval for the present study was undertaken from the institutional ethical committee. Before initiating the study, written informed consent was obtained from all the enrolled study participants.
Intraoral examination was performed using the WHO probe, a simple mouth mirror, and ordinary dental chair illumination for measuring the community periodontal index score along with clinical loss of attachment. All subjects who gave written informed consent were included as study participants.
All study observational data were entered using Microsoft Excel workbook and was subsequently analyzed using the statistical tool, SPSS version 22.0 (IBM,Chicago). The descriptive study values were expressed in form of mean ± standard deviation (mean ± SD) for continuous variables and as percentages for nominal variables.
Statistical tools such as Mann–Whitney “U”-test and Kruskal–Wallis tests were used for comparing the OHIP-14 scores. Statistically significant value was fixed at P < 0.05.
Results and Observations A total 300 study participants formed part of our study. The mean age of study participants was found to be 52.8 ± 14 (mean ± SD) years. Majority of study participants were of female gender (n = 186, 62.0%).
Periodontal examination using the community periodontal index and loss of attachment showed that majority of study participants reported with presence of calculus with community periodontal index score of one (n = 135, 91.2%), while a loss of attachment measuring 3–5 mm with score 1 was seen in 40.1% (n = 65) individuals. The periodontal status of all study participants is shown in [Table 1] and [Graph 1].
The responses of study participants toward the OHIP-14 questionnaire items was given in [Table 2].
Table 2: Oral Health Impact Profile 14 responses of the study participantsPost hoc analysis using pair-wise comparison demonstrated statistically significant difference between sub groups with highest corruption perceptions index (CPI)-2 and CPI-3 scores (P < 0.003. Similarly, post hoc analysis with pair-wise comparison revealed significant differences between subgroups with highest loss of attachment (LOA) score of 0 and LOA score of 1 (P = 0.01), while significant difference between subgroups with highest LOA score of 0 and highest LOA index score of 3 was seen (P = 0.02).
Discussion OHRQoL has been defined as a subject's assessment of various factors on an individual's well-being such as-various functional reasons, various psychological reasons, socially based factors, and any experience related to pain or discomfort with respect to any orofacial issues.[13],[14]
OHRQoL has an important role at both individual as well as population level. At patient's level, factors affecting quality of life have been given complete attention at the time of diagnosis, selection of various options for treatment and evaluation of various outcomes for treatment, while at level of population, OHRQoL must be considered while monitoring various trends regarding oral health, evaluation of various policies concerning oral health, and during allocation of resources.[15]
Our study has reported a significant association between periodontal health or chronic periodontitis and OHRQoL. There are various studies which have reported a significant association between clinical diagnosis of periodontal disorders and subjective assessment of OHRQoL.[16]
Bhagat et al. (2021) found a significant association between periodontal health and oral health associated quality of life.[16] However, Hirjayana in 2021 found no association between periodontal diseases and OHRQoL.[12] Bhat et al. in 2021 in their observational study reported a 15.2% prevalence of poor self-assessed oral health which was found to be linked with severe form of periodontitis and decayed, missing, and filled primary teeth index score of >4.[17]
Marya et al. in 2020 found that OHRQoL was found to have significant association with main factors which may cause variety of periodontal problems such as mobility of teeth, loss of alveolar bone etc. No statistical difference was noted in OHRQoL on comparison between male and female genders.[18]
Yadav et al. found that the severity of disease affecting the periodontium has direct influence over the OHRQoL. The prevalence of oral disease has been found to be 59% and 81% among all study participants with moderate and severe grade of periodontal diseases, respectively. Furthermore, the extent as well as severeness of disease was also found proportional to degree of periodontitis.[19]
Masood et al.(2017) in their study found that existence of active dental caries and presence of single or more than one polyunsaturated fatty acids indicators is associated with an impaired OHRQoL among elder subjects however, indicators related to periodontal health status were not found to be related to determinants of OHRQoL in this age group.[20]
Fotedar et al. in 2016 in their study population observed high levels of oral disorders. Approximately 50% the respondent population found that their oral health negatively affected them in one or another way, thus, affecting quality of life.[21]
Pathak et al. in 2015 reported that mean OHRQoL score significantly reduced as there was a worsening of periodontal health status, therefore, suggestive of a negative effect on OHRQoL.[22]
Batista et al. in 2014 in their cross-sectional analysis involving individuals aged between 20 and 64 years in Brazil reported psychological discomfort in 35.8% cases, physical pain in 19.6%, psychological problems in 19.4% and physical disabilities in 17.0% individuals.[23]
Hajian-Tilaki et al. in 2014 observed a significant and positive correlation between various dental as well as periodontal variables with OHIP-14 scores.[24]
Conclusion OHRQoL has been shown to have strong influence over severity of periodontal diseases. Thus, with an increase in severity of periodontal disease, there is deterioration of health-associated Quality of life. The major limitations of current study were its cross-sectional nature. However, most of the evidence present are reflected by numerous cross-sectional studies. There is a requirement of conducting longitudinal studies for broadening the current understanding of various changes or transitions in status of oral health during various stages of life.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References 
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