The impact of dental caries on the oral health related quality of life in children in Kanpur City, North India

Nitin Sharma; Shitanshu Malhotra; Manu Narayan

doi:10.4103/jhnps.jhnps_11_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 10 | Issue : 1 | Page : 97-102

The impact of dental caries on the oral health related quality of life in children in Kanpur City, North India

Nitin Sharma, Shitanshu Malhotra, Manu Narayan
Department of Public Health Dentistry, Public Health Dentistry, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh, India

Date of Submission	28-Feb-2022
Date of Decision	28-Mar-2022
Date of Acceptance	31-Mar-2022
Date of Web Publication	23-Jun-2022

Correspondence Address:
Nitin Sharma
Public Health Dentistry, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jhnps.jhnps_11_22

Abstract

Introduction: Childhood dental caries can have a negative impact on the oral health of both children and their caregivers. The purpose of this research was to assess the severity of dental caries and other covariates such as age and gender and affected the oral health-related quality of life of preschool children and their parents. Materials and Methods: 1110 preschool children aged 4–6 years attending both public and private schools of Kanpur city were studied. dmft index was used for quantifying dental caries. Oral Health-related Quality of LifeScale (OHRQoL) questionnaire of Michigan OHRQoL–Child Version and parent version was used to assess OHRQoL. Chi-square test was run for analyzing the relationship of OHRQoL with dental caries, age and gender. P < 0.05 was considered to be statistically significant. Results: Children with higher caries experience reported with compromised OHRQoL in each domains of “Pain/discomfort,” “Temperomandibular joint disorders,” “Consequences of poor oral health” and “Psychological/Esthetic domain.” OHRQoL exhibiting no difference between males and females in each domains of “Pain/discomfort,” “Temperomandibular joint disorders,” “Consequences of poor oral health” and “Psychological/Esthetic domain.” The younger age Group i.e., 4 year old reported with worse OHRQoL as compared to 5-year-old and 6 year old in each domains of “Pain/discomfort,” “Temperomandibular joint disorders,” “Consequences of poor oral health” and “Psychological/Esthetic domain.” Parent's perception of OHRQoL was high when compared to their children's OHRQoL. Conclusion: In the sample of preschool children evaluated, the overall influence of dental caries prevalence on OHRQoL was rather significant. Longitudinal analyses should be used in future studies to measure risk markers.

Keywords: Children, dental caries, oral health, parents, quality of life

How to cite this article:
Sharma N, Malhotra S, Narayan M. The impact of dental caries on the oral health related quality of life in children in Kanpur City, North India. J Head Neck Physicians Surg 2022;10:97-102

How to cite this URL:
Sharma N, Malhotra S, Narayan M. The impact of dental caries on the oral health related quality of life in children in Kanpur City, North India. J Head Neck Physicians Surg [serial online] 2022 [cited 2022 Jun 28];10:97-102. Available from: https://www.jhnps.org/text.asp?2022/10/1/97/347981

Introduction

Dental caries in preschool children is one of the major dental public health problem across the world. While it is considered to be the most common childhood ailment in United States,^[1] the prevalence is as high as 55% among 3–5 year aged children.^[2] A (Dental Council of India) reported stated a prevalence of 51.9% for dental caries in 5-year old.^[3],[4]

The early years of a child are crucial for growth and development. About 90% of dental caries in preschoolers in many developing and underdeveloped nations remain untreated.^[5],[6]

(Oral Health Related Quality of Life [OHRQoL]) is a holistic subjective paradigm for patient evaluation. It is defined as Individuals' “perceptions of their situation in life in terms of culture and value systems in which they live, and in connection to their objectives, expectations, standards, and worries,” as per the World Health Organization.^[7],[8],[9]

Literature evidence documents that children with unmet dental needs had considerably lower OHRQoL as compared to their counterparts without dental caries, as per the opinion of both children and their caregivers.^[10]

Caries experience of a preschool child is significantly associated with their lack of awareness and poor attitude regarding oral health care or intervention. It is noteworthy to mention that the dental health of preschoolers is heavily reliant on their caregivers, notably parents, babysitters, and instructors. As a result, it's critical to examine the caregivers' oral health knowledge as well in addition to the children so as to make appropriate changes to ensure proper dental health maintenance.^[11]

Vast amount of research on dental caries and OHRQoL are being conducted in various countries, particularly in the developing world. Caries has increased dramatically in nations like India over the years, owing primarily to changing lifestyle and food patterns. Hence the current research was undertaken to answer the following research questions

What is the relationship between OHRQoL of children and caries severity?
What is the influence of covariates (gender and age) and parental perceptions on OHRQoL of children?

Materials and Methods

A descriptive study design was employed to evaluate the effect of dental caries on the OHRQoL in school going children, aged 4–6 years, in Kanpur city (UP). Institutional Ethical board of Career Dental College granted permission to conduct the study. Informed consent of all participating children and parents were obtained after explaining the risks and benefits of the study. Children were selected from 12 private and 3 public schools employing a cluster random sampling technique. Children who were anxious, noncooperative and suffering from any medical or systemic illness were excluded.

Dental caries examination was conducted by a single invigilator on a sample of 1110 preschool children. dmft index was employed for quantifying dental caries and Type III examination was followed. OHRQoL in children was graded on the basis of Michigan OHRQoL –Child Version.

SPSS 23.0 version (IBM, Chicago) (Statistical Package for the Social Sciences) was used for analysis of data. Chi-square test was applied to find significant differences between OHRQoL with dental caries severity and age group. A P < 0.05 was considered statistically significant. Logistic regression analysis was used to predict the influence of age and dental caries.

Results

One thousand one hundred ten preschool children with the mean age of 5.02 + 1.43 years were examined. An almost equal distribution of genders was noted with 49.72% (552) being females and the remaining 50.27% (558) constituting males.

[Table 1] shows the association of dental caries on OHRQoL. The frequencies of dental caries were significantly associated with all variables of “Physical pain/discomfort” such as teeth hurt now, teeth hurt when you eat something hot or cold, teeth hurt when you eat something sweet, teeth hurt when you chew or bite teeth at significantly at P < 0.001.

Table 1: Association of caries status on oral health-related quality of life

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Even the domain of “Temperomandibular joint disorders” was found to be exhibit significantly higher in the dental caries group than the other counterpart. OHRQoL domain of “Consequences of poor oral health like hurting tooth ever wake you up at night, hurting tooth ever stop you from playing, tooth ever hurt you while you are in school, hurting tooth ever keep you home from school, hurting tooth keep you from learning in school, hurting tooth keep you from paying attention in school exhibited greater frequency in children who had caries than noncarious cohorts.

When OHRQoL scores was assessed in relation to gender, no differences was noted in the domain of “Pain/Discomfort,” “Temperomandibular joint disorders” and “Consequences of Poor oral health” between males and females. In the “Psychological/esthetic domain,” boys opined to have nicer smile as compared to girls (56.2 vs. 47.2%), which was statistically significant at P = 0.002. Also girl children reported greater frequency of their teeth being made fun of with 38.2% as against 31.7% in males, which was significant at P = 0.02.

Observation from [Table 2] shows the OHRQoL domains as related to age. Children were categorized as 4 years, 5 and 6 years. When evaluated for “Pain/discomfort” domain, the younger age group complained of teeth hurting for any stimulus in greater percentages as compared to the older age group, which was statistically significant. However, “Temperomandibular discomfort” domain showed equal distribution in all the age groups for the variables elicited, which was not significant. On looking for the “Consequences of poor oral health” domain, younger children woke up more frequently as compared to their older counterparts which was significant at P < 0.001, Contradictorily, it was the younger age group of children who liked their teeth most, with 62.2% of 4 years in favour of their teeth as against 51.7% of 5 years and 44.1% of 6 years which was significant at P < 0.001.

Table 2: Association of age on oral health-related quality of life

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[Table 3] shows the various variables of parent's perception of child's OHRQoL.

Table 3: Michigan oral health-related quality of life questionnaire - Parent version

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As per [Table 4], as dental caries severity increased, it enhanced the mean values of OHRQoL, thus suggesting a poorer dental health status.

Table 4: Logistic regression analysis for association between oral health-related quality of life and covariates

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The OHRQoL score was categorized into Low, mild and high scores for regression analysis. Scores lesser than 7 was considered low, while 8–12 of moderate and 13 and above to be high category. Linear regression analysis showed us that for every added carious tooth, there is 1.24 (95% confidance intervel 0.88–3.24) increase in total OHRQoL, which was statistically significant. Similarly, age and parent perception was also found to be significantly corelated with OHRQoL, while gender had no impact [Table 4].

Discussion

The study intended to assess the severity of dental caries on OHRQoL in a representative sample of school going children aged 4–6 years in Kanpur. The results suggested that an increased caries experience was correlated with a negative impact various domains related to the OHRQoL of the children. This study is the first of its kind, which systematically investigates the correlation between dental caries and OHRQoL of preschool children in Kanpur City.

Dental caries can bear a significant impact on the children OHRQoL.^[11],[12] When left untreated it significantly affects the children's weight, growth, quality of life, and cognitive development, and can lead to hospitalisation and emergency dental consultations. Early childhood caries (ECC) is prevalent globally. Children with unmet caries need have a lower OHRQoL than their healthy counterparts. Research further indicates ECC can be burdensome for parents as they have to miss work in order to care for their ward added with financial burden associated with dental problems.^[13],[14] It was noted that the parents held themselves accountable for any oral health issue or treatment needs due to their profound role in child's grooming and oral health. Children with higher caries experience reported with compromised OHRQoL in each domains of “Pain/discomfort,” “Temperomandibular joint disorders,” “Consequences of poor oral health” and “Psychological/Esthetic domain.”

There were no gender differences noted in OHRQoL. Nemati et al.^[15] also observed no significant difference in the influence of oral health on quality of life between gender, which is similar to the findings of our study. This could probably be because the children in this study were extremely young (preschool), and gender disparities in these children's awareness of the aesthetic components of oral health might have not yet influenced their comprehension.

The results of this study showed a significant relationship between the mean score of OHRQoL and age, which was contradictory to the study results of Li et al.^[11] in which the quality of life had a significant relationship with age, i.e., an increase in age increased the impact of oral health on the quality of life. Parents perception of OHRQoL was high when compared to their children's OHRQoL.

The study cannot establish a causal relation owing to its cross sectional design. Also, as the sample is drawn from a specified population (preschool children enrolled in public schools) and those who could not attend schools were not considered, it cannot be generalized. Another merit of the study was that as both private and government school children were evaluated it overcame the confounding effect of socio-economic status on dental caries and in turn on OHRQoL.

Conclusion

In the sample of preschool children studied, the overall influence of dental caries prevalence on OHRQoL was rather significant. Children with caries had compromised OHRQoL in all domains as assessed by Child version-Michigan format. Gender did not have any effect on OHRQoL. OHRQoL of young age children was significantly affected when compared to the older cohorts. Longitudinal analyses should be used in future studies to measure risk markers. In the planning, implementation, and evaluation of oral health promotion initiatives, a comprehensive information on the prevalence of dental caries and its effects on OHRQoL is an important tool.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Disclosure

This material has never been published and is not currently under evaluation in any other peer-reviewed publication.

Ethical approval

The permission was taken from Institutional Ethics Committee prior to starting the project. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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