Table of Contents  
ORIGINAL ARTICLE
Year : 2013  |  Volume : 5  |  Issue : 1  |  Page : 27-31

Impact of oral diseases on quality of life in subjects attending out-patient department of a dental hospital, India


1 Department of Oral Medicine and Radiology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
2 Department of Orthodontics and Dentofacial Orthopedics, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India

Date of Web Publication20-Jun-2013

Correspondence Address:
N Saimadhavi
Department of Oral Medicine and Radiology, Vishnu Dental College, Bhimavaram - 534 202, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-8844.113690

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  Abstract 

Context: Currently there is a growing interest in oral health outcomes in how oral health affects quality of life. When oral health related quality of life measures are used alongside traditional clinical methods of measuring oral health status, a more comprehensive assessment of the impact of oral diseases on the several dimensions of subjective wellbeing becomes possible. In this context, we attempted to study the impact of oral diseases on quality of life, so as to address the patient's needs in an appropriate way and thereby improving one's quality of life. Aims: To evaluate the impact of different oral diseases on quality of life using a modified OHIP-14 questionnaire, so as to address the patient's needs in an appropriate way and thereby improving one's quality of life. Settings and Design: The study was carried out among 302 subjects, attending the outpatient department a dental hospital, India, for check up and treatment of their oral condition. Subjects aged above 20 years, who gave their consent for the study were included. Materials and Methods: The study sample was categorized in to two groups based upon the duration of the affecting disease - group 1 consisted of subjects suffering with chronic diseases and group 2 of subjects suffering with acute diseases. All the subjects were asked to fill up their responses in the given OHIP-14 questionnaires. The completed questionnaires were then collected and statistically analyzed. Statistical Analysis Used: To evaluate the role of age on QOL, age was divided in to 2 groups using median split procedure. For inter and intragroup comparisions, independent sample t test, anova followed by post hoc test and Chi-square tests were employed. Results: Chi square test revealed a moderately impaired quality of life among all the diseases investigated. On comparing the mean domain and total OHIP score between the two groups, the domain of psychological discomfort and disability and the total OHIP score showed statistically significant values in acute diseases. However, no significant differences were obtained on comparing the grades of QOL in between the two groups. Conclusions: Oral health related quality of life is moderately impaired among those suffering with oral diseases. Routine evaluation using patient centred measures like Oral health Impact Profile during clinical activity is feasible, and provides relevant and useful information for the clinical management of patients with oral mucosa pathology.

Keywords: Acute diseases, chronic diseases, oral health impact profile-14, oral health related quality of life


How to cite this article:
Saimadhavi N, Raju M, Reddy R S, Ramesh T, Tabassum D A, Ramya K. Impact of oral diseases on quality of life in subjects attending out-patient department of a dental hospital, India. J Orofac Sci 2013;5:27-31

How to cite this URL:
Saimadhavi N, Raju M, Reddy R S, Ramesh T, Tabassum D A, Ramya K. Impact of oral diseases on quality of life in subjects attending out-patient department of a dental hospital, India. J Orofac Sci [serial online] 2013 [cited 2019 Nov 13];5:27-31. Available from: http://www.jofs.in/text.asp?2013/5/1/27/113690


  Introduction Top


Although the majority of oral diseases are not fatal, they can give rise to significant morbidity, resulting in physical, social and psychological consequences, influencing the "goodness" or "quality of life (QOL)." Oral health related QOL plays a significant role in patient's perception of need and/or their demand for the dental treatment. To that end a number of different patient-centered oral health status measures have been developed over the last decade, to assess the physical, social and psychological consequences of oral health, and thus the impact of oral health status on QOL. The Oral Health Impact Profile (OHIP) questionnaire is one of the most technically sophisticated instruments for assessment of oral health related QOL. [1],[2],[3],[4],[5]

OHIP is based on a conceptual model of oral health that uses the World Health Organization international classification of impairments, disabilities, and handicaps frame-work. It is a 49-item questionnaire that assesses even subjective dimensions (functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap) through structured questions, with answers in a Likert type scale of impact frequency during a certain period of time. The reduced version of this instrument, OHIP-14, was developed by Slade in 1997 and has been shown to be reliable, sensitive to changes, and to exhibit suitable cross-cultural consistency. Since its development, the OHIP-14 is preferred to the OHIP-49 by a number of researchers due to its practicality. [6],[7],[8],[9],[10]

In the light of an expanding concept of oral health, knowledge of specific oral conditions for self-perceived QOL is warranted. Very few studies have documented the effect of oral diseases on QOL [11],[12],[13],[14],[15] and more studies are needed to address the patient's needs in an appropriate way and thereby improving one's QOL. In this juncture, the present study was conducted to evaluate the impact of different oral diseases on QOL using a modified OHIP-14 questionnaire.


  Materials and Methods Top


Selection and description of participants

The study was carried out among 302 subjects, attending the outpatient department a dental hospital, India, for check-up and treatment of their oral condition. Subjects aged above 20 years, who gave their consent for the studies were included. The sample was categorized into two groups based upon the duration of the affecting disease - group 1 comprised of 203 subjects, 90 males and 113 females, who were diagnosed with the chronic abscess, lichen planus, pemphigus and oral submucous fibrosis, diseases affecting their life for a longer period of time (chronic diseases). Group 2 comprised of 99 subjects, 52 males and 47 females, who were diagnosed with acute abscess and acute ulcer, diseases affecting their QOL for a shorter period of time (acute diseases). Subjects with any positive medical history were excluded.

The instrument used for the purpose of the study was OHIP-14 questionnaire, modified to suit these cultural settings. The questions monitor functional limitation, physical pain and disability, psychological discomfort and disability, social disability and handicap on a four-level scale ranging from never (score 0), occasionally (score 1), very often (score 2), to always (score 3). Oral health related QOL was expressed as the sum of the scores for the 14 questions (OHIP-sum, maximum 42 points).

All the study subjects were asked to fill up their responses in the given questionnaire. The completed questionnaires were then collected and statistically analyzed.

Statistical analysis

To evaluate the role of an age on QOL, age was divided into 2 groups using a median split procedure. For inter and intra group comparisons, independent sample t-test, anova followed by post-hoc test, and Chi-square tests were employed.


  Results Top


The mean age of subjects in group 1 is 36.73 and in group 2 is 37.88 years.

On comparison of mean domain and the total OHIP score among various chronic conditions, the domain of physical pain and disability showed statistically significant values (P < 0.001), in pemphigus. However, the total OHIP score remained non-significant [Table 1].
Table 1: Comparison of mean domain and total OHIP score among a various chronic conditions

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On comparison of mean domain and the total OHIP score between various acute conditions, the domains of functional limitation showed statistically significant values in acute ulcer (P value < 0.001) although the psychological discomfort and disability and handicap showed statistically significant values (P value < 0.001) in acute abscess. However, the total OHIP score remained non-significant [Table 2].
Table 2: Comparison of mean domain and total OHIP score among various acute conditions

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On comparing, the mean domain and total OHIP score between the two groups, the domain of psychological discomfort and disability, and the total OHIP score showed statistically significant values (P value < 0.001) in acute diseases [Table 3].
Table 3: Comparison of mean domain and total OHIP score between the groups

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In the present study, Chi-square test revealed a moderately impaired QOL among all the diseases investigated. However, no significant differences were obtained on comparing the grades of QOL in between the two groups and among various diseases within the same group [Table 4],[Table 5] and [Table 6].

Taking median age as 35 (median split procedure), the domain of handicap showed statistically significant values (P < 0.001) in the age group ≤ 35 years. However, the total OHIP score remained non-significant [Table 7].
Table 4: Comparison of grades of QOL among various chronic conditions

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Table 5: Comparison of grades of QOL among various acute conditions

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Table 6: Comparison of grades of QOL between acute and chronic conditions

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Table 7: Comparison of mean domain and total OHIP score between age groups

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No significant differences were observed when the total OHIP score was compared among the two genders.


  Discussion Top


The impact of health on the QOL has received attention in both medicine and dentistry. There is an increasing recognition that oral health has a significant impact not only on physical, but also on social and psychological well-being. As in general medicine, perceptions of dental patients are also important in the assessment of treatment need, in planning of appropriate therapy, and in the clinical outcome. The patient-centered outcome measures may therefore, also be utilized in oral medicine. Hence, the present study was proposed to evaluate the impact of oral diseases on QOL, using one such measure the OHIP.

In the present study, among various chronic diseases investigated, physical pain and disability is significantly affected in pemphigus, followed by lichen planus, chronic abscess and oral submucous fibrosis [Table 1], providing information on treatment demands of these subjects.

In the present study, among the acute diseases investigated, functional limitation was significantly affected in acute ulcer although the psychological discomfort and disability and handicap were significant in acute abscess [Table 2], emphasizing the areas to be addressed among these subjects.

On comparing, the mean domain and total OHIP score between the two groups, psychological discomfort and disability and the total OHIP score were significant in acute diseases [Table 3], suggesting a need for early diagnosis and institution of appropriate treatment regimens in these subjects.

In the present study, QOL is moderately impaired among all diseases investigated [Table 4],[Table 5] and [Table 6] reflecting the consequences of oral disease upon day today living and QOL. This finding was in close correlation with that of, Caglayan et al., [16] Liu et al. [17] and Lopez-Jornet et al., [18] who reported a poor QOL among subjects with the oral diseases.

The results of the present study showed the domain of handicap to be significantly affected in the age group ≤ 35 years [Table 7]. The only probable explanation drawn for this could be the life-style and food habits among this age group owing to the lack of time to focus on their oral health needs.

No significant differences were observed when the total OHIP score was compared among the two genders. This finding was in contrast to that of Caglayan et al. [16] who reported, females to be more susceptible to disruption by oral disorders. This disparity could have resulted from variations in the populations studied and their sample sizes. Further, investigations on larger samples may corroborate the results.

The findings of the present study highlighted the impact of acute and the chronic diseases on QOL and addressed the need for early diagnosis and institution of appropriate treatment regimens among the suffering, thereby improving their QOL. On the other hand, it also emphasized the need for oral health awareness campaigns among the general population.


  Conclusion Top


Oral health related QOL is moderately impaired among those suffering with oral diseases. Routine evaluation using patient centered measures like OHIP during clinical activity is feasible and provides the relevant and useful information for the clinical management of patients with the oral mucosa pathology. These measures are suggested to complement the traditional clinical oral health status, improving communication between patients and their doctors. They provide greater understanding of the consequences of oral disease upon subject's day-to-day living and QOL and hence that their needs and demands for dental treatment are addressed. Further studies are advocated to determine the association between education, harmful habits, and their oral health related QOL.

 
  References Top

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


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