ABSTRACT
Background:
After COVID-19 pandemic, when the restrictions were lifted, it would have impacted the quality of life associated with dental health, particularly in children. Rationale of the present investigation was to evaluate and compare the quality of life related to oral health (OHRQoL) among children aged 5–9 years in Riyadh, Saudi Arabia, and Kuwait following the easing of pandemic restrictions.
Materials and Methods:
This current descriptive cross-sectional investigation evaluated the parental perception of OHRQoL of their children aged 5–9 years from selected hospitals in Riyadh and Kuwait after the lifting of pandemic restrictions. Parents were administered with Child Oral Health Impact Profile-Short Form (COHIP-SF) questionnaire to assess the OHRQoL of children. The questionnaire elicited responses on oral symptoms, functional well-being, socioeconomic well-being, school environment, and self-image of the children. All the obtained responses were scored and compared between Saudi and Kuwaiti parents by applying appropriate statistical tests. P value of <0.05 was decided for all statistical tests for significance.
Results:
The parents of total of 718 children (448 male and 270 female) aged between 5 and 9 years responded to the COHIP questionnaire, in which 243 parents were from Kuwait City and 475 were from Riyadh City. A significantly higher overall mean COHIP score was reported by Riyadh City parents than Kuwaiti parents (2.44 ± 0.445 vs. 2.29 ± 0.434, P < 0.001). Kuwaiti parents showed significantly higher scores in school environment and self-image domains than the Riyadh parents. Contrarily, Riyadh’s parents showed significantly higher scores in socioeconomic well-being, functional well-being, and oral symptoms than Kuwaiti parents.
Conclusion:
In conclusion, the present study showed differences in OHRQoL among children in Kuwait and Riyadh. Gender and age differences in OHRQoL were observed. Furthermore, the present study identified changes in the OHRQoL of children during COVID-19 restrictions and after in Kuwait and Riyadh City.
KEYWORDS: COHIP, COVID-19, OHQRoL, pandemic
INTRODUCTION
The COVID-19 epidemic has caused considerable disruptions in daily life for everyone, even children. The limits put in place to prevent the virus from spreading have had an impact on their oral health-related quality of life (OHRQoL), which explores how oral health affects an individual’s daily experiences.
Emotional well-being of children’s is affected by oral health.[1] Furthermore, if we see, the mental and social development of the child affects oral health, with potentially high risk for trauma and high incidence of caries.[2] OHRQoL refers to the insights provided by individuals regarding their oral health status and its influence on different aspects of their lives.[3] Previous investigations have proved that deprived oral health negatively affects the OHRQoL of children.[4] Children with dental caries or other oral health problems experience pain, discomfort, difficulty eating, and social embarrassment, which can affect their academic performance, social interactions, and self-esteem.[5]
The COVID-19 pandemic and the resulting restrictions have affected OHRQoL of children. The closure of schools and dental clinics has limited access to oral health services, resulting in delayed treatment and increased risk of dental problems. The COVID-19 pandemic affected adolescent’s OHRQoL variably over time, showing an initial decrease in effects followed by a deterioration with prolonged exposure to the situation.[6]
The closure of schools and the transition to online learning have also affected the oral health behavior of children. The lack of face-to-face interaction with teachers and classmates has reduced the motivation to maintain good oral hygiene. A study conducted in Italy found that children’s oral hygiene habits deteriorated during the pandemic due to reduced supervision and motivation.[7]
Numerous studies have highlighted shifts in children’s oral health behaviors during the COVID-19 pandemic. Research from Saudi Arabia revealed a decline in toothbrushing frequency, attributed to increased screen time and disrupted daily routines.[8] Additionally, another study reported a rise in the consumption of sugary snacks and beverages driven by restricted access to healthier food choices.[9] Furthermore, the COVID-19 pandemic has been reported to adversely impact individuals’ mental and oral health, consequently affecting their overall well-being.[10]
However, some studies have reported positive changes in the oral health behavior of children during the pandemic. Frequency of brushing teeth increased during the pandemic due to increased awareness and motivation.[11]
During the COVID-19 pandemic, daily services have been disrupted due to community-wide mitigation measures taken by many countries.[12] In June 2020, the Saudi Ministry of Interior and Kuwaiti authorities announced the start of precautionary measures and preventive protocols for sectors to limit the spread of the coronavirus. Saudi Arabia lifted COVID-19 precautionary measures restrictions in June 2022, followed by Kuwait in April 2022. The Middle East region has been significantly impacted by havoc created by pandemic called COVID-19, with several restrictions imposed to control the spread of virus. Kuwait and Riyadh are two major cities in the region that have implemented strict measures to limit the transmission of the virus, including closure of schools and dental clinics. Therefore, comparing the OHRQoL of children in these two cities during and after the restrictions can provide insights into impact of COVID-19 on oral health of children in these specific regions.
Additionally, there is a lack of studies that have compared the OHRQoL of children during and after the COVID-19 pandemic, particularly in the Middle East region. Hence, the purpose of the present study was to compare the OHRQoL of children aged 5–9 years in Riyadh and Kuwait after the lifting of pandemic restrictions. The present investigation can significantly provide valuable evidence to the accessible literature present now by further providing evidence on the changes in OHRQoL of children during pandemic and the possible long-term effects. Additionally, the study can shed light on shifts in children’s oral health behaviors during the pandemic, providing valuable insights for designing targeted interventions to enhance oral health outcomes. Comparison between Kuwait and Riyadh can also provide insights into the effectiveness of different policies and measures implemented by the two cities in mitigating impact of COVID-19 on children’s oral health.
MATERIALS AND METHODS
Patient selection
At Riyadh Elm University Hospital in Riyadh, Saudi Arabia, study participants were randomly selected from patient records of the pediatric dentistry clinic from pediatric dentistry department at dental center Al Jahra Specialized Dental Center. The children, within the age range of 5–9 years, visited the clinics following the lifting of pandemic restrictions in April 2022.
Evaluation of OHRQoL
Parents were given a previously validated Arabic version of the COHIP-SF questionnaire following informed consent. The collected data was entered into a spreadsheet (MS Excel, Microsoft Corp., Palo Alto, CA, USA) for analysis.
Statistical analysis
For the research variables, descriptive statistics such as frequency distribution, percentages, mean, and standard deviation were computed. Age and gender differences were compared using an independent t-test, while OHRQoL differences between groups were analyzed using the Mann–Whitney U test. Spearman’s correlation coefficient was used to evaluate the relationship between age and OHRQoL. SPSS version 25 was used for all statistical analyses (IBM SPSS, IBM Corp., Armonk, NY, USA).
Approval and regulation authority
The study received approval from the Research and Innovation Center at the College of Dentistry, Riyadh Elm University.
RESULTS
The COHIP questionnaire was administered to parents of 718 children (448 males and 270 females) within the age range of 5–9 years. Of these, 243 parents from Kuwait and 475 parents from Riyadh completed the questionnaire. Table 1 shows insignificant age differences among female and male children in the City of Kuwait (P > 0.05). However, in Riyadh, a statistically significant age difference was seen between female and male children (P < 0.05), with the average age of male children (M = 7.06, SD = 1.22) being significantly more as compared to that of female children (M = 6.82, SD = 1.10).
Table 1.
Population distribution according to demographics
| Cities | Gender | n | Mean Age | SD | t | Sig. |
|---|---|---|---|---|---|---|
| Kuwait City | Male | 170 | 6.78 | 1.22 | -1.09 | 0.273 |
| Female | 73 | 6.95 | 1.04 | |||
| Riyadh City | Male | 278 | 7.06 | 1.22 | 2.24 | 0.026 |
| Female | 197 | 6.82 | 1.10 |
*=Significance level P<0.05
Parents of children in Riyadh reported higher mean scores in oral symptoms when comparing the COHIP scores across domains across the two cities (M = 2.33, SD = 0.520), functional well-being (M = 2.35, SD = 0.672), socioeconomic well-being (M = 2.33, SD = 0.682), and overall COHIP scores (M = 2.44, SD = 0.445) compared to parents in Kuwait City, with a significant difference (P < 0.001), as shown in Figure 1. Kuwait City Parents, on the other hand, reported much higher mean scores for the school atmosphere (M = 3.59, SD = 0.935) and self-image (M = 3.65, SD = 1.17) than those in Riyadh, with statistically significant differences across all domains [Table 2].
Figure 1.
Comparison of the COHIP domains between Kuwait and Riyadh City
Table 2.
Differences in COHIP scores between Kuwait and Riyadh City
| Variables | Kuwait | Riyadh | Sig. | ||
|---|---|---|---|---|---|
|
|
|
||||
| Mean | SD | Mean | SD | ||
| Oral Symptoms | 2.09 | 0.664 | 2.33 | 0.520 | <0.001 |
| Functional Well-being | 1.87 | 0.663 | 2.35 | 0.672 | <0.001 |
| Socioeconomic Well-being | 1.86 | 0.634 | 2.33 | 0.682 | <0.001 |
| School Environment | 3.59 | 0.935 | 2.86 | 0.823 | <0.001 |
| Self-Image | 3.65 | 1.17 | 2.80 | 1.01 | <0.001 |
| Overall COHIP Score | 2.29 | 0.434 | 2.44 | 0.445 | <0.001 |
*Significance level accepted
Gender differences for OHRQoL were observed in Kuwait and Riyadh [Table 3]. In Kuwait City, parents of boys reported considerably higher oral symptom scores (M = 2.24, SD =0.588) and functional well-being (M = 1.96, SD =0.681) than female children, P < 0.01. However, females reported significantly higher scores in self-image (M = 3.54, SD = 1.12) and overall COHIP score (M = 2.36, SD =.445) than male children, P < 0.05. Furthermore, there was no significant difference in socioeconomic well-being and school environment, P > 0.05.
Table 3.
Gender differences in OHRQoL
| Country | Variables | Male | Female | Sig. | ||
|---|---|---|---|---|---|---|
|
|
|
|||||
| Mean | SD | Mean | SD | |||
| Kuwait | Oral Symptoms | 2.24 | 0.588 | 1.75 | 0.709 | 0.000 |
| Functional Well-being | 1.96 | 0.681 | 1.67 | 0.576 | 0.001 | |
| Socioeconomic Well-being | 1.91 | 0.669 | 1.75 | 0.533 | 0.080 | |
| School Environment | 3.64 | 0.878 | 3.48 | 1.05 | 0.798 | |
| Self-Image | 3.54 | 1.12 | 3.90 | 1.27 | 0.007 | |
| Overall COHIP Score | 2.36 | 0.445 | 2.11 | 0.354 | 0.000 | |
| Riyadh | Oral Symptoms | 2.36 | 0.544 | 2.28 | 0.483 | 0.057 |
| Functional Well-being | 2.50 | 0.632 | 2.13 | 0.671 | 0.000 | |
| Socioeconomic Well-being | 2.52 | 0.640 | 2.08 | 0.659 | 0.000 | |
| School Environment | 2.72 | 0.694 | 3.06 | 0.942 | 0.000 | |
| Self-Image | 2.65 | 0.906 | 3.01 | 1.11 | 0.003 | |
| Overall COHIP Score | 2.51 | 0.453 | 2.35 | 0.415 | 0.000 | |
Parents of male children in Riyadh significantly reported higher scores in functional well-being (M = 2.50, SD = 0.632), socioeconomic well-being (M = 2.52, SD = 0.640), and overall COHIP score (M = 2.51, SD =.452) than parents of female children, P < 0.01. Whereas parents of female children reported significantly higher score in school environment (M = 3.06, SD = .942) and self-image (M = 3.01, SD = 1.11) than parents of male children, P < 0.05. Additionally, there were no appreciable variations in oral symptoms, P > 0.05 [Table 3].
Correlations between age and OHRQoL scores across domains were noted [Table 4]. In Kuwait City, oral symptoms, functional well-being, socioeconomic well-being, and overall COHIP scores were found to decrease with age. Conversely, in Riyadh City, these scores increased with age. Negative correlations were observed in Kuwait City, while positive correlations were found in Riyadh City (P < 0.05). Additionally, no noteworthy association was found amid age and the school environment or self-image in either Kuwait or Riyadh City.
Table 4.
Correlation between age and the different domains of OHRQoL
| Variables | Kuwait | Riyadh | |
|---|---|---|---|
| Oral Symptoms | Correlation coefficient | −0.270** | 0.098* |
| Sig. (two-tailed) | 0.000 | 0.033 | |
| n | 243 | 475 | |
| Functional Well-being | Correlation coefficient | −0.190** | 0.100* |
| Sig. (two-tailed) | 0.003 | 0.029 | |
| n | 243 | 475 | |
| Socioeconomic Well-being | Correlation coefficient | −0.236** | 0.122** |
| Sig. (two-tailed) | 0.000 | 0.008 | |
| n | 243 | 475 | |
| School Environment | Correlation coefficient | 0.043 | −0.007 |
| Sig. (two-tailed) | 0.500 | 0.875 | |
| n | 243 | 475 | |
| Self-Image | Correlation coefficient | 0.118 | 0.029 |
| Sig. (two-tailed) | 0.066 | 0.530 | |
| n | 243 | 475 | |
| Overall COHIP Score | Correlation coefficient | −0.223** | 0.117* |
| Sig. (two-tailed) | 0.000 | 0.011 | |
| n | 243 | 475 | |
*=Significance level at P<0.05, **=Significance level at P<0.001
DISCUSSION
Comparing the oral health quality (OHRQoL) of children in Kuwait and Riyadh during the periods before and after the COVID-19 lockdown was the goal of this study. However, parents of children in Kuwait City scored better on school environment and self-efficacy than parents in Riyadh City. The results of this study align with previous research that highlights the impact of oral health on children’s quality of life. It has been noted that poor oral health is strongly linked to a lower quality of life in children within the age range of 8–10 years.[13] One of the similar studies conducted in Thailand[14] found that children with poor oral health were more likely to understand a lesser quality of life than those with good oral health. These studies reinforce the findings of the present research, which indicates that oral health is a crucial factor influencing children’s quality of life.
The variations in OHRQoL between Kuwait City and Riyadh may be due to differences in socio-cultural factors, healthcare infrastructure, and health education programs. These findings align with previous research, which demonstrated that socioeconomic and cultural factors significantly impact children’s OHRQoL.[15] Parents of children in Riyadh may have greater access to healthcare services and a better understanding of oral health compared to parents in Kuwait.
The present study also identified gender differences in COHIP scores among female and male children in both Kuwait and Riyadh. For Kuwait City, parents of male children reported significantly higher scores in oral symptoms and functional well-being, while female children had better scores in self-image and overall COHIP scores. For Riyadh, parents of male children reported significantly higher scores in functional well-being, socioeconomic well-being, and overall COHIP scores, while parents of female children reported higher scores in school environment and self-image. These findings indicate that gender is a key factor influencing the OHRQoL of children.
The results of this study also revealed correlations between age and COHIP scores across various domains. In Kuwait City, oral symptoms, socioeconomic and functional well-being, and overall COHIP scores decreased with age, while in Riyadh City, these scores increased with age. These conclusions advocate that the effect of oral health on children’s quality of life may vary depending on age and location. A study by Bernabé and Sheiham[16] found that the impact of oral health on quality of life differed by age, with younger children being more affected than older children. These results imply that interventions aimed at improving oral health and quality of life in children should be tailored to age and location-specific needs.[16]
The study’s conclusions have important ramifications for practice and policy. They stress the necessity of public health campaigns to improve the dental health and general well-being of children, particularly in underprivileged areas. Additionally, it stresses the necessity for age- and location-specific interventions that address the unique challenges and opportunities associated with various age groups and geographical areas.
CONCLUSION
In conclusion, this study revealed differences in OHRQoL among children in Kuwait City and Riyadh. Compared to parents of children in Kuwait City, parents of children in Riyadh City reported higher OHRQoL scores. Kuwait City Parents reported higher scores in the school environment and self-image. Gender and age differences in OHRQoL were also noted. Additionally, the study provides valuable insights into children’s OHRQoL during and after COVID-19 restrictions in both cities. It emphasizes the significant role of oral health in determining quality of life among children and highlights the need for interventions tailored to the specific desires and preferences of different age groups, genders, and geographic locations. Future studies should investigate the intricate relationship between children’s dental health and quality of life in greater detail and find efficient ways to enhance both.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
REFERENCES
- 1.Alsumait A, ElSalhy M, Behzadi S, Raine KD, Gokiert R, Cor K, et al. Impact evaluation of a school-based oral health program: Kuwait National Program. BMC Oral Health. 2019;19:202. doi: 10.1186/s12903-019-0895-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Goldfeld SR, Wright M, Oberklaid F. Parents, infants and health care: Utilization of health services in the first 12 months of life. J Paediatr Child Health. 2003;39:249–53. doi: 10.1046/j.1440-1754.2003.00146.x. [DOI] [PubMed] [Google Scholar]
- 3.Bennadi D, Reddy CVK. Oral health related quality of life. J Int Soc Prev Community Dent. 2013;3:1–6. doi: 10.4103/2231-0762.115700. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Petersen PE. The world oral health report 2003: Continuous improvement of oral health in the 21st century–The approach of the WHO global oral health programme. Community Dent Oral Epidemiol. 2003;31((Suppl 1)):3–23. doi: 10.1046/j..2003.com122.x. [DOI] [PubMed] [Google Scholar]
- 5.Locker D. Measuring oral health: A conceptual framework. Community Dent Health. 1988;5:3–18. [PubMed] [Google Scholar]
- 6.Pohl MB, Noronha-Ramos TG, Knorst JK, Lito MFP, de Araujo G, Emmanuelli B, et al. Short and long effects of the COVID-19 context on oral health-related quality of life of adolescents. Oral Dis. 2024;30:4683–90. doi: 10.1111/odi.14885. [DOI] [PubMed] [Google Scholar]
- 7.Conti G, Amadori F, Bordanzi A, Majorana A, Bardellini E. The impact of the COVID-19 pandemic on pediatric dentistry: Insights from an Italian cross-sectional survey. Dent J. 2023;11:154. doi: 10.3390/dj11060154. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Ezzeldin T, Alzayer Y, Aljandan J, Alsahwan B, Siddiqui IA. Impact of the COVID-19 pandemic lockdown on oral health and behaviour change among children in the eastern province of Saudi Arabia. J Clin Diagn Res. 2022;16:36. [Google Scholar]
- 9.Sylvetsky AC, Kaidbey JH, Ferguson K, Visek AJ, Sacheck J. Impacts of the COVID-19 pandemic on children's sugary drink consumption: A qualitative study. Front Nutr. 2022;9:860259. doi: 10.3389/fnut.2022.860259. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Samuel SR, Kuduruthullah S, Khair AMB, Al Shayeb M, Elkaseh A, Varma SR, et al. Impact of pain, psychological-distress, SARS-CoV2 fear on adults'OHRQOL during COVID-19 pandemic. Saudi J Biol Sci. 2021;28:492–4. doi: 10.1016/j.sjbs.2020.10.033. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Abbas H, Takeuchi K, Koyama S, Osaka K, Tabuchi T. Association between toothbrushing habits and COVID-19 symptoms. Int Dent J. 2023;73:302–10. doi: 10.1016/j.identj.2022.07.011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Hassounah M, Raheel H, Alhefzi M. Digital response during the COVID-19 pandemic in Saudi Arabia. J Med Internet Res. 2020;22:e19338. doi: 10.2196/19338. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Xiao L, Karapen K, Dong S, Yang H, Zhang X. Epidemiology of periodontal disease in adolescents in mainland China, 1983–2020: A systematic review and meta-analysis. Ann Palliat Med. 2021;10:450–60. doi: 10.21037/apm-20-1919. [DOI] [PubMed] [Google Scholar]
- 14.Gherunpong S, Tsakos G, Sheiham A. Developing and evaluating an oral health-related quality of life index for children;the CHILD-OIDP. Community Dent Health. 2004;21:161–9. [PubMed] [Google Scholar]
- 15.Moghaddam LF, Vettore MV, Bayani A, Bayat AH, Ahounbar E, Hemmat M, et al. The Association of oral health status, demographic characteristics and socioeconomic determinants with oral health-related quality of life among children: A systematic review and meta-analysis. BMC Pediatr. 2020;20:489. doi: 10.1186/s12887-020-02371-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Bernabé E, Sheiham A. Age, period and cohort trends in caries of permanent teeth in four developed countries. Am J Public Health. 2014;104:e115–121. doi: 10.2105/AJPH.2014.301869. [DOI] [PMC free article] [PubMed] [Google Scholar]
