Abstract
Background: To associate oral health related quality of life with dental anxiety and depression along with general health among people of Bhopal district, Madhya Pradesh. Materials & Methods: A cross sectional questionnaires based survey was conducted among the subjects of Bhopal district, Madhya Pradesh. The survey was carried among 101 subjects aging from 20-40 years. Subjects under investigation were belonging to various occupations. They were assigned a questionnaire. Questionnaire consisted of four parts, first part consists of socio-demographic data along with dental visiting habits, second part has OHqOL-questionnaire, third part has general health (sf-12) and fourth part has hospital anxiety and depression questionnaire. Questionnaire was used for assessment of OHqOL. It consists of 16 questions which takes into account both effect and impact of oral health on quality of life. Dental anxiety and depression was measured by Hospital Anxiety and Depression Scale. Each question was provided with four options and numbering ranging from 0-3. For general health consideration sf-12 v2 was being used, which calculates two values PCS and MCS giving result in percentage. Results: A large proportion of respondent perceived oral health as having an enhanced effect on their quality of life in all three aspects that is general health, social and psychological. This is in stark contrast to other studies, where only physical aspects of oral health were more frequently considered to have the greatest overall impact of life quality compared with items relating to social, psychological and general health aspects. Conclusion: Gender variations were not apparent in the study. Both genders were likely to perceive oral health as it is impacting strongly on their quality of life. No significant gender variations are seen. But both have specific oral health needs and are most likely to utilize dental services which may be the key in understanding oral health behavior, including dental attendance patterns. How to cite this article: Shet RG, Jain G, Maroli S, Srivastava KJ, Kasina SP, Shwetha GS. Association of oral health related quality of life with dental anxiety and depression along with general health among people of Bhopal district, Madhya Pradesh. J Int Oral Health 2013; 5(6):1-8 .
Key Words: : Dental anxiety and depression, general health, hospital anxiety and depression scale, OHqOL
Introduction
In 1948, the World Health Organization (WHO) defined health as being "complete physical, mental and social well-being, and not merely the absence of diseases or illnesses".
Measures of oral health-related quality of life (OHqOL) are increasingly being used in descriptive population-based research as a means of capturing nonclinical aspects of oral health that patients deem most relevant to their overall health and well-being. 1 When OHqOL 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 well-being becomes possible. 2 These dimensions include functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap 3 it has also been suggested that sex and socioeconomic status (SES) can have a moderating role on OHqOL. When overall oral health is considered, there are few or no differences between men and women, but sex differences are quite apparent when the utilization of dental care services, treatment outcomes, or OHqOL are examined. 4 Oral health affects people physically and psychologically and influences how they grow, enjoy life, look, speak, chew, taste food and socialize, as well as their feelings of social well-being. 5 Contemporary concepts of health suggest that oral health should be defined in general physical, psychological and social well-being terms in relation to oral status. 6
Research on health-related behaviors and their correlations is of interest to public health for several reasons. First, implementation of successful health promotion programmes depends on both information about the prevalence of such behaviors and an understanding of their determinants. Secondly, research may highlight interactions between health related behaviors which may bring about synergistic effects on health status. Thirdly, information about patterns of health related behaviors can provide important data for adjustment of health education interventions within the context of health promotion programmes. We can relate hospital dental anxiety to general health, as various studies are done by using HADS to measure out anxiety level and its direct and indirect consequences on general health. To date most anxiety scales have received limited attention to their theoretical underpinnings. Dental anxiety is not unitary and has been typically conceived under three connected approaches: behavioral, cognitive, and physiological. Self report methods primarily assess the cognitive component which can be split into at least 2 valid constructs.
So present study was conducted to associate oral health related quality of life with dental anxiety and depression along with general health among people of Bhopal district, Madhya Pradesh.
Materials and Methods
A cross sectional questionnaires based survey was conducted among the subjects of Bhopal. The survey was carried among 101 subjects aging from 20-40 years. Subjects under investigation were belonging to various occupations. They were assigned a questionnaire. This study was done between the time period of november 2012 to february 2013. The sample taken into account was a select sample which was considered as a sample of convenience and feasibility.
Survey thus undertaken was a questionnaire survey in which a specially designed questionnaire was used. Questionnaire consisted of four parts, first part consist of socio-demographic data along with dental visiting habits, second part has OHqOL-questionnaire, third part has general health (sf-12) and fourth part has hospital anxiety and depression questionnaire. The questionnaire was distributed among the individuals and were tried to make understand each and every question. The questionnaire was constructed in English as well as in Hindi. OHqOL questionnaire was used for assessment of OHqOL. 7 It consists of 16 questions which takes into account both effect and impact of oral health on quality of life. 8 The effect of oral health on quality of life has three domains - physical containing 6 items and social and psychological consisting of five items each. All the respondents were made to understand each question along with the effect and impact related to the questions and each of the proposed 16 items were scored first on “effect” (with responses ranging from bad to good effect on quality of life) and later on the “impact” of each “effect”. The impact of each effect was recorded under five categories that is No, Little, Moderate, Great and Extreme. The score for each effect was ranging from 1 to 9 with score 1 being bad effect having extreme impact, score 5 representing no effect with no impact and 9 being good effect having extreme impact. The sum of individual item responses were added together to generate an overall score with possible values ranging from 16 to 144. 8 All the data collected was entered into the spreadsheets.
Dental anxiety and depression was measured by Hospital Anxiety and Depression Scale. Each question was provided with four options and numbering ranging from 0-3. This is a self screening questionnaire for depression and anxiety. 1 The patient should be instructed not to take too long over their replies: their immediate reaction to each item will probably be more accurate than a long thought-out response. It consists of 14 questions, seven for anxiety and seven for depression. Although it was designed for hospital General Medical Outpatients, it has been extensively used in Primary Care. 2 For general health consideration sf-12 v2 was being used, which calculates two values PCS and MCS giving result in percentage. All responses to questions in SF-12v2 are printed in a horizontal (left-to-right) format, There is considerable empirical evidence that the SF-12v2 five-choice response categories substantially improve the two SF-12 role. Advantage of the SF-12v2 form over the original v1 form is the provision for estimating the eight-domain profile of scales, in addition to the PCS-
12 and MCS-12 summary measures. The on-line scoring software, now available for SF-12v2, also incorporates Quality Metric Incorporated's MDE algorithms which reduce the bias in estimates of missing responses, and makes it possible to compute scale and summary scores for many respondents who would have otherwise been lost due to missing data. The SF-12 was designed for applications in which health status would be measured weekly or biweekly. It was created by changing the recall period for six SF-12 scales (Role Physical, Bodily Pain, Vitality, Social Functioning, Role Emotional, and Mental Health) from “the past four weeks” to “the past week”. For example, the question, “During the past four weeks, how much of the time has your physical health or emotional problems interfered with your social activities like visiting friends, relatives, etc was changed as during the past week, how much of the time has your physical health or emotional problems interfered with your social activities like visiting friends, relatives, etc. Two SF-12 scales, Physical functioning and general health, do not have a recall period, so are identical across acute and standard forms. (sf -36. org)
Results
Table 1 reveals that OHqOL variation between the male candidates and they show more positive effect on OHqOL by eating, sleep and confidence in their life and show slight or more negative effect on smiling and mood. They feel that they are slightly affected or have a moderate effect of OHqOL on work, finance, personality, social life and romantic relationship.
Table 1: Distribution of response to OHqOL - Effects & Impacts (MALES)
| Responses(physical aspect) | Bad effect of extreme empect | Bad effect of great impact | Bad effect of moderate impact | Bad effect of little impact | None | Great effect of little impact | Great effect of moderate impact | Great effect of great impact | Great effect of extreme impact |
| Eating | 0 | 0 | 0 | 0 | 11(10.9) | 18(17.8) | 5(5.0) | 12(11.9) | 3(3.0) |
| Appearance | 0 | 0 | 0 | 0 | 3(3.0) | 10(9.9) | 15(14.9) | 14(13.9) | 7(6.9) |
| Speech | 0 | 0 | 0 | 0 | 6(5.9) | 11(10.9) | 14(13.9) | 16(15.8) | 2(2.0) |
| General Health | 0 | 1 (1.0) | 0 | 0 | 9(8.9) | 12(11.9) | 11(10.9) | 10(9.9) | 6(5.9) |
| Breath odor | 0 | 1 (1.0) | 1 (1.0) | 0 | 5(5.0) | 14(13.9) | 11(10.9) | 11(10.9) | 6(5.9) |
| Comfort | 0 | 0 | 0 | 0 | 7(6.9) | 5(5.0) | 17(16.8) | 15(14.9) | 5(5.0) |
| Sleep(psychological aspect) | 0 | 0 | 0 | 1 (1.0) | 6(6.0) | 7(7.0) | 14(14.0) | 18(18.0) | 3(3.0) |
| Confidence | 0 | 0 | 1 (1.0) | 1 (1.0) | 6(5.9) | 4(4.0) | 18(17.8) | 11(10.9) | 8(7.9) |
| Worky | 0 | 0 | 0 | 0 | 8(7.9) | 11(10.9) | 14(13.9) | 14(13.9) | 2(2.0) |
| Mood | 0 | 0 | 1 (1.0) | 0 | 6(5.9) | 10(9.9) | 8(7.9) | 16(15.8) | 8(7.9) |
| Personality | 0 | 0 | 1 (1.0) | 1 (1.0) | 8(7.9) | 8(7.9) | 13(12.9) | 11(10.9) | 7(6.9) |
| Social life | 0 | 0 | 1 (1.0) | 0 | 4(4.0) | 6(5.9) | 12(11.9) | 13(12.9) | 13(12.9) |
| Romantic relation | 0 | 0 | 0 | 0 | 12(11.9) | 5(5.0) | 10(9.9) | 13(12.9) | 9(8.9) |
| Smiling | 0 | 0 | 1 (1.0) | 0 | 10(9.9) | 7(6.9) | 10(9.9) | 16(15.8) | 5(5.0) |
| Work | 0 | 0 | 0 | 0 | 10(9.9) | 8(7.9) | 13(12.9) | 11(10.9) | 7(6.9) |
| Finance | 0 | 0 | 0 | 1 (1.0) | 8(7.9) | 11(10.9) | 17(16.8) | 6(5.9) | 6(5.9) |
Table 2 reveals that OHqOL variation between the female candidates and they show more positive effect
Table 2: Distribution of response to OHqOL - Effects & Impacts (FEMALES)
| Bad effect of extreme empect | Bad effect of extreme empect | Bad effect of great impact | Bad effect of moderate impact | Bad effect of little impact | None | Great effect of little impact | Great effect of moderate impact | Great effect of great impact | Great effect of extreme impact |
| Eating | 0 | 0 | 2(2.0) | 0 | 7(6.9) | 11(10.9) | 11(10.9) | 16(15.8) | 5(5.0) |
| Appearance | 0 | 0 | 0 | 0 | 3(3.0) | 10(9.9) | 17(16.8) | 18(17.8) | 4(4.0) |
| Speech | 0 | 0 | 0 | 0 | 1(1.0) | 10(9.9) | 17(16.8) | 15(14.9) | 9(8.9) |
| General Health | 0 | 1(1.0) | 0 | 0 | 5(5.0) | 13(12.9) | 13(12.9) | 14(13.9) | 6(5.9) |
| Breath odor | 0 | 1(1.0) | 0 | 1(1.0) | 6(5.9) | 13(12.9) | 17(16.8) | 6(5.9) | 8(7.9) |
| Comfort | 0 | 0 | 0 | 2(2.0) | 4(4.0) | 10(9.9) | 18(17.8) | 13(12.9) | 5(5.0) |
| Sleep(psychological aspect) | 0 | 0 | 0 | 1(1.0) | 7(7.0) | 9(9.0) | 17(17.0) | 11(11.0) | 6(6.0) |
| Confidence | 0 | 0 | 1(1.0) | 0 | 6(5.9) | 9(8.9) | 15(14.9) | 15(14.9) | 6(5.9) |
| Worky | 0 | 0 | 2(2.0) | 0 | 12(11.9) | 12(11.9) | 11(10.9) | 12(11.9) | 3(3.0) |
| Mood | 0 | 0 | 1(1.0) | 0 | 11(10.9) | 2(2.0) | 18(17.8) | 13(12.9) | 7(6.9) |
| Personality | 0 | 0 | 0 | 0 | 11(10.9) | 3(3.3) | 16(15.8) | 16(15.8) | 6(5.9) |
| Social life | 0 | 0 | 0 | 0 | 9(8.9) | 6(5.9) | 11(10.9) | 14(13.9) | 9(8.9) |
| Romantic relation | 0 | 0 | 0 | 0 | 10(9.9) | 9(8.9) | 9(8.9) | 18(17.8) | 5(5.0) |
| Smiling | 0 | 0 | 0 | 0 | 11(10.9) | 8(7.9) | 17(16.8) | 11(10.9) | 5(5.0) |
| Work | 0 | 0 | 0 | 0 | 8(7.9) | 5(5.0) | 20(19.8) | 12(11.9) | 7(6.9) |
| Finance | 0 | 0 | 0 | 0 | 8(7.9) | 9(8.9) | 17(16.8) | 16(15.8) | 2(2.0) |
on OHqOL by appearence, comfort and work in their life and show slight or more negative effect on eating and breath odour. They feel that they are slightly affected or have a moderate effect of OHqOL on sleep,
finance, personality, social life and romantic relationship.
Table 3 reveals that OHqOL variation among the general population and they show more positive affect of OHqOL on appearance, comfort, finance, speech ,sleep, confidence and relationship show slight or more negative effect on eating and breath odor. They feel that they are slightly affected or have a moderate effect of OHqOL on personality, social life and mood.
Table 3: Distribution of response to OHqOL - Effects & Impacts (TOTAL)
| Responses(physical aspect) | Bad effect of extreme empect | Bad effect of great impact | Bad effect of moderate impact | Bad effect of little impact | None | Great effect of little impact | Great effect of moderate impact | Great effect of great impact | Great effect of extreme impact |
| Eating | 0 | 0 | 2(2.0) | 0 | 18(17.8) | 29(28.7) | 16(15.8) | 28(27.7) | 8(7.9) |
| Appearance | 0 | 0 | 0 | 0 | 6(5.9) | 20(19.8) | 32(31.7) | 32(31.7) | 11(10.9) |
| Speech | 0 | 0 | 0 | 0 | 7(6.9) | 21(20.8) | 31(30.7) | 31(30.7) | 11(10.9) |
| General Health | 0 | 2(2.0) | 0 | 0 | 14(13.9) | 25(24.9) | 24(23.8) | 24(23.8) | 12(11.9) |
| Breath odor | 0 | 2(2.0) | 1(1.0) | 1(1.0) | 11(10.9) | 27(26.7) | 28(27.7) | 17(16.8) | 14(13.9) |
| Comfort | 0 | 0 | 0 | 2(2.0) | 11(10.9) | 15(14.9) | 35(34.7) | 28(27.7) | 10(9.9) |
| Sleep(psychological aspect) | 0 | 0 | 0 | 2(2.0) | 13(13.0) | 16(16.0) | 31(31.0) | 29(29.0) | 9(9.0) |
| Confidence | 0 | 0 | 2(2.0) | 1(1.0) | 12(11.9) | 13(12.9) | 33(32.7) | 26(25.7) | 14(13.9) |
| Worky | 0 | 0 | 2(2.0) | 0 | 20(19.8) | 23(22.8) | 25(24.8) | 26(25.7) | 5(5.0) |
| Mood | 0 | 0 | 2(2.0) | 0 | 17(16.8) | 12(11.9) | 26(25.7) | 29(28.7) | 15(14.9) |
| Personality | 0 | 0 | 1(1.0) | 1(1.0) | 19(18.8) | 11(10.9) | 29(28.7) | 27(26.7) | 13(12.9) |
| Social life | 0 | 0 | 1(1.0) | 3(3.0) | 13(12.9) | 12(11.9) | 23(22.8) | 27(26.7) | 22(21.8) |
| Romantic relation | 1(1.0) | 0 | 0 | 0 | 22(21.8) | 14(13.9) | 19(18.8) | 31(30.7) | 14(13.9) |
| Smiling | 0 | 0 | 1(1.0) | 0 | 21(20.8) | 15(14.9) | 27(26.7) | 27(26.7) | 10(9.9) |
| Work | 0 | 0 | 0 | 0 | 18(17.8) | 13(12.9) | 33(32.7) | 23(22.8) | 14(13.9) |
| Finance | 0 | 0 | 0 | 1(1.0) | 16(15.8) | 20(19.8) | 34(33.7) | 22(21.8) | 8(7.9) |
Table 4 reveals the anxiety and depression ratio of males. Males show more anxiety and depression ratio slight in positive aspect. Least ratio is shown in extreme in negative aspect. They show moderate ratio extreme in positive aspect and slight in negative aspect. Table 5 reveals the anxiety and depression ratio among females. Females show the more anxiety and depression ratio in the extreme in positive aspect. Least ratio is shown in extreme in negative aspect. They show moderate ratio slight in positive aspect and slight in negative aspect.
Table 4: Anxiety and depression ratio among males
| Extreme in positive aspect | Slight in positive aspect | Sight in negative aspect | Extreme in negative aspect | |
| Anxiety | 29(28.7) | 13(12.9) | 5(5.0) | 2(2.0) |
| Depression | 22(21.8) | 21(20.8) | 6(5.9) | 0 |
| Anxiety | 18(17.8) | 20(19.8) | 8(7.9) | 3(3.0) |
| Depression | 17(16.8) | 24(23.8) | 6(5.9) | 2(2.0) |
| Anxiety | 18(17.8) | 19(18.8) | 10(9.9) | 2(2.0) |
| Depression | 23(22.8) | 17(16.8) | 8(7.9) | 1(1.0) |
| Anxiety | 14(13.9) | 29(28.7) | 5(5.0) | 1(1.0) |
| Depression | 18(17.8) | 23(22.8) | 8(7.9) | 0 |
| Anxiety | 20(19.8) | 16(15.8) | 8(7.9) | 5(5.0) |
| Depression | 14(13.9) | 22(21.8) | 13(12.9) | 0 |
| Anxiety | 9(8.9) | 26(25.7) | 11(10.9) | 3(3.0) |
| Depression | 14(13.9) | 25(24.8) | 10(9.9) | 0 |
| Anxiety | 18(17.8) | 20(19.8) | 8(7.9) | 3(3.0) |
| Depression | 18(17.8) | 12(11.9) | 11(10.9) | 2(2.0) |
Table 5: Anxiety and depression ratio among females
| Extreme in positive aspect | Slight in positive aspect | Sight in negative aspect | Extreme in negative aspect | |
| Anxiety | 23(22.8) | 24(23.8) | 2(2.0) | 3(3.0) |
| Depression | 25(24.8) | 19(18.8) | 7(6.9) | 1(1.0) |
| Anxiety | 25(24.8) | 19(18.8) | 5(5.0) | 3(3.0) |
| Depression | 27(26.7) | 16)15.88) | 7(6.9) | 2(2.0) |
| Anxiety | 25(24.7) | 21(20.8) | 6(5.9) | 0 |
| Depression | 25(24.7) | 17(16.8) | 6(5.9) | 3(3.0) |
| Anxiety | 7(6.9) | 35(34.7) | 8(7.9) | 2(2.0) |
| Depression | 14(13.9) | 24(23.8) | 13(12.9) | 1(1.0) |
| Anxiety | 21(20.8) | 17(16.8) | 13(12.9) | 1(1.0) |
| Depression | 27(26.7) | 12(11.9) | 12(11.9) | 1(1.0) |
| Anxiety | 10(9.9) | 27(26.8) | 13(12.9) | 2(2.0) |
| Depression | 21(20.8) | 22(21.8) | 7(6.9) | 2(2.0) |
| Anxiety | 24(23.8) | 16(15.8) | 8(7.9) | 2(2.0) |
| Depression | 18(17.8) | 16(15.8) | 6(5.9) | 5(5.0) |
Table 6 reveals the anxiety and depression values of the males and females. They show the great impact on the slight in positive aspect. Least ratio is shown in extreme in negative aspect. They show moderate ratio extreme in positive aspect and slight in negative aspect.
Table 6: Anxiety and depression ratio of all individuals
| Extreme in positive aspect | Slight in positive aspect | Sight in negative aspect | Extreme in negative aspect | |
| Anxiety | 52(51.5) | 37(36.6) | 7(6.9) | 5(5.0) |
| Depression | 47(46.5) | 40(39.6) | 13(12.9) | 1(1.0) |
| Anxiety | 43(42.6) | 39(38.6) | 13(12.9) | 6(5.9) |
| Depression | 44(43.6) | 40(39.6) | 13(12.9) | 4(4.0) |
| Anxiety | 43(42.6) | 40(39.6) | 16(15.8) | 2(2.0) |
| Depression | 48(47.5) | 34(33.7) | 14(13.9) | 4(4.0) |
| Anxiety | 21(20.8) | 64(63.4) | 13(12.9) | 3(3.0) |
| Depression | 32(31.7) | 47(46.5) | 21(20.8) | 1(1.0) |
| Anxiety | 41(40.6) | 33(32.7) | 21(20.8) | 6(5.9) |
| Depression | 41(40.6) | 34(33.7) | 25(24.8) | 1(1.0) |
| Anxiety | 19(18.8) | 53(52.5) | 24(23.8) | 5(5.0) |
| Depression | 35(34.7) | 47(46.5) | 17(16.8) | 2(2.0) |
| Anxiety | 42(41.6) | 36(35.6) | 16(15.8) | 5(5.0) |
| Depression | 36(35.6) | 28(27.7) | 17(16.8) | 7(6.9) |
Table 7 reveals the mean and standard deviation values among the males and females. For general health males have responded more than women in both aspects. Besides for anxiety and depression and OHqOL females have responded more in both positive and negative aspects.
Table 7: Mean and standard deviation the OHqOL
| Sex | N | Mean | SD | |
| AGE | Male | 49 | 7.18 | 0.99 |
| Female | 52 | 5.73 | 0.79 | |
| PCS | Male | 49 | 13.682 | 1.955 |
| Female | 52 | 11.084 | 1.537 | |
| MCS | Male | 49 | 12.841 | 1.834 |
| Female | 52 | 9.201 | 1.276 | |
| QT | Male | 49 | 4.76 | 0.68 |
| Female | 52 | 5.79 | 0.80 | |
| AT | Male | 49 | 9.33 | 1.33 |
| Female | 52 | 8.85 | 1.23 |
Discussion
This study shows the association between the oral health status of the people, anxiety and depression with the general health of the people and quality of the life. This study is important because it is the first one in the context of elderly beneficiaries of social security. However, we have to accept that it does not allow identifying predictive factors since the design was cross-sectional.
First in this study utilizing the OHqOL questionnaire indicator. It was observed that majority perceived their oral health as impacting on there quality of life. Perhaps the greater effect of oral health on life quality observed here reflex the fact that OHqOL instrument measured both positive and negative dimensions of oral health related quality of life. This supports the findings of others, where large proportions of respondents perceived oral health as affecting there life quality.
Secondly, it is interesting that the respondents claimed that their oral health status more frequently enhanced their life quality as opposed to detracting from it and this too was evident in that OHQoL scores were skewed towards positive oral health related quality of life. Existing quality of life measures in dentistry typically measure only the negative impacts of oral health on life quality, the burden of oral disease and fail to incorporate the positive perspective. A large proportion of respondent perceived oral health as having an enhanced effect on their quality of life in all three aspects that is general health, social and
psychological. This is in stark contrast to other studies, where only physical aspects of oral health were more frequently considered to have the greatest overall impact of life quality compared with items relating to social, psychological and general health aspects. The reason might be because of the younger age group with partial or limited exposure to life.
Gender variations were not apparent in the study. Both genders were likely to perceive oral health as it is impacting strongly on their quality of life. No significant gender variations are seen. But both have specific oral health needs and are most likely to utilize dental services which may be the key in understanding oral health behavior, including dental attendance patterns.
These variations varied from other studies. Previously studies were done to identify associations between level of dental anxiety and the impact of oral health on quality of life (OHqOL) in Britain, controlling for socio demographic and oral health status factors which gave result as p < 0.001 and showed approximately two times as likely to be among those experiencing the poorest OHqOL below the population median OHqOL score in Britain. 7 Another study was done to identify association between general health and their impact on oral health related quality of life in Califorina and measured as p < .03 and thus showed impact of these factors on each other. 9 Further study was done to show relation between OHqOL and general health were done at a assessment clinic which showed strong correlation between both giving p< < .001. 10 But in our study p > 0.05 and thus show no significant variation between male and female.
Conclusion
Gender variations were not apparent in the study. Both genders were likely to perceive oral health as it is impacting strongly on their quality of life. No significant gender variations are seen. But both have specific oral health needs and are most likely to utilize dental services which may be the key in understanding oral health behavior, including dental attendance patterns.
Footnotes
Source of Support: Nil
Conflict of Interest: None Declared
Contributor Information
RGK Shet, Department of Prosthodontics, Manasarovar Dental College, Bhopal, Madhya Pradesh, India.
Gaurvi Jain, Department of Prosthodontics, Rishiraj College of Dental Sciences, Bhopal, Madhya Pradesh, India.
Sohani Maroli, Department of Conservative Dentistry & Endodontics, St. Joseph Dental College, Eluru, Andhra Pradesh, India.
Kirti Jajoo Srivastava, Department of Prosthodontics, Peoples Dental Academy, Bhopal, Madhya Pradesh, India.
Sitaram Prasad Kasina, Department of Prosthodontics, St. Joseph Dental College, Eluru, Andhra Pradesh, India.
GS Shwetha, Department of Orthodontics & Dento-facial Orthopaedics, KLE Society’s Institute of Dental Sciences, Bangalore, Karnataka, India.
References
- 1.AA Weiner, DV Sheehan. Etiology of dental anxiety: psychological trauma or CNS chemical imbalance? Gen Dent. 1990;38:39–43. [PubMed] [Google Scholar]
- 2.D Locker, A Liddell, L Dempster, D Shapiro. Age of onset of dental anxiety. J Dent Res. 1999;78(3):790–796. doi: 10.1177/00220345990780031201. [DOI] [PubMed] [Google Scholar]
- 3.GD Slade. Assessment of oral health-related quality of life. In: Inglehart MR, Bagramian RA (Editors). Oral health-related quality of life. Carol Stream, IL: Quintessence Publishing Co. Inc. 2002:29–45. [Google Scholar]
- 4.GD Slade, N Nuttall, AE Sanders, JG Steele, PF Allen, S Lahti. Impacts of oral disorders in the United Kingdom and Australia. Br Dent J. 2005;198:489–493. doi: 10.1038/sj.bdj.4812252. [DOI] [PubMed] [Google Scholar]
- 5.GD Slade. Dental Ecology. Measuring oral health and quality of life. Chapel Hill: University of North Carolina, USA. 1997:11–23. [Google Scholar]
- 6.LK Cohen, JD Jago. Toward the formulation of sociodental indicators. Int J Health Serv. 1976;6(4):681–698. doi: 10.2190/LE7A-UGBW-J3NR-Q992. [DOI] [PubMed] [Google Scholar]
- 7.C McGrath, R Bedi. Gender variations in the social impact of oral health. J Ir Dent Assoc. 2000;46(3):87–91. [PubMed] [Google Scholar]
- 8.H Tapsoba, JP Deschamps, MH Leclercq. Factor analytic study of two questionnaires measuring oral health-related quality of life among children and adults in New Zealand, Germany and Poland. Qual Life Res. 2000;9:559–569. doi: 10.1023/a:1008931301032. [DOI] [PubMed] [Google Scholar]
- 9.SS Ingram, PH Seo, R Sloane, T Francis, EC Clipp, ME Doyle, GS Montana, HJ Cohen. The association between oral health and general health quality of life in older male cancer patients. J Am Geriatr Soc. 2005;53(9):1504–1509. doi: 10.1111/j.1532-5415.2005.53452.x. [DOI] [PubMed] [Google Scholar]
- 10.B Smith, A Baysan, M Fenlon. Association between Oral Health Impact Profile and General Health scores for patients seeking dental implants. J Dent. 2009;37(5):357–359. doi: 10.1016/j.jdent.2009.01.004. [DOI] [PubMed] [Google Scholar]