Oral Health-Related Quality of Life and Severity of Periodontal Disease

Abstract

Background:

Oral diseases are among the most common diseases which could not dissociate from general conditions with regards to impacts on quality of life (QoL). The present study is aimed to assess the impact of the severity of periodontal disease on oral health QoL using oral health-related quality of life (OHQoL)-UK questionnaire.

Materials and Methods:

The OHQoL-UK questionnaire consists of 16 variables within four domains made up of symptoms, psychological, social dimensions, and physical dimensions. Summing up the responses produce overall OHQoL-UK scores ranging from 16 to 80. Internal consistency was assessed using Cronbach's reliability coefficient. Each patient underwent a periodontal examination including periodontal attachment levels with Williams' periodontal probe as part of his or her routine assessment by one clinician collaborating on the study.

Results:

Within 200 patients participating in this study, 51% were < diploma, 32% were < bachelor's degree, and 17% were bachelor's degree and higher. Patients with higher educational level have a higher mean QoL score (P = 0.0001) which was statistically significant in regard to all aspects.

Conclusion:

The mean QoL score was significantly lower in patients with severe periodontitis when compared to patients with mild periodontitis, patients with better academic qualification have higher mean QoL score. According to the effect of severity of periodontal condition and educational level on QoL, required intervention should be done for treatment to improve QoL as a result.

INTRODUCTION

Around 5%–15% of the general population is affected by severe periodontitis[1] with the potential of a negative impact on patient's oral health.[2,3] Moreover, it should be measured to assess periodontal treatment efficacy[4,5] as mentioned in a study which shows conventional nonsurgical periodontal therapy ameliorated quality of life (QoL) in the Japanese patients.[6] The QoL is a multidimensional subjective construct connected with the impact of health and disease on daily performances. Periodontitis is a common inflammatory disease which is caused by specific bacterial complexes in the dental plaque biofilm that affects supporting structures of the teeth that can lead to loss of the periodontal ligament and alveolar bone clinically characterized by the pocket formation and/or gingival recession. Oral diseases are among the most common diseases which could not dissociate from general conditions with regards to impacts on QoL.[7,8] Various aspects of life including functional, psychological, social factors, and experience of pain or discomfort in relation to the orofacial region should be considered for oral health-related quality of life.[9,10,11] There are various methods available for the measurement of oral health QoL[12,13,14] and among them, the oral health-related quality of life (OHQoL-UK) is one of the most common instruments which is used to evaluate the effect of oral conditions on QoL.[15] This method includes a series of items about the impact of oral health on specific aspects of daily lives with a bidirectional (positive or negative) aspect.[16] Negative impacts of periodontal disease on aspects of daily living and health-related QoL were shown using mean oral health QoL-UK scores.[17] There is very less literature available that has used oral health QoL-UK questionnaire and the association of periodontal disease and QoL have not yet been evaluated by this questionnaire so, the aim of our study was to assess the impact of severity of periodontal disease on oral health QoL using OHQoL-UK questionnaire.

MATERIALS AND METHODS

The study was carried out on patients in a private dental institution. Patients without any systemic diseases included in the present study. Two hundred patients were participated in the study and were informed about the purpose of the study, and informed consent was obtained. The ethical clearance was obtained from the ethical committee of the Dental Institute. The impact of oral health on the patients' life quality was assessed using the OHQoL-UK questionnaire that was also translated into local regional language. Patients completed a self-administered questionnaire which requested information about personal history and educational level.

The OHQoL-UK questionnaire consists of 16 variables within four domains made up of symptoms, psychological, social dimensions, and physical dimensions. Scores were derived from response categories to each question that is:

• Very bad (Score 1)

• Bad (Score 2)

• Ineffective (Score 3)

• Good (Score 4)

• Very good (Score 5).

Summing up the responses produce overall OHQoL-UK scores ranging from 16 to 80. Internal consistency was assessed using Cronbach's reliability coefficient. Each patient underwent a periodontal examination including periodontal attachment levels with Williams' periodontal probe as part of his or her routine assessment by one clinician collaborating on the study.

The severity of chronic periodontitis was classified based on the amount of clinical attachment loss as follows:

• Mild = 1 or 2 mm

• Moderate = 3 or 4 mm

• Severe ≥ 5 mm.

Statistical analysis

Data were analyzed through SPSS 18.0 (IBM United States) and P ≤ 0.05 was considered statistically significant.

RESULTS

Among 200 completed questionnaires, seven questionnaires were excluded due to incomplete information. The questionnaires were responded by ninty men (45%) and 110 women (55%) in the age range of 18–65 years. Within 200 patients participating in this study, 51% were < diploma, 32% were < bachelor's degree, and 17% were bachelor's degree and higher. Patients with higher educational levels have higher mean QoL score (P = 0.0001) which was statistically significant in regard to all aspects. Mean QoL score for the patients having educational level < diploma degree was reported lower than that of other groups (P < 0.05). As well, patients with better educational level have a higher mean QoL score that was statistically significant (P = 0.0001). There was a statistically significant association between and OHQoL the severity of periodontal disease scores. The mean QoL score of patients decreased which was statistically significant in the psychological aspect. Patients with severe periodontitis had significantly lower mean QoL scores as compared to patients with mild periodontitis [Table 1].

Table 1.

Mean, standard deviation, and P value of each domain of oral health quality of life in periodontal patients

OHQoL-UK questionnaire domains	Severity of periodontal disease	Mean	Standard deviation	P
Symptoms	Mild	8.0010	0.88077	0.144
	Moderate	8.0575	1.22593
	Severe	9.6872	1.15530
Physical	Mild	21.3260	2.64387	0.107
	Moderate	22.343	2.15599
	Severe	11.6685	1.46751
Psychological	Mild	22.2200	1.94467	0.044
	Moderate	21.2667	2.27447
	Severe	20.0570	2.38543
Social	Mild	17.1240	3.25997	0.052
	Moderate	17.1608	3.14516
	Severe	16.2547	1.47298
	Total	14.8455	1.29197
Total	Mild	70.5675	6.67858	0.031
	Moderate	67.8453	6.96719
	Severe	65.4885	7.06771

OHQoL: Oral health quality of life

DISCUSSION

There have been clinical studies based on the impact of periodontitis on oral health QoL, comparing their results is difficult as they have used a range of methods defining periodontal status and assessing OHQoL,[18,19,20,21,22] In most of the observational studies relationship between severe or moderate periodontitis and OHQoL has been established.[23,24,25,26,27]

Patients with chronic periodontitis have significantly poorer OHQoL when compared to periodontally healthy patients, specifically in functional, physical, and psychological domains. The impact of periodontal diseases on patient QoL was moderate in psychological disability and physical pain and domains.[28,29] The severity of periodontal disease was not significantly associated with functional limitation,[30] which was in contrast with other studies.[31,32] In the present study, there was a statistically significant association between the severity of periodontal disease and OHQoL score when related to psychological factors. There was a significant impact of periodontitis on OHQoL prevalence and severity.

The early stages of periodontitis indicating few symptoms have less impact on QoL compared with other oral conditions.[33] In the current study, the mean QoL score was significantly lower in patients with severe periodontitis than in patients with mild periodontitis but not in case of moderate periodontitis. Periodontal health is sensitive to the generic oral health QoL, both self-reported and clinically observed.[34]

When the effect of oral health on the QoL was evaluated by the OHQoL-UK measure the prevalence of impact was high.

The instrument indicated discriminative validity in recognizing clinical evidence of periodontitis and self-reported symptoms.[35] Patients with elementary school education levels had greater oral impacts on daily performance scores than patients with more than an elementary school education indicating their poor oral health which is in agreement with our study. The first limitation in the current study is that patients presenting for an initial periodontal examination have frequent problems related to teeth, gums, and dentures that may affect OHQoL measurements. Another limitation is the cross-sectional nature of the study, in which exposure and outcome are determined simultaneously, and the time sequence is often diffcult to define. In addition, the people perceptions of QoL may change over time and information bias may exist in this type of study.

We found that periodontal disease had a negative impact on QoL, and this impact was higher in patients with severe periodontal disease. In preventive programs, periodontal disease assessment, treatment, and subsequent evaluation of periodontal care, these findings have significant implications for the use of oral health QoL measures as objective clinical parameters. In addition, to improve the QoL, oral health educations should be considered in general health promotion programs.

CONCLUSION

The mean QoL score was significantly lower in patients with severe periodontitis when compared to the patients with mild periodontitis, patients with better academic qualification have a higher mean QoL score. According to the effect of severity of the periodontal condition and educational level on QoL, required intervention should be done for treatment to improve QoL as a result.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.