The influence of oral health conditions, socioeconomic status and home environment factors on schoolchildren's self-perception of quality of life

Paula, Leite, Almeida, Ambrosano, Pereira, Mialhe

Description

The objective this study was to investigate the influence of clinical conditions, socioeconomic status, home environment, subjective perceptions of parents and schoolchildren about general and oral health on schoolchildren's oral health-related quality of life (OHRQoL). Methods A sample of 515 schoolchildren, aged 12 years was randomly selected by conglomerate analysis from public and private schools in the city of Juiz de Fora, Brazil. The schoolchildren were clinically examined for presence of caries lesions (DMFT and dmft index), dental trauma, enamel defects, periodontal status (presence/absence of bleeding), dental treatment and orthodontic treatment needs (DAI). The SiC index was calculated. The participants were asked to complete the Brazilian version of Child Perceptions Questionnaire (CPQ 11-14 ) and a questionnaire about home environment. Questions were asked about the presence of general diseases and children's self-perception of their general and oral health status. In addition, a questionnaire was sent to their parents inquiring about their socioeconomic status (family income, parents' education level, home ownership) and perceptions about the general and oral health of their school-aged children. The chi-square test was used for comparisons between proportions. Poisson's regression was used for multivariate analysis with adjustment for variances. Results Univariate analysis revealed that school type, monthly family income, mother's education, family structure, number of siblings, use of cigarettes, alcohol and drugs in the family, parents' perception of oral health of schoolchildren, schoolchildren's self perception their general and oral health, orthodontic treatment needs were significantly associated with poor OHRQoL (p < 0.001). After adjusting for potential confounders, variables were included in a Multivariate Poisson regression. It was found that the variables children's self perception of their oral health status, monthly family income, gender, orthodontic treatment need, mother's education, number of siblings, and household overcrowding showed a strong negative effect on oral health-related quality of life. Conclusions It was concluded that the clinical, socioeconomic and home environment factors evaluated exerted a negative impact on the oral health-related quality of life of schoolchildren, demonstrating the importance of health managers addressing all these factors when planning oral health promotion interventions for this population.

Informations

• Publié par: biomed
• Publié le: 01 janvier 2012
• Nombre de lectures: 4
• Langue: English

Extrait

Paula
etal
.
HealthandQualityofLifeOutcomes
2012,
10
:6
http://www.hqlo.com/content/10/1/6

RESEARCH

OpenAccess

Theinfluenceoforalhealthconditions,
socioeconomicstatusandhomeenvironment
factorsonschoolchildren
’
sself-perceptionof
qualityoflife
JFaánbiicoeLSMPiaaullhae
1
,
1*
IsabelCGLeite
2
,AndersoBAlmeida
2
,GlauciaMBAmbrosano
1
,AntônioCPereira
1
and

Abstract
Background:
Theobjectivethisstudywastoinvestigatetheinfluenceofclinicalconditions,socioeconomicstatus,
homeenvironment,subjectiveperceptionsofparentsandschoolchildrenaboutgeneralandoralhealthon
schoolchildren
’
soralhealth-relatedqualityoflife(OHRQoL).
Methods:
Asampleof515schoolchildren,aged12yearswasrandomlyselectedbyconglomerateanalysisfrom
publicandprivateschoolsinthecityofJuizdeFora,Brazil.Theschoolchildrenwereclinicallyexaminedfor
presenceofcarieslesions(DMFTanddmftindex),dentaltrauma,enameldefects,periodontalstatus(presence/
absenceofbleeding),dentaltreatmentandorthodontictreatmentneeds(DAI).TheSiCindexwascalculated.The
participantswereaskedtocompletetheBrazilianversionofChildPerceptionsQuestionnaire(CPQ
11-14
)anda
questionnaireabouthomeenvironment.Questionswereaskedaboutthepresenceofgeneraldiseasesand
children
’
sself-perceptionoftheirgeneralandoralhealthstatus.Inaddition,aquestionnairewassenttotheir
parentsinquiringabouttheirsocioeconomicstatus(familyincome,parents
’
educationlevel,homeownership)and
perceptionsaboutthegeneralandoralhealthoftheirschool-agedchildren.Thechi-squaretestwasusedfor
comparisonsbetweenproportions.Poisson
’
sregressionwasusedformultivariateanalysiswithadjustmentfor
variances.
Results:
Univariateanalysisrevealedthatschooltype,monthlyfamilyincome,mother
’
seducation,familystructure,
numberofsiblings,useofcigarettes,alcoholanddrugsinthefamily,parents
’
perceptionoforalhealthof
schoolchildren,schoolchildren
’
sselfperceptiontheirgeneralandoralhealth,orthodontictreatmentneedswere
significantlyassociatedwithpoorOHRQoL(p<0.001).Afteradjustingforpotentialconfounders,variableswere
includedinaMultivariatePoissonregression.Itwasfoundthatthevariableschildren
’
sselfperceptionoftheiroral
healthstatus,monthlyfamilyincome,gender,orthodontictreatmentneed,mother
’
seducation,numberofsiblings,
andhouseholdovercrowdingshowedastrongnegativeeffectonoralhealth-relatedqualityoflife.
Conclusions:
Itwasconcludedthattheclinical,socioeconomicandhomeenvironmentfactorsevaluatedexerteda
negativeimpactontheoralhealth-relatedqualityoflifeofschoolchildren,demonstratingtheimportanceofhealth
managersaddressingallthesefactorswhenplanningoralhealthpromotioninterventionsforthispopulation.

*Correspondence:[e-mail]
1
DepartmentofCommunityDentistry,DivisionofHealthEducationand
HealthPromotion,PiracicabaDentalSchool,P.O.BOX52,Universityof
Campinas-UNICAMP,13414-903,Piracicaba,SP,Brazil
Fulllistofauthorinformationisavailableattheendofthearticle
©2012Paulaetal;licenseeBioMedCentralLtd.ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommons
AttributionLicense(http://creativecommons.org/licenses/by/2.0),whichpermitsunrestricteduse,distribution,andreproductionin
anymedium,providedtheoriginalworkisproperlycited.

Paula
etal
.
HealthandQualityofLifeOutcomes
2012,
10
:6
http://www.hqlo.com/content/10/1/6

Background
Nowadays,researchespointouttheneedtoconsiderthe
functionalandpsychosocialdimensionsoforalhealth
fortheimplementationandevaluationofpublichealth
dentistryinterventions.Inordertoachievethesedimen-
sions,instrumentsthatevaluatetheoralhealth-related
impactonqualityoflife(OHRQoL)havebeendevel-
oped[1,2],amongthem,theChildPerceptionQuestion-
naire(CPQ
11-14
)toassessOHRQoLataspecificage[3].
Severalstudiesfocusedonchildrenandadolescents
haveconfirmedthatoraldiseasescouldhaveanimpact
ontheirqualityoflife[2,4-9],ascarieslesions[10-14]
andmalocclusion[15-18].
However,adirectrelationshipbetweenOHRQoLand
clinicalindicatorsshouldbeinterpretedwithcaution,
becausetheseimpactscouldbemediatedbyotherfactors,
suchpersonal,social,andenvironmentalvariables
[2,19-21].
Forexample,thesocioeconomicstatusofthehousehold
inwhichthechildrenlivemayconfoundtherelationships
betweenoralhealthandOHRQoL[14,22,23].Thiscould
occurbecauseseveralstudieshaveshownassociations
betweenlowincomeandpoororalhealth[8,24-30].
Relativetothehomeenvironment,somestudieshave
verifiedtheinfluenceoffamilyontheoralhealthout-
comesofchildren,consideringthattheirfamiliesplaya
centralroleinpromotingtheiroralhealth[31,32].The
parentalperceptionsoftheirchildren
’
soralhealthcondi-
tionsmayinterfereinchildren
’
soralhealth[33].Other
studieshavefoundthatparents
’
socioeconomiccharacter-
isticsareassociatedwiththeirsubjectiveperceptions
relatedtotheirchildren
’
soralhealthstatus[33,34].There-
fore,thefamilyenvironmentmayhaveanimpactonchil-
dren
’
sself-perceptionabouttheirOHRQoL,butthereis
scarcelyanyinformationonsuchassociationinthelitera-
ture[14,32].
Althoughsocioeconomicstatusandfamilyenviron-
mentcouldbelinkedtoOHRQoL,thisaspecthasnot
yetbeensufficientlyinvestigatedinstudiestoevaluate
thisassociationinschoolchildren.Onlytheresearch
developedbyLockeretal[22]studiedtheassociation
betweensocioeconomicstatusandfamilystructureon
OHRQoLofschoolchildren.Theauthorsverifiedthat
childrenwithparentsearningalowincome,andwith
onlyoneadultinthehouseholdhadnegativeimpactin
theirOHRQoL.InBrazil,onlyonestudy[23]evaluated
theimpactofsocioeconomicfactors,especiallymothers
’
education,onOHRQoL.
Inspiteoftheseevidences,thehypothesisofthepre-
sentstudywasthatthereweremanyotherclinical,
socioeconomicandhomeenvironmentfactorsthat
couldinfluencetheOHRQoLofchildren,whichhave
notyetbeenstudiedinastatisticalregressionmodel.

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Purpose
Theobjectivethisstudywastoinvestigatetheinfluence
ofclinicalconditions,socioeconomicstatus,homeenvir-
onmentofchildrenandsubjectiveperceptionsofpar-
entsandchildrenaboutgeneralandoralhealthon
OHRQoLofschoolchildren.
Methods
Ethicalissues
Priortoimplementation,theresearchprojectwassub-
mittedtotheEthicsCommitteeofthePiracicabaDental
School,UniversityofCampinas,Brazil,andapproved
underProtocol055/2009.Writteninformedconsentwas
obtainedfromtheparticipantsorparents/guardiansofthe
participantsofthisstudy.
Studypopulation
Thepresentcross-sectionalstudyreferredtoarepresenta-
tivesampleofchildrenfromofJuizdeFora,Brazil.Juizde
Foraisoneofthepioneeringcitiesintheindustrialstate
ofMinasGerais,Brazil,anditspredominatingeconomic
sectorsareindustryandservices.Thecityhasabout
570,000inhabitants,spreadoverawiderangeofsocio-
economicbackgrounds,ofwhom98.91%haveaccessto
fluoridatedwater[35].
Atotalof515schoolchildren,12yearsofage,were
examinedaccordingtoarandommultistagesampling
design,whichwasconsideredrepresentativeofthecity.
Thetotalnumberofschoolchildrenattheageof12years
was7993[35].Tocalculatetheprobabilitysample,we
adopteda95%confidenceintervallevel,20%accuracyand
designeffect(deff)of2.Thesamplesizecalculationwas
basedontheDMFT(2.3)andstandarddeviation(2.72)of
epidemiologicalsurveypreviouslyconducted[36].The
schoolchildrenwereenrolledinpublicandprivateelemen-
taryschoolsandwereincludedinaconglomerateanalysis
ofapopulation-basedstudy.
Clinicalexamination
Theschoolchildrenwereclinicallyexaminedatschoolby
twocalibratedexaminers,inanoutdoorsetting,under
naturallightwithball-pointprobesandmirrors,according
totherecommendationsoftheWorldHealthOrganiza-
tion(WHO)forepidemiologicalsurveys[37].Theexami-
nercalibrationprocessfollowedtheWHOcriteriaand20
childrenwereexaminedinthisphase.Withregardtothe
questionnaire,asithasbeenvalidated,itwasnotnecessary
toconductapilotphasetoimplementthem.Theexami-
nerswerecalibrated,andgoodintra-examinerreproduci-
bility(Kappa>0.91)wasreached.
Oneexaminercollecteddatawithreferencetothepre-
senceofdecayed,missing,andfilledteethintheperma-
nentandprimarydentition(DMFTanddmftindex).For

Paula
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HealthandQualityofLifeOutcomes
2012,
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statisticalanalysis,thepresenceorabsenceofuntreated
carieswasevaluatedaccordingtotheDcomponentof
DMFTindex.Dentaltrauma,enameldefects(DDE
index),periodontalstatus(bleeding)anddentaltreatment
needswereevaluatedinexamsandcategorizedaccording
topresenceorabsence,accordingWHOrecommenda-
tions[37].
WeusedtheWHOcategorizationoftreatmentneeds
andsubsequentlythedataweredichotomized:zero,with-
outtreatmentneedscorrespondingclassificationzeroof
theWHOcriteria;andone,withtreatmentneedsclassifi-
cation1-9oftheWHOcriteria[37].
TheSignificantCariesIndex(SiC)wasusedtomeasure
polarizationoftheoccurrenceofcariesamongparticipants
ofthetercilewithhigherDMF-T.Theindexwascalcu-
latedaccordingrecommendationsofNishietal[38].
TheotherexaminercollecteddataonMalocclusion
accordingtheDentalAestheticIndex(DAI),which
assessesthedental