|Year : 2021 | Volume
| Issue : 4 | Page : 117-122
Evaluation of oral health-related quality of life among institutionalized orphan children
KL Girish Babu, Gururaj Hebbar Kavyashree
Department of Dentistry, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
|Date of Submission||09-Nov-2020|
|Date of Decision||29-May-2021|
|Date of Acceptance||05-Sep-2021|
|Date of Web Publication||30-Dec-2021|
K L Girish Babu
Department of Dentistry, Hassan Institute of Medical Sciences, Hassan - 573 201, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Children residing in orphanages are a disadvantaged section of the population. Inadequate care can impair the quality of life of orphan children. Aim: The aim of this study was to assess the oral health-related quality of life and dental caries status among institutionalized orphan children. Materials and Methods: Children without parents, aged 6–14 years, were selected from government-run orphanages. Children who were willing to participate were included. Data on oral health-related quality of life were collected by personal interviews by a single investigator. Following, intraoral examination of each child was carried out in an adequate natural light using a sterilized mouth mirror and probe. Dental caries was assessed according to the World Health Organization criteria. The data obtained were subjected to statistical analysis. Results: The Decayed, Missed and Filled teeth (DMFT) score of males was 0.41 ± 0.86 and females was 0.97 ± 1.44, and the difference was statistically significant. The mean of oral symptoms, functional limitation, emotional well-being, and social well-being was 26.49 ± 4.48, 37.75 ± 3.63, 33.31 ± 4.18, and 47.92 ± 3.37, respectively. Conclusions: The prevalence of dental caries was low among these orphan children. The quality of life of these children was not affected by their dental caries status.
Keywords: Dental caries, oral health related quality of life, orphans
|How to cite this article:|
Girish Babu K L, Kavyashree GH. Evaluation of oral health-related quality of life among institutionalized orphan children. J Forensic Sci Med 2021;7:117-22
|How to cite this URL:|
Girish Babu K L, Kavyashree GH. Evaluation of oral health-related quality of life among institutionalized orphan children. J Forensic Sci Med [serial online] 2021 [cited 2022 May 16];7:117-22. Available from: https://www.jfsmonline.com/text.asp?2021/7/4/117/334488
| Introduction|| |
The World Health Organization (WHO) defines the quality of life as “the individual's perception of his or her position in life within his or her cultural context and system of values and about his or her objectives, standards, and concerns”., The quality of life can be influenced by many factors. Previous studies have demonstrated the impact of systemic health issues and/or oral health problems on the quality of life.,, Oral health is part of overall health. It is an important factor that impacts an individual's quality of life. Locker and Allen have defined the oral health-related quality of life as“the impact of oral diseases and disorders on the everyday lives of people or their values of sufficient magnitude in terms of frequency, severity, and duration to affect a person's experience and perception of their life as a whole”.
Poor oral health may have profound impacts on the physical, social, and psychological well-being of individuals. Sheiham noted that oral health affects people physically and psychologically and influences how they grow and enjoy life, look, speak, chew and taste food, and socialize. Additionally, systematic reviews of the literature provide strong support for the negative impact of oral health problems on quality of life., Previous studies have shown that these problems may change the lives of people, such as increased absenteeism in the workplace among adults and increased school absenteeism among children, which may compromise financial and social mobility.,,
The assessment of the oral health-related quality of life is very useful as it provides essential information for assessing the treatment needs of individuals and populations. Its measurement among people with health issues has implications on the understanding of the impact of the disease on physical, functional, social, and psychological well-being. Oral health-related quality of life can be evaluated among healthy and special health-care need populations. Orphan children are one such group needing special health care. UNICEF and global partners define an orphan as a child who has lost one or both parents. India has the highest population of children below the age of 18, i.e. 41% of the total population. According to the study done by SOS Children's Village by analyzing data from the National Family Health Survey-3 (2005–2006), about 4% of the Indian population are orphans which constitute about 20 million children.
Children residing in orphanages are a disadvantaged section of the population as these homes can barely meet the needs due to poor funding and a low caretaker-to-child ratio. Children without parental care find themselves at a higher risk of discrimination, inadequate care, abuse, and exploitation, and their well-being is often insufficiently monitored. The emotional and social needs among these children are least addressed, so they form a risk population concerning abnormal psychosocial development. Inadequate oral health care can impair the quality of life of these children. There is a paucity of published literature regarding oral health-related quality of life in orphan children, particularly in southern India. Hence, the present study aimed to determine the oral health-related quality of life and dental caries status among institutionalized orphan children.
| Materials and Methods|| |
Before the commencement of this cross-sectional study, permission was obtained from the Institutional Research Committee and Institutional Ethical Committee, Hassan Institute of Medical Sciences, India IEC/HIMS/049/2016 Date: 31-01-2017. The lists of orphanages were obtained from the Department of Women and Children's Welfare, Hassan district. Hassan district has eight taluks (zones). There are two orphanages in Hassan district situated in Hassan city. The children aged 6 years and above are admitted to these orphanages and they are sheltered here up to their 18 years. The written permission was obtained from the concerned government authorities and the head of the orphanages. The caretakers of orphanages offered written proxy consent for the children selected from orphanages. Before the clinical examination, children and caretakers were assured that the information collected from them would be kept confidential and will be reported in aggregate form. Written informed consent was obtained from each study participant before their clinical oral examination. The sample size was calculated based on the reports of previous studies conducted at different cities of India.,,
n = N/(1 + Ne2),
where n is the sample size,
N is the population size,
e is the margin of error,
The estimated sample size was 86 which was rounded off to 100.
Training and calibration for oral examination and diagnosis of dental caries were carried out in the Department of Dentistry, Hassan Institute of Medical Sciences, India. Dental caries was recorded by a dental surgeon sitting beside the examiner so that the codes given by the examiner could be easily heard. Ten percent of children were examined twice for intra-examiner reliability. The kappa value for the intra-examiner agreement was 0.88.
Normal, healthy, cooperative orphan children, aged 6–14 years and residing in orphanages from their 6 years of age, were included. Children who were not willing to participate were excluded. Children with physical and mental disabilities and compromised systemic/medical conditions were also not included, as their condition itself will affect oral health status.
Written consent was taken from the management of orphanage homes. All children were informed about the study's objectives and method. Data on oral health-related quality of life were collected by personal interviews by a single investigator using a questionnaire.
Before the oral examination, the child was asked to rinse the mouth thoroughly. The teeth were cleaned and dried with cotton pellets to eliminate any food debris on the teeth. Each child was examined on an upright chair in an adequate natural light using a sterilized mouth mirror and probe. An oral examination of each child was carried out by a single investigator. Dental caries was assessed according to the WHO criteria (2013). The data obtained were entered into a Microsoft Excel sheet and statistically analyzed using SPSS software 19.0 (IBM Corp. Released 2010. IBM SPSS Statistics for Windows, version 19.0. Armonk, NY, USA: IBM Corp.) Student t-test and Chi-square test were used for comparison.
| Results|| |
A total of 64 males and 39 females participated in this study. None of the children were with physical and mental disabilities or had compromised systemic/medical conditions. The mean Decayed, extracted due to caries, filled teeth (DEFT) score was 0.69 ± 0.15 and 0.68 ± 0.23 among males and females, respectively. The DMFT score of males was 0.41 ± 0.86 and females was 0.97 ± 1.44, and the difference was statistically significant [Table 1]. The mean value of oral symptoms, functional limitations, emotional well-being, and social well-being was 26.49 ± 4.48, 37.75 ± 3.63, 33.31 ± 4.18, and 47.92 ± 3.37, respectively [Table 2] and [Table 3]. There was a negative correlation between oral symptoms and dental caries. Dental caries in primary dentition correlated negatively with emotional well-being [Table 4].
|Table 2: Frequency and mean score of oral health-related quality of life of orphanage children|
Click here to view
|Table 4: Correlation between dental caries and oral health-related quality of life|
Click here to view
| Discussion|| |
Oral diseases in children impair quality of life that may affect various aspects of life, including function, appearance, interpersonal relationships, and even career opportunities. In turn, oral disease pattern is dependent on various socioeconomic characteristics of the children and parents. Thus, it can be hypothesized that the pattern of oral disease and quality of life would be different among children living with their parents and orphan children. Furthermore, the children residing in orphanages differ from other children as they are underprivileged and do not receive as much care as other children receive from their parents. It was observed that the environment in which they live and the associated lifestyles make these children vulnerable to a wide range of health-related and other problems including economic hardship, lack of love, affection, attention, malnutrition, communicable and infectious disease, and poor oral health.
There are different approaches to measure the oral health-related quality of life. The most popular one is the use of self-reported multiple-item questionnaires. It consists of the domains of functional, social, and psychosocial outcomes of oral disorders. They help in making clinical decisions and in evaluating interventions, services, and oral health programs. The ability of children to make evaluative judgments of their appearance; the quality of friendships; and other people's thoughts, emotions, and behaviors gradually develop during middle childhood (6–10 years). By the age of 11 or 12, they view health as a multidimensional concept organized around the following constructs: being functional, adhering to good lifestyle behaviors, a general sense of well-being, and relationships with others., In this study, normal and healthy children aged 6–14 years participated by answering the itemized questionnaire given to them. Studies have shown that physical and medical conditions themselves affect the oral health along with poor oral hygiene.,,,, Hence, these children were not included as they may influence the results. Furthermore, the selected orphanages were not the home for such children. Other different philanthropic societies (hemophilia society, thalassemia society, etc.), government organizations, and nongovernment organizations (NGOs) of the city are providing adequate care on a one-to-one basis for the children with special health-care needs.
In the present study, the mean value of dental caries in primary and permanent dentition was low. These observations are consistent with other Indian studies., Factors such as strict food selection by a government authority to make sure that these children are given proper healthy, nutritious, and fibrous food with low sugar content; absence of frequent snacking of carbohydrate-rich sticky foods; fixed time for breakfast, lunch, and dinner; and serving sweets made of jaggery only during lunch would have contributed for low dental caries experience in these children. Additionally, the oral health services rendered by the philanthropic institutions, dental schools, and NGOs by providing oral health aids and reinforcing them to brush their teeth twice daily and making it mandatory would have resulted in lower caries experience in these children.
The oral health status impacts the quality of life of an individual. Furthermore, families characterized by conflict, hostility, aggression, cold parent–child relationship, and neglect will place the child at risk for physical and psychological problems in adolescence and chronic health conditions in adulthood. The score for oral symptoms among the orphan children was less in the present study. This result is consistent with the reports from northern as well as southern parts of India., Similar observation was seen among children living with parents in North-West Russia. However, Norwegian children living with their parents scored higher scores. We observed a significant negative correlation between dental caries and oral symptoms. This may be due to the pain threshold of the studied children and the stage of dental caries. As the pain threshold increases with age, children with younger age complain of pain more often than older children. Furthermore, the enamel and dentin are thinner in primary teeth leading to the spread of dental caries faster causing pain in younger children.
The participated orphan children did not report any significant functional limitations. None of them restricted their diet or had any difficulty in eating foods they like. The only functional limitation reported was slow eating followed by unclear speech. Most of them had no limitations for chewing firm food, drinking/eating hot/cold food and none were mouth breathers. The possible reason could be dental caries might not have progressed to such a stage that compromised their functions. This finding is similar to the observation of orphan children of Bangalore city, India. However, in contrast to our results, Kumar et al. reported greater functional limitations. Greater functional limitations have also been reported among Russian children living with their parents.
Almost all of the participated children were not worried about being less attractive than others or different from others or having fewer friends or felt irritated/frustrated. Only a small percentage of children felt shy/embarrassed, anxious/fearful, or were upset. In contrast to our results, an Indian study reported orphan children being more shy, anxious, fearful, frustrated, and irritated. This difference may be due to the individual attention and emotional security given to the studied children. The participated orphan children are made to attend frequent group counseling classes as they are vulnerable to psychological disorders. It has been suggested that adolescents aged 19 years or more are capable of handling life situations, including oral health care than younger children.
The social well-being of the orphan children was satisfactory and was not influenced by their dental caries status. Most of them were not teased or asked by other children about their oral conditions. They were confident to talk to other children, speak aloud in the class, and never felt left out by others. Furthermore, very rarely, they missed their school or had difficulty paying attention. Only a small number of children avoided smiling in public. Kumar et al. reported poor social well-being among North Indian orphan children compared to children living with parents. Additionally, Koposova et al. reported disturbing social well-being among children of North-West Russia than children of Northern Norway. Among Jordanian students, dentofacial features were negatively associated with quality of life affecting their social interaction. The childhood circumstances as indicated by socioeconomic position, family structure, and parenting quality, affect the psychology of children. In turn, the altered psychology influences the oral health outcomes in terms of the social impact of dental disease.
The result of the present study showed that the quality of life in these orphan children was not negatively impacted by their oral conditions. However, among Brazilian 12-year-old children, the clinical and perceived conditions of oral health were associated with a negative impact on oral health-related quality of life. Additionally, subjects from metropolitan regions of Greek had a lower oral health-related quality of life than in the nonmetropolitan region. This difference in observations may be because dental caries might not have progressed to such a stage that influenced their quality of life. Another reason could be that all items on the scale chosen might not be sensitive enough to extract the impact of dental caries on these orphan children. Moreover, this scale measured impacts in the last 3 months which might not be sufficient enough to scale the effect of dental caries on these individuals. Nevertheless, the results presented are valid and representative of the orphan population of 6–12 years. Furthermore, the findings offer some insight into how oral health issues may affect the quality of life in this population.
The results of the study shed new light on the influence of functional, emotional, and social domains of oral health on quality of life. The impacts of oral health diseases should be considered in National Oral Health Policies to improve the oral health-related quality of life. Further, this study emphasizes the need for conducting regular psychological counseling to improve the social and emotional well-being of orphan children. Dental health professionals should be actively involved in improving the oral health of this deprived group of children. The desired oral health in this special group of children can be achieved by utilizing resources of the dental schools, NGOs, and the encouragement of public–private partnerships.
The major limitations of this study are its cross-sectional nature and small sample size that limits the generalizability of the findings. Furthermore, we did not include a control group as it would be unethical to create a group that would not receive oral health care. As social desirability bias is associated with the questionnaire study, the quality of life scale chosen might not have reflected the true results. Future longitudinal studies with a control group and large sample size should be carried out to further validate the findings of this study.
| Conclusions|| |
- The prevalence of dental caries was low among these orphan children
- The quality of life of these children was not affected by their dental caries status.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
The WHOQOL Group. The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med 1995;41:1403-9.
Oliva-Moreno J, Lopez-Bastida J, Worbes-Cerezo M, Serrano-Aguilar P. Health related quality of life of canary Island citizens. BMC Public Health 2010;10:675.
Solimeo SL, Silverman SL, Calderon AD, Nguyen A, Gold DT. Measuring health-related quality of life (HRQOL) in osteoporotic males using the Male OPAQ. Osteoporos Int 2012;23:841-52.
Locker D, Quiñonez C. To what extent do oral disorders compromise the quality of life? Community Dent Oral Epidemiol 2011;39:3-11.
Souza JG, Martins AM, Silveira MF, Jones KM, Meirelles MP. Impact of oral clinical problems on oral health-related quality of life in brazilian children: A hierarchical approach. Int J Paediatr Dent 2017;27:66-78.
Locker D, Allen F. What do measures of 'oral health-related quality of life' measure? Community Dent Oral Epidemiol 2007;35:401-11.
Locker D, Jokovic A, Clarke M. Assessing the responsiveness of measures of oral health-related quality of life. Community Dent Oral Epidemiol 2004;32:10-8.
Sheiham A. Oral health, general health and quality of life. Bull World Health Organ 2005;83:644.
Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and oral health-related quality of life: A systematic review and meta-analysis. Health Qual Life Outcomes 2010;8:126.
Naito M, Yuasa H, Nomura Y, Nakayama T, Hamajima N, Hanada N. Oral health status and health-related quality of life: A systematic review. J Oral Sci 2006;48:1-7.
Reisine S, Miller J. A longitudinal study of work loss related to dental diseases. Soc Sci Med 1985;21:1309-14.
Moure-Leite FR, Ramos-Jorge J, Ramos-Jorge ML, Paiva SM, Vale MP, Pordeus IA. Impact of dental pain on daily living of five-year-old Brazilian preschool children: Prevalence and associated factors. Eur Arch Paediatr Dent 2011;12:293-7.
Ahuja V. Oral Health Related Quality of Life Among Iowa Adolescents. University of Iowa; 2013 (Unpublished Master's Thesis). Available from:http://ir.uiowa.edu/etd/4943
. [Last accessed on 2019 Feb 28].
Thetakala RK, Sunitha S, Chandrashekar BR, Sharma P, Krupa NC, Srilatha Y. Periodontal and dentition status among orphans and children with parents in Mysore City, India: A comparative study. J Clin Diagn Res 2017;11:C115-8.
Sharma A, Gaur A, Pareek S, Raja V, Sanadhya S, Sharma AV. Oral health status and treatment needs among orphanage children of Jaipur City. Sch J App Med Sci 2014;2:1776-80.
Shah AF, Tangade P, Ravishankar TL, Tirth A, Pal S, Batra M. Dental caries status of institutionalized orphan children from Jammu and Kashmir, India. Int J Clin Pediatr Dent 2016;9:364-71.
Jokovic A, Locker D, Tompson B, Guyatt G. Questionnaire for measuring oral health-related quality of life in eight- to ten-year-old children. Pediatr Dent 2004;26:512-8.
World Health Organization. Oral Health Surveys, Basic Methods. 5th
ed. Geneva: World Health Organization; 2013.
Gift HC, Redford M. Oral health and the quality of life. Clin Geriatr Med 1992;8:673-83.
Kahabuka FK, Mbawalla HS. Oral health knowledge and practices among Dar es Salaam institutionalized former street children aged 7-16 years. Int J Dent Hyg 2006;4:174-8.
Al Shamrany M. Oral health-related quality of life: A broader perspective. East Mediterr Health J 2006;12:894-901.
Slade GD. Measuring Oral Health and Quality of Life. North Carolina: Department of Dental Ecology, School of Dentistry, University of North Carolina; 1997.
Jokovic A, Locker D, Guyatt G. Short forms of the child perceptions questionnaire for 11-14-year-oldchildren (CPQ11-14): Development and initial evaluation. Health Qual Life Outcomes 2006;4:4.
Barbosa TS, Gavião MB. Oral health-related quality of life in children: Part I. How well do children know themselves? A systematic review. Int J Dent Hyg 2008;6:93-9.
Barbosa TS, Gavião MB. Oral health-related quality of life in children: Part II. Effects of clinical oral health status. A systematic review. Int J Dent Hyg 2008;6:100-7.
Subramaniam P, Girish Babu K, Mohan Das L. Assessment of salivary total antioxidant levels and oral health status in children with Down syndrome. Spec Care Dentist 2014;34:193-200.
Subramaniam P, Mohan Das L, Babu KL. Assessment of salivary total antioxidant levels and oral health status in children with cerebral palsy. J Clin Pediatr Dent 2014;38:235-9.
Babu KL, Subramaniam P, Kaje K. Assessment of dental caries and gingival status among a group of type 1 diabetes mellitus and healthy children of South India – A comparative study. J Pediatr Endocrinol Metab 2018;31:1305-10.
Subramaniam P, Kumar K, Girish Babu KL. Levels of salivary immunoglobulin A (SIgA) in HIV infected children. J Clin Pediatr Dent 2015;39:377-81.
Pratap R, Puranik MP, Uma SR. Caries experience and its relationship with oral health related quality of life among orphanage children in Bengaluru city: A cross-sectional study. J Indian Assoc Public Health Dent 2016;14:397-402. [Full text]
Repetti RL, Taylor SE, Seeman TE. Risky families: Family social environments and the mental and physical health of offspring. Psychol Bull 2002;128:330-66.
Kumar S, Goyal A, Tadakamadla J, Tibdewal H, Duraiswamy P, Kulkarni S. Oral health related quality of life among children with parents and those with no parents. Community Dent Health 2011;28:227-31.
Koposova N, Eriksen HM, Widstrãm E, Eisemann M, Opravin A, Koposov R. Oral health-related quality of life among 12-year-olds in Northern Norway and North-West Russia. Oral Health Dent Manag 2012;11:206-14.
Yezierski RP. The effects of age on pain sensitivity: Preclinical studies. Pain Med 2012;13 Suppl 2:S27-36.
Oscarson N, Kallestål C, Lindholm L. A pilot study of the use of oral health-related quality of life measures as an outcome for analyzing the impact of caries disease among Swedish 19-year-olds. Caries Res 2007;41:85-92.
Al-Omari IK, Al-Bitar ZB, Sonbol HN, Al-Ahmad HT, Cunningham SJ, Al-Omiri M. Impact of bullying due to dentofacial features on oral health-related quality of life. Am J Orthod Dentofacial Orthop 2014;146:734-9.
Sanders AE, Spencer AJ. Childhood circumstances, psychosocial factors and the social impact of adult oral health. Community Dent Oral Epidemiol 2005;33:370-7.
Papaioannou W, Oulis CJ, Latsou D, Yfantopoulos J. Oral health-related quality of life of Greek adults: A cross-sectional study.Int J Dent 2011;2011:1-7.
[Table 1], [Table 2], [Table 3], [Table 4]