IMPACT OF DENTAL CARIES ON ORAL HEALTH RELATED QUALITY OF LIFE AMONG INDIAN ADOLESCENTS – AN EXPLORATORY STUDY.

in adolescents, especially in the Indian context. The aim of the present study was to assess the impact of dental caries on OHRQoL among 12 to 15 years old school going children in Mangalore. A cross-sectional study was conducted among 12 to 15 years old school going children in Mangalore. OHRQoL was assessed by using Child Perception Questionnaire (CPQ). Participants were examined for dental caries by using WHO criteria for dental caries. Information regarding malocclusion and demographics were also collected. Dental caries was significantly associated with the overall OHRQoL scores (r=0.86 and p=0.03). Malocclusion also showed statistically significant association with OHRQoL subscale of oral symptoms score. However, there were no significantly significant associations between dental caries and other subscales of OHRQoL (p>0.05). Results indicate that dental caries might significantly affect the OHRQoL of children.

Dental caries is one of the most widely prevalent diseases afflicting populations the world over. Untreated dental caries can have a definite impact on mastication, nutrition, growth and development of individuals, particularly among adolescents. Few studies have examined impact of dental caries on Oral Health Related Quality of Life (OHRQoL) in adolescents, especially in the Indian context. The aim of the present study was to assess the impact of dental caries on OHRQoL among 12 to 15 years old school going children in Mangalore. A cross-sectional study was conducted among 12 to 15 years old school going children in Mangalore. OHRQoL was assessed by using Child Perception Questionnaire (CPQ). Participants were examined for dental caries by using WHO criteria for dental caries. Information regarding malocclusion and demographics were also collected. Dental caries was significantly associated with the overall OHRQoL scores (r=0.86 and p=0.03). Malocclusion also showed statistically significant association with OHRQoL subscale of oral symptoms score. However, there were no significantly significant associations between dental caries and other subscales of OHRQoL (p>0.05). Results indicate that dental caries might significantly affect the OHRQoL of children.

ISSN: 2320-5407
Int. J. Adv. Res. 6(5), 1057-1062 1058 Dental cariesafflicting children during their initial growth and development periods might lead to the difficulties in chewing, speech and appearance,and have an adverse impacton individual's overall quality of life (QoL) (Do and Spencer, 2007). Since the etiologyof dental caries is multifactorial, it poses unique challenges in its prevention and control and the population or community. Various factors which might lead to dental caries includes: local, mechanical and systemic factors, neurologic, psychological factors, genetics, lifestyle and behavioral factors, diet, etc.. Appearance of a black spot, small hole in the teeth, food lodgment are the most common clinical symptoms of caries. Tooth ache and pain radiating to head, swelling, draining fistula are the other associated symptoms (Locker, 2007). Individuals with dental caries have compromised quality of life and psychological aspects and need definitive care and adequate treatment.
Dental indices assessing oral diseases only indicate the presence or absence of a condition. They do not reflect the impact that these diseases might have on social, emotional wellbeing and perceptions of oral health (Do and Spencer, 2007). Measures of Quality of Life (QoL) with respect to oral health have emerged as crucial supplements to conventional measurement of clinical outcomes (Piovesan et al., 2007).They reflect the potential impacts that oral health might have on an individuals' perceptions and social and emotional wellbeing. Although literature linking oral health parameters to OHRQoL continues to grow, few studies have examined its impact in adolescents, especially in the Indian context. In a systematic review on the impact of clinical oral health parameters on OHRQoL among children, Barbosa et al., have reported that oral health status does have an impact on OHRQoL among children (Barbosa and Gavião, 2008). However, there is a scarcity of information related to dental caries and OHRQoL among children in India. Keeping this in mind, this study was conceptualized for the determination of the dental caries on Oral Health Related Quality of Life (OHRQoL) among the school children in Mangalore.

Material and methods:-
A cross-sectional design was employedin the present study. List of all the schools in Mangalore was obtained from the Block Education Officer. A stratified random sampling technique was employed to select the schools. Ethical clearance was obtained from the institutional ethics committee of MCODS, Mangalore. (Protocol Ref no.16045).
A pilot survey was carried out among school going children aged 12-15 years in Mangalore. Sample size was calculated according to the findings of the pilot study using G Power software (version 3.1.2) with Effect size of 0.5 and with 95% CI (Confidence Interval) and keeping the power of the study at 80%.
Children and their parents unwilling to give written informed assent and consent respectively for the study were excluded. Children with any systemic illness or under medication were also excluded. Data collection was completed over a period of six months. Calibration of the examiner was done to establish inter-examiner reliability, which was assessed by employing the Kappa Statistic. And the score was 0.9 which suggests of good agreement.
The questionnaire was translated to the local language (Kannada), which was later back translated to English. The final version of the questionnaire in Kannada was then finalized by the investigators. Before the commencement of the main study, the questionnaires was administered to study subjects. Reliability of the questionnaire was assessed by employing Crohnbachs' alpha. The questionnaire was validated with 30 subjects before administration.
Informed written consent was procured from the parents of the participants prior to the start of the study and an informed assent was procured from the study participants. Confidentiality pertaining to the information obtained during the course of the study was maintained at every stage of the study.

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Demographic details, medical history and the dental attendance pattern of the study subjects was obtained from their parents by using the questionnaire method. Dental caries was assessed by using the WHO oral health assessment proforma 2013. OHRQoL was measured by the 16-item version of Children Perception Questionnaire (CPQ [11][12][13][14] ) (Jokovic et al., 2002).
Data analysis was done using the Statistical Package for Social Sciences (SPSS), version 11.5 (SPSS Inc, Chicago IL). Correlation analysis was used to determine the association between dental caries and OHRQoL among school children in Mangalore. Level of significance was kept at 95% (p<0.05).

Results:-
A total of 74 boys and 34 girls participated in the present study. The mean age of the participants was 14.21±0.81 years. Association of Overall OHRQoL scores with various variables such as malocclusion and dental caries have been presented in Table 1. Results indicate that there was a statistically significant association between dental caries and overall CPQs scores. It is also observed that there is no statistically significant association between any other variables with overall score of CPQ.
Association of domains of OHRQoL with various variables have been presented. Results indicate that there is a significant impact of malocclusion on the oral symptom score of the study subjects (table 2). There were however, no significant impact of dental caries on the oral symptom and functional limitation domains of OHRQoL (Tables 2  & 3). It can be observed that there were no statistically significant associations between dental caries and malocclusion with emotional wellbeingand social wellbeing scores of the study subjects (Tables 4& 5).

Discussion:-
The present study was undertaken to determine the impact of dental caries on Oral Health Related Quality of Life among school children in Mangalore. Dental caries is a common oral health problem that is widely prevalent in the population, especially among children. It might have a definite impact on an individual's QoL and their social life as well. There are very few studies in literature that have explored the potential impact of dental caries on Oral Health Related Quality of Life, especially in the Indian context. OHRQoL instruments help in supplementing the information obtained by clinical indicators. They help in addressing the psychosocial effects of oral complications and provide a holistic approach to patient care.
Cross-sectional study design has been employed in majority of the studies to address the current issue, but these elements may not shed light on inference of causality. However, the present study allows for the determination of the putative risk factors and risk indicators, and a preliminary assessment of the strength of the relationship between an event and risk factors. They provide valuable baseline data for planning, implementing and evaluating oral health programs for prevention and control of common oral health problems such as dental caries (Firmino et al., 2016).
There were no significant associations between demographic variables and OHRQoL, which is in contrast with the findings reported by Krisdapong Barbosa et al. (2008).It can also be observed that malocclusion was significantly associated with the domain related to the oral symptoms score. Dental caries is associated with psycho-emotional and/or systemic problems that  (Kiyak, 2008;Costa, 2011).Malocclusion can lead to low self-esteem of individuals and can be one of the common symptoms of patients.
Results also indicate that dental caries was not significantly associated with social well-being domain of OHRQoL (O'brien et al., 2007;Bendo et al., 2010).This is in contrast with those reported by Krisdapong et al. (2012), who reported that caries had a significant impact on the daily activities of participants. One has to keep in mind the different tools used for measuring child OHRQoL by different researchers. The social wellbeing domain addresses social co-existence issues like avoiding smiling or laughing in public, arguing with another pupil or family member, or the child being the subject to funny nicknames on account of her/his dentition and other orofacial structures.
The assessment of OHRQoL was carried out on the self-report measures, which is in accordance with current literature. Further studies have to be conducted to explore the potential limitation of self-reported measures on oral health. Such studies might help in better epidemiological viability to the findings. Further studies are also essential to assess parental perceptions of child OHRQoL and concurrence between parental and child perceptions regarding the child OHRQoL (Abanto et al., 2014). The present study can provide valuable baseline information for further studies on various aspects of impact of dental caries on OHRQoL. It can be of assistance to patients, as it can pave the way for providing better quality of life. The present study might give crucial insights into the pathways by which dental caries impacts OHRQoL. The present study was conducted among school children in the community, and the findings have important implications for child oral health and OHRQoL.

Conclusions:-
Dental caries had significant impact on overall OHRQoL scores of the study subjects. Malocclusion was significantly associated with the oral symptoms domain of OHRQoL. However, there was no association of dental caries on various domains of OHRQoL. Our results indicate that dental caries may have an impact on psychosocial functioning of children.