Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 16 nº 3 - Jul/Sep - 2019

Original Article Imprimir 

Páginas 59 a 69


Association between quality of life and periodontal disease in adolescents

Asociación entre calidad de vida y enfermedad periodontal en adolescentes

Associação entre qualidade de vida e doença periodontal em adolescentes

Autores: Alexia Luise Andrade1; Alessandra Tereza Callado2; Adelaine Maria Sousa3; Thais Carine da Silva4; Renata Cimões5; Bruna Farias Vajgel6

1. Studente in Dentistry by the Federal University of Pernambuco (UFPE). Recife, PE, Brazil
2. Student in Dentistry by the Federal University of Pernambuco (UFPE). Recife, PE, Brazil
3. Doctoral student in Dentistry by the Federal University of Pernambuco (UFPE). Master in Dentistry from the Federal University of Pernambuco (UFPE). Recife, PE, Brazil
4. Doctoral student in Dentistry by the Federal University of Pernambuco (UFPE). Master degree in Hebiatry from the University of Pernambuco (UPE). Recife, PE, Brazil
5. Postdoctoral in Periodontics at Eastman Dental Institute, University College London, England. Teacher at the Federal University of Pernambuco (UFPE). Recife, PE, Brazil
6. Postdoctorate in Dentistry by the Federal University of Pernambuco (UFPE). Teacher at the Federal University of Pernambuco (UFPE). Recife, PE, Brazil

Thais Carine da Silva
(thais_carine1@hotmail.com)
Universidade Federal de Pernambuco (UFPE), Centro de Ciências da Saúde, Pós-Graduação em Odontologia UFPE
Av. Prof. Moraes Rego, s/n - Cidade Universitária
Recife, PE, Brasil. CEP: 50670-901

Submitted on 12/18/2018
Approved on 3/19/2019

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How to cite this article

Keywords: Adolescent; Oral Health; Quality of Life.
Palabra Clave: Adolescente Salud bucal; Calidad de vida.
Descritores: Adolescente; Saúde Bucal; Qualidade de Vida.

Abstract:
INTRODUCTION: Adolescence is a period that culminates the entire process of biopsychosocial maturation that leads to changes in health-related behavior. These changes may put these individuals at risk for periodontal health. For this reason, it is essential to understand the understanding of how clinical aspects can influence subjective aspects of this phase.
OBJECTIVE: To verify if there is an association between self-perception of quality of life and periodontal disease. Methods: This is an observational cross-sectional, analytical, and school-based study. The instrument used was the Oral Health Impact Profile (OHIP-14) and clinical periodontal examination.
RESULTS: The target population studied was composed of 200 schoolchildren of both sexes at high school year in public schools of the municipality of Camaragibe - PE. Among the studied adolescents, 18% had periodontitis, and 9% had gingivitis.
CONCLUSION: According to the study analysis, it was not possible to identify the association between periodontal disease and the negative impact on adolescent´s quality of life.

Resumen:
INTRODUCCIÓN: la adolescencia es un período que culmina todo el proceso de maduración biopsicosocial que conduce a cambios de comportamiento relacionados con la salud. Estos cambios pueden poner a estas personas en riesgo de tener salud bucal. Por esta razón, es importante comprender cómo los aspectos clínicos pueden influir en los aspectos subjetivos en esta etapa de la vida.
OBJETIVO: verificar si existe una asociación entre la autopercepción de la calidad de vida y la enfermedad periodontal.
MÉTODOS: Este es un estudio observacional transversal, analítico y basado en la escuela. El instrumento utilizado fue el cuestionario Oral Health Impact Profile (OHIP-14) y el examen clínico periodontal. Resultados: La población objetivo estudiada consistió en 200 escolares, de ambos sexos, matriculados en la escuela secundaria en las escuelas públicas estatales de Camaragibe - PE. De los adolescentes estudiados, el 18% tenía periodontitis y el 9% gingivitis.
CONCLUSIÓN: Dado el análisis, no fue posible identificar la asociación entre la enfermedad periodontal y el impacto negativo en la calidad de vida de los adolescentes.

Resumo:
INTRODUÇÃO: A adolescência é um período que culmina todo o processo da maturação biopsicossocial que levam a mudanças de comportamento relacionadas à saúde. Essas mudanças podem colocar esses indivíduos em situação de risco quanto à saúde bucal. Por essa razão, torna-se importante a compreensão de como os aspectos clínicos podem influenciar os aspectos subjetivos nesta fase da vida.
OBJETIVO: Verificar se há associação entre a auto percepção da qualidade de vida e doença periodontal.
MÉTODOS: Trata-se de um estudo observacional de corte transversal, analítico e de base escolar. O instrumento utilizado foi o questionário Oral Health Impact Profile (OHIP- 14) e exame clínico periodontal.
RESULTADOS: A população alvo estudada foi composta por 200 adolescentes escolares, de ambos os sexos, matriculados no ensino médio das escolas da rede pública estadual do município de Camaragibe - PE. Dos adolescentes estudados, 18% apresentaram periodontite, e 9% gengivite.
CONCLUSÃO: Diante da análise, não foi possível identificar a associação entre doença periodontal e o impacto negativo na qualidade de vida dos adolescentes.

INTRODUCTION

Concerns about health issues have long been linked only to identifying disease-causing agents and controlling their symptoms, a traditional focus on the biological determinants of disease¹. Over the years and advances in research, the limitations of this model have become increasingly clear, highlighting a new paradigm of approach to the health-disease process. It considers the multidimensionality of health, including subjective information through more complex assessments that consider the repercussions of illness on the lives of individuals2,3.

As adolescence is a period that culminates the whole process of biopsychosocial maturation of the individual, in which health behaviors often assume a role of predictor of future health condition of the individual, it is becoming increasingly important to understand the factors not only biological, but also subjective as the perception of quality of life in this phase of life4,5.

Particularly during adolescence, the determinants of health and disease move in the social and psychological fields, because the individual experiences experiments and transformations. As it involves an identity building phase, such experiences can lead to risky behaviors, shaping their attributes and attitudes in the future. A deeper knowledge about how adolescents perceive their lives allows a greater understanding about their health6.

Successive epidemiological studies on oral health of adolescents conducted by the Brazilian Ministry of Health in 2003 and 2010 showed that periodontal disease still remains an important public health problem due to the high rates of this disease7,8. However, only assessments of oral health conditions through clinical and epidemiological indicators, presented through the normative view of professionals, although they are important and essential to monitor the health status of the population, leave gaps, as they do not consider the subjective dimensions that the health professionals have oral health conditions imply individuals' lives9,10.

Thus, investigations that allow the concomitant evaluation of clinical indicators of oral health, and subjective aspects, such as the impact caused by these indicators on the quality of life of school adolescents, may bring a broader understanding of oral health problems, as well as allow the development of oral health to planning of integral and equitable public policy actions for adolescent oral health2,11.

Given the above, the objective of this study was to evaluate the association between periodontal health condition and quality of life of adolescent students, considering racial socioeconomic and ethnic factors.


METHODOLOGY

This is an observational cross-sectional, analytical and school-based study. The target population studied was composed of male and female adolescents enrolled in high school in the state public schools of Camaragibe - PE.

The sample consisted of 200 adolescents, which corresponds to 20% of the value calculated for the study "Oral Health and Biopsychosocial Factors in School Adolescents", approved by the Ethics Committee in research on protocol number (130837/2016). The sample selection was performed in two phases, in the first phase the schools were drawn, and in the second, the classes.

The study included students of both sexes, aged 13 to 19 years old, regularly enrolled in high school in the state public schools of Camaragibe - PE. Those who did not answer the proposed questionnaire were excluded from the study.

The questionnaire was applied in the school environment, containing aspects related to demographic data and access/use of dental services. A previous explanation of the objectives and methods of the study was performed, removing all doubts that arose at the time of the research.

To assess the perception of quality of life the Oral Health Impact Profile (OHIP) questionnaire in its reduced version (OHIP-14) was used, translated and adapted to Portuguese and widely used for epidemiological investigations12, including samples of teenagers13. Questionnaire response options correspond to a Likert scale (never = 0; rarely = 1; sometimes = 2; constantly = 3 and always = 4). For association analyzes, OHIP-14 values were dichotomized in the presence of impact on quality of life (at least one response "sometimes = 2", "constantly = 3" or "always = 4") and no impact (only answers "never = 0" and "rarely = 1" on all items).

Then, an intra-oral clinical examination was performed in the participating schools' own classroom, under indirect natural light and artificial light, with the adolescent and the examiner sitting face to face. The exam was performed by the responsible researcher previously trained and calibrated (Kappa = 0.81) and assisted by a student of scientific initiation. The material used for the clinical examination consisted of a flat oral mirror, wooden spatula, gauze and periodontal probe. Periodontal clinical examination was performed with hand millimeter probes (PC15, University of North Carolina). Bleeding data and probing depth were collected. To verify the bleeding, the presence (score 1) or absence (score 0) of bleeding was recorded after 30 seconds after probing depth14. For probing depth, the distance between the gingival margin and the most apical portion of the pocket or groove was measured. The measurement was performed with a millimeter probe, circumferentially on the buccal, lingual/palatal, mesial and distal surfaces. The periodontal record was recorded for values from 4 mm in ordinal way on a scale of 1 mm15.

Periodontal disease was classified as: gingivitis, when characterized by the presence of 25% or more of sites with bleeding on probing, or periodontitis, when characterized by finding at least one site simultaneously presenting PS ≥ 4mm15.

To verify possible associations, the Pearson Chi-square independence test was applied. Data were entered in an Excel spreadsheet and analyzed using SPSS version 20.0. Statistical significance was considered when p <0.05.


RESULTS

Two hundred young people with ages ranging from 13 to 21 years old participated in the study, with an average of 15,958 (± 1.30), being 57,1% male. The highest frequency of registered maternal education was Incomplete Superior or Complete High (35.6%). The most frequent income was R$ 478,00 to R$ 1,908,00 (57.9%). Figure 1 shows the percentage distribution of adolescents with impact on quality of life, according to OHIP-14, with psychological discomfort the most affected dimension (13.7%).


Figure 1. Survey data according to Oral Health Impact Profile (OHIP).



Females had the highest percentage of impact on quality of life in two dimensions, Pain (p = 0.035), and Psychological Disability (p = 0.040). Total OHIP also showed differences with statistical significance between males and females, being p = 0.029 (Table 1).




Table 2 shows that the mother's education (p = 0.110), family income (p = 0.564) and dentist visit (p = 0.419) did not significantly affect the quality of life (OHIP) of young people.




It was not possible to detect statistically significant differences in OHIP dimensions (Functional Limitation (p = 0.686), Pain (p = 0.608), Psychological discomfort (p = 0.812), Physical Disability (p = 1.000), Psychological Disability (p = 0.459). ), Social Disability (p = 1,000), Disability (p = 0,866) and total OHIP (p = 0,803)) with periodontitis, as shown in Table 3.




It was also not possible to detect differences with statistical significance of OHIP dimensions (Table 4).




DISCUSSION

Adolescence is a time when there is an increased risk of oral diseases and oral hygiene is a complex practice. It is at this stage that attitudes, values and behaviors regarding health are established. Thus, this life cycle represents a period of risk to periodontal health. Therefore, oral health has been related as a primary part of health and an important indicator of the individual's general health16.

Two hundred adolescents with ages ranging from 13 to 21 years old participated in the present study, most of them under 17 years old (69.8%). 15.8 (± 1.02) years. The most frequent income (57.9%), between R $ 478.00 to 1,908.00, is also in line with that observed by Paredes5, where most adolescents (69.46%) had a monthly income of 1 minimum wage or less.

Regarding gender, the majority (57.1%) of the participants were male, opposite to other studies with adolescents, where females were more prevalent, ranging from 51.4 to 57.1% 5,17,18. However, in the present study, although most were boys, the impact on quality of life was associated with females. The study by Peres17 reported negative impacts on quality of life related to oral health, being higher in females compared to males, corroborating the findings of the present study, which found that females had a higher percentage of impact on quality of life. Pain (p = 0.035) and Psychological Disability (p = 0.040) dimensions, when compared to males. Total OHIP also showed statistically significant differences between males (20.4%) and females (34.1%) (p = 0.029) (Table 1).

Regarding the mother's education level, the highest frequency (35.6%) was recorded in Incomplete Superior or Complete High School, which is in line with the findings of a study conducted in Natal-RN18, where most of these adolescents had mothers who completed the high school. However, Paredes5 found that most mothers of the participants in his study (59.8%; n = 110) only studied until elementary school. The mother's education (p = 0.110), family income (p = 0.564) and dentist visits (p = 0.419) did not significantly affect the quality of life (OHIP) of young people. This result corroborates a Greek study in which the level of education and occupation of family members of adolescents did not show correlation with OHIP-14 or its dimensions10. In contrast, a study conducted in Sumé, Paraíba, showed that maternal education had a significant influence on quality of life through OHIP5.

Of the students participating in the research, a total of 18% had periodontitis, a higher rate when compared to similar research data, where 0.5% to 10% of adolescents had periodontal pocket depth of four millimeters or more17,18. However, it was not possible to detect statistically significant differences in OHIP-14 dimensions with periodontitis (Functional Limitation (p = 0.686), Pain (p = 0.608), Psychological Discomfort (p = 0.812), Physical Disability (p = 1.000), Psychological disability (p = 0.459), Social Disability (p = 1.000), Disability (p = 0.866) and total OHIP-14 (p = 0.803)). One possible explanation may be that these periodontal conditions have not yet reached a degree of severity where they are detected or that bother adolescents in their personal appearance or daily activities.

Of the students participating in the research, a total of 18% had periodontitis, a higher rate when compared to similar research data, where 0.5% to 10% of adolescents had periodontal pocket depth of four millimeters or more17,18. However, it was not possible to detect statistically significant differences in OHIP-14 dimensions with periodontitis (Functional Limitation (p = 0.686), Pain (p = 0.608), Psychological Discomfort (p = 0.812), Physical Disability (p = 1.000). ), Psychological disability (p = 0.459), Social Disability (p = 1.000), Disability (p = 0.866) and total OHIP-14 (p = 0.803)). One possible explanation may be that these periodontal conditions have not yet reached a degree of severity where they are detected or that bother adolescents in their personal appearance or daily activities.

Regarding gingivitis, 9% (18) of the adolescents participating in the study were diagnosed with this problem, a result lower than that reported in previous studies with similar methodologies, where 24.6% to 34.1% of adolescents had bleeding on probing17, 18. However, this result is still considered alarming, since this condition, when identified and treated early, can prevent the progression of periodontal disease. Similarly, it was not possible to detect significant differences in OHIP-14 dimensions with gingivitis (Functional Limitation (p = 1,000), Pain (p = 0,323), Psychological discomfort (p = 0,982); Physical Disability (p = 1,000), Psychological disability (p = 0.773), Social Disability (p = 0.571), Disability (p = 1.000) and Total OHIP-14 (p = 0.674)).

According to Elias19, the factors that most motivate adolescents to take care of their oral health are: personal appearance, sexuality, employment, and health in general. This may explain the fact that no significant differences in OHIP-14 dimensions were detected in this study, such as Functional Limitation, Psychological Disability, Physical Disability, Psychological Disability, Social Disability, Disability and total OHIP-14, with presence of gingivitis or periodontitis. Because they are adolescents, these periodontal conditions may not have reached a degree of severity that would facilitate their detection by lay people and cause embarrassment or damage to their personal appearance.


CONCLUSION

It was not possible to identify the association between periodontal disease and negative impact on adolescents' quality of life. It is suggested that the absence of the negative impact of quality of life related to periodontal disease is due to an early stage of its manifestation. Thus, adolescents with periodontitis or gingivitis cannot yet identify the consequences of the disease.

Thus, in view of the results found, it is suggested a greater attention of dentists to adolescent health through programmed actions of active search for the tracking and treatment of periodontal disease still at early levels. Since their presence does not initially have a negative impact on the daily lives of adolescents, they would hardly seek health care spontaneously, being an equally worrying issue.


ACKNOWLEDGMENTS

The authors thank the municipality of Camaragibe for their solicitude during data collection and the school adolescents who volunteered to participate in the research.


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