INTRODUCTION

For a long time, concerns about health-related issues were linked only to the identification of disease-causing agents and the control of their symptoms, a traditional approach centered on the biological determinants of diseases ¹ . Over the years and with advances in research, the limitations of this model have become increasingly clear, revealing a new paradigm for approaching the health-disease process. This takes into account the multidimensionality of health, including subjective information through more complex assessments that consider the repercussions of illness on the lives of individuals ^2,3 .

Since adolescence is a period that culminates the entire process of biopsychosocial maturation of the individual, in which health behaviors often assume a predictive role of the individual’s future health condition, it becomes increasingly important to understand not only biological factors, but also subjective factors such as the perception of quality of life at this stage of life ^4,5 .

Particularly during adolescence, the determinants of health and disease move through the social and psychological fields, as the individual experiences experiments and transformations. As it involves a phase of identity construction, such experiences can lead to risk behaviors, shaping their attributes and attitudes in the future. A deeper knowledge of how adolescents perceive their lives allows a greater understanding of their health ⁶ .

Successive epidemiological studies on the oral health of adolescents conducted by the Ministry of Health in Brazil, in 2003 and 2010, showed that periodontal disease remains an important public health problem due to the high rates of this disease ^7,8 . However, assessments of oral health conditions through clinical and epidemiological indicators, presented through the normative view of professionals, although important and essential for monitoring the health status of the population, leave gaps, as they do not consider the subjective dimensions that oral health conditions imply in the lives of individuals ^9,10 .

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 adolescent students, can provide a broader understanding of problems related to oral health, as well as allow the planning of comprehensive and equitable public policy actions for adolescent oral health ^2,11 .

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

METHODOLOGY

This is an observational, cross-sectional, analytical, school-based study. The target population studied was composed of adolescent schoolchildren, of both sexes, enrolled in high school in state public schools in the city of Camaragibe – PE.

The sample consisted of 200 adolescents, a value that corresponds to 20% of the value calculated for the study “Oral Health and Biopsychosocial Factors in Adolescent Schoolchildren”, approved by the Research Ethics Committee under protocol number (130837/2016). The sample selection was carried out in two phases: in the first phase, schools were selected at random, and in the second, classes.

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

The questionnaire was administered in the school environment and included aspects related to demographic data and access to/use of dental services. The objectives and methods of the study were explained in advance, and any questions that arose during the research were clarified.

To assess the perception of quality of life, the Oral Health Impact Profile (OHIP) questionnaire in its reduced version (OHIP-14) was used, which has been translated and adapted to Portuguese and is widely used for epidemiological investigations ¹² , including samples of adolescents ^{13 . The response options in the questionnaire correspond to a} Likert- type scale (never = 0; rarely = 1; sometimes = 2; constantly = 3 and always = 4). For association analyses, OHIP-14 values ​​were dichotomized into presence of impact on quality of life (at least one response “sometimes = 2”, “constantly = 3” or “always = 4”) and absence of impact (only responses “never = 0” and “rarely = 1” in all items).

Next, an intraoral clinical examination was performed in the classroom of the participating schools, under indirect natural light and artificial light, with the adolescent and the examiner sitting face to face. The examination was performed by the previously trained and calibrated researcher in charge (Kappa = 0.81) and assisted by a scientific initiation student. The material used for the clinical examination consisted of a flat oral mirror, wooden spatula, gauze and periodontal probe. The periodontal clinical examination was performed with millimeter-sized manual probes (PC15, University of North Carolina). Bleeding and probing depth data were collected. To verify bleeding, the presence (score 1) or absence (score 0) of bleeding was recorded 30 seconds after probing depth ¹⁴ . For probing depth, the distance between the gingival margin and the most apical portion of the pocket or sulcus was measured. The measurement was performed with a millimeter probe, circumferentially on the buccal, lingual/palatal, mesial and distal surfaces. The periodontal chart records were made for values ​​from 4 mm onwards in an ordinal manner on a 1 mm scale ¹⁵ .

Periodontal disease was classified as: gingivitis, when characterized by the presence of 25% or more sites with bleeding on probing, or periodontitis, when characterized by the finding of at least one site simultaneously presenting PS ≥ 4 mm ¹⁵ .

To verify possible associations, Pearson’s chi-square test of independence was applied. The data were entered into an Excel spreadsheet and analyzed in the SPSS program version 20.0. Statistical significance was considered when the p value < 0.05.

RESULTS

Two hundred young people aged 13 to 21 years participated in the study, with a mean of 15.958 (± 1.30), of which 57.1% were male. The highest frequency of maternal education recorded was incomplete higher education or complete secondary education (35.6%). The most frequent income was between R$478.00 and 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 being the most affected dimension (13.7%).

Females presented a higher percentage of impact on quality of life in two dimensions, Pain (p=0.035) and Psychological Disability (p=0.040). The total OHIP also presented statistically significant differences between males and females, with p=0.029 (Table 1).

Table 2 shows that the mother’s education level (p=0.110), family income (p=0.564) and visits to the dentist (p=0.419) did not have a statistically significant influence on the quality of life (OHIP) of the young people.

It was not possible to detect statistically significant differences in the 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 statistically significant differences in the OHIP dimensions (Table 4).

DISCUSSION

Adolescence is a time when there is an increased risk of oral diseases and when oral hygiene is a complex practice. It is during this phase that attitudes, values, and behaviors regarding health are established. Thus, this life cycle represents a period of risk for periodontal health. Therefore, oral hygiene has been related to a fundamental part of health and an important indicator of the individual’s general health ¹⁶ .

The present study involved two hundred adolescents aged 13 to 21 years, the majority of whom were under 17 years old (69.8%), data that coincide with the study on quality of life and oral health of adolescents by Paredes ⁵ , which revealed similar averages of 15.8 (± 1.02) years. The most frequent income was in accordance with that observed by Paredes ⁵ , where the majority of adolescents (69.46%) had a monthly income of 1 minimum wage or less.

Regarding gender, the majority (57.1%) of the participants were male, a result that is 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 the majority were boys, the impact on quality of life was associated with the female gender. The study by Peres ¹⁷ reported negative impacts on quality of life related to oral health, being greater 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 in the dimensions of Pain (p=0.035) and Psychological Disability (p=0.040), when compared to males. The 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, the highest frequency (35.6%) was incomplete higher education or complete secondary education, which is in line with the findings of a study carried out in Natal-RN ¹⁸ , where most of these adolescents had mothers who completed secondary education. However, Paredes ⁵ found that the majority of the mothers of the participants in his study (59.8%; n=110) only studied up to elementary school. The mother’s education (p=0.110), family income (p=0.564) and visits to the dentist (p=0.419) did not have a statistically significant influence on the quality of life (OHIP) of the young people. This result corroborates a Greek study in which the level of education and occupation of the adolescents’ family members showed no correlation with the OHIP-14 or its dimensions ¹⁰ . In contrast, a study carried out in Sumé, Paraíba, demonstrated that maternal education had a significant influence on quality of life through the OHIP^5.

Of the students participating in the study, a total of 18% had periodontitis, a higher rate when compared to data from similar studies, where 0.5% to 10% of adolescents had periodontal pockets with a depth equal to or greater than four millimeters 17,18 ^. However, it was not possible to detect statistically significant differences in the 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 the fact that these periodontal conditions have not yet reached a level of severity where they are detected or that they 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 recorded in previous studies with similar methodologies, where 24.6% to 34.1% of the adolescents presented bleeding upon probing ^17,18 . 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 the 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 Elias ¹⁹ , the factors that most motivate adolescents to take care of their oral health are: personal appearance, sexuality, employment, and health in general. This is because the importance of oral health for adolescents is related to physical, psychological, and social aspects. This may explain the fact that no statistically significant differences were detected in this study in the dimensions of OHIP-14, such as Functional Limitation, Psychological Discomfort, Physical Disability, Psychological Disability, Social Disability, Disability, and total OHIP-14, with the presence of gingivitis or periodontitis. Since these are adolescents, these periodontal conditions may not have reached a level of severity that would facilitate their detection by lay people and cause embarrassment or harm to their personal appearance.

CONCLUSION

It was not possible to identify the association between periodontal disease and the negative impact on the quality of life of adolescents. It is suggested that the absence of a negative impact on the quality of life related to periodontal disease is due to an early stage of its manifestation. Thus, adolescents affected by periodontitis or gingivitis are still unable to identify the consequences of the disease.

Thus, given the results found, it is suggested that dentists pay greater attention to adolescent health, through scheduled active search actions for the screening and treatment of periodontal disease even at its initial stages. Since its presence does not initially cause a negative impact on the daily lives of adolescents, they would hardly seek health services spontaneously, which is an equally worrying issue.

NOTE OF ACKNOWLEDGMENTS

The authors thank the Municipality of Camaragibe for their willingness during data collection and the adolescent students who agreed to participate in the research.