DOI: 10.1111/ipd.

12162

Impact of dental caries and its treatment on the quality of life

of 12- to 15-year-old adolescents in Benin, Nigeria

NNEKA M. CHUKWUMAH1, MORENIKE O. FOLAYAN2,*, ELIZABETH O. OZIEGBE2,* &

ALICE A. UMWENI3,*
1
Department of Preventive Dentistry, University of Benin Teaching Hospital, Benin, Nigeria, 2Department of Child Dental
Health, Obafemi Awolowo University, Ile-Ife, Nigeria, and 3Department of Preventive Dentistry, University of Benin, Benin,
Nigeria

International Journal of Paediatric Dentistry 2015 children with caries reported negative impact on
their QoL pre-treatment. Eating (47.6%) was the
Aim. To assess the impact of caries and its treat- most affected domain. The mean pre-treatment
ment on quality of life (QoL) in 12- to 15-year- QoL score was 8.40  10.34. Four weeks post-
old children in Benin, Nigeria. treatment, only 1.12% of participants reported
Design. This was a cross-sectional study involving negative impact of caries treatment on their QoL.
1790 children. Clinical examinations were con- The mean post-treatment QoL score was
ducted using the WHO criteria for diagnosis and 0.22  0.91 There was a significant difference
coding of caries. The Decayed Missing Filled Teeth between pre- and post-treatment QoL scores
score of each child was calculated. The child Oral (P = 0.0001) with significant changes in all the
Impact on Daily Performance questionnaire was eight domains studied. Age, sex, and socio-eco-
used to assess the QoL of children with caries pre- nomic status had no significant impact on QoL
and post-treatment. Associations between age, pre- and post-treatment.
sex, and socio-economic status and caries were Conclusions. Caries had a significant impact on
analysed using bivariate and multivariate logistic the QoL of adolescents. Its treatment resulted in
regression analysis. marked improvement in QoL.
Results. The prevalence of caries in the study
population was 21.9%. Approximately 57% of

Pain is a common sequela of dental caries

Introduction
and can be distressing and excruciating5.
Dental caries is the most prevalent chronic Toothache can lead to absence from school
disease among children worldwide1. Although and is an indicator of children’s health. In the
it is not often life threatening, caries nega- United States, dental visits resulting from car-
tively affects the overall well-being of individ- ies or dental problems accounted for
uals and of the population. Caries has its 117,000 h of school lost per 100,000 chil-
largest impact on the performance of daily dren6. Loss of school time resulting from car-
activities, with the degree of impact directly ies mainly results from time spent seeking
related to the number of affected teeth2. Daily dental care services, which are often available
life activities affected by caries include tooth primarily during school hours7. Loss of
cleaning, social contact, sleeping, smiling, schooling among children from low socio-eco-
speaking, schoolwork and, most commonly, nomic strata is also high7. Other conse-
eating3. Toothache is the most common cause quences of caries include increased risk of
of negative impact on daily activities4. hospitalization and emergency dental visits8,
more days with restricted activity9,10, and
diminished educational development10. Caries
also affects nutrition11, growth, and weight
Correspondence to:
gain12 and results in anaemia when there is
Nneka M. Chukwumah, Department of Preventive
Dentistry, University of Benin Teaching Hospital, Benin
associated chronic inflammation13.
PMB 300001, Nigeria. E-mail: [email protected] Caries and its sequelae therefore have a
*These authors contributed equally to this work. large impact on the oral health-related quality

© 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd 1
2 N. M. Chukwumah et al.

of life (OHRQoL) of children14–16. Caries strata in the study sample. In Nigeria, chil-
affected the quality of life (QoL) of 36% of dren who attend public schools are majorly
children negatively in a study conducted in from the lower socio-economic strata whereas
Tanzania17 and showed moderate but signifi- those who attend private schools are majorly
cant improvements in the OHRQoL following from the upper socio-economic strata. Treat-
intervention. A Brazilian study also found ment was provided to participating children
that caries exerted a strong influence on the at the Paediatric Dental Clinic of the Univer-
OHRQoL of children, and its management sity of Benin Teaching Hospital.
improved the functional, emotional, and
social aspects of their OHRQoL18.
Study location
Little is known about the impact of dental
caries and its sequelae on the OHRQoL of The study was conducted in four of the six
children in sub-Saharan Africa, including local government areas (LGAs) in the city of
Nigeria, where the prevalence of untreated Benin. The four LGAs were selected because
caries and its sequelae is high19,20. The preva- of their close proximity to the Paediatric Den-
lence of dental caries in Benin City is particu- tal Clinic at the University of Benin Teaching
larly high, higher than what is observed in Hospital and the ease of access of the hospital
many other cities in Nigeria21. Understanding by study participants. Treatment of lesions
the social and physical implications of caries was provided at no cost to the participating
and its treatment on the QoL of these chil- students.
dren is important. Moreover, there are
reported cultural variability in the response to
Duration of study
pain22, which is the most frequent caries-
associated complication. This study aimed to Study participants were recruited for the
assess the impact of dental caries and its treat- study between December 2012 and April
ment on the QoL of young adolescents aged 2013. All study participants who reported to
12–15 years in Benin, Nigeria. the Paediatric Dental clinic of the University
of Benin Teaching Hospital were recalled for
follow-up assessment 4 weeks after treat-
Materials and methods
ment. The study was implemented over a
period of 12 months.
Ethical considerations
Ethical approval for this study was obtained
Sample size and sampling procedure
from the University of Benin Teaching Hospi-
tal Ethics and Research Committee (ADM/E The sample size was powered to determine
22/A/VOL. VII/789). Permission was also the prevalence of caries in the study popula-
obtained from the State Ministry of Education tion based on the assumption that a caries
and the principals of participating schools. prevalence of 50% would be detected. The
Written informed consent was obtained from sample size was calculated using the Cochran
the parents of participating children. Only formula23. This gave a minimum sample size
children who agreed to participate were of 384 per LGA. The sample size was
enrolled in the study. increased by 10% to account for attrition,
giving a required sample size of 422 study
participants per LGA. During study imple-
Study design
mentation, however, the minimum sample
This was a cross-sectional study. Study partic- size of 1688 was increased to 2150 due to the
ipants were 12- to 15-year-old adolescents need to include all eligible study participants
living in Benin City, Nigeria. Participants in the classrooms were students were
were recruited from public and private sec- recruited for the study.
ondary schools as a means of ensuring repre- A multiphase sampling method was
sentation of all cadres of the socio-economic employed. This started with the selection of

© 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Impact of caries on QOL in adolescents 3

schools, followed with the selection of classes conditions was performed in respect to the
in each school and the selection of study par- perceived oral health problems such as calcu-
ticipants in each class. The first stage involved lus (presence of deposits), oral ulcers (sores in
selection of schools using a simple random mouth), sensitivity (shocking sensations),
sampling technique, from a list of 297 regis- erupting permanent (painful growing tooth),
tered public and private secondary schools in fractured tooth (broken tooth), exfoliating
the four LGA. The list was obtained from the primary tooth (shaking baby tooth), and cleft
State Ministry of Education. Thirty of the 297 lip/palate (abnormal cut/hole in mouth) to
schools were selected (seven public and 23 provide better understanding for the study
private) using a ratio that ensured proportion- participants. The internal consistency of
ate representation of schools in each LGA. Child-OIDP, determined using the Cronbach’s
The class registration list for each school was coefficient alpha score, was 0.75. Corrected
then used to determine specific classes to par- total and interitem correlation was evaluated
ticipate in the study. Classes with large num- to assess internal reliability. The scores ranged
bers of 12- to 15-year-old pupils at each of from 0.12 (relaxing and smiling) to 0.51
the schools were listed as eligible recruitment (cleaning and eating). The test–retest reliabil-
sites. Specific classes for study participants’ ity score, determined with the Pearson prod-
recruitment were selected by a ballot. Study uct moment coefficient, was 0.56. Face
participants were then recruited from the validity was supported by completion of the
selected classes. All children in the selected questionnaire following the interview,
classes who were eligible to participate were whereas its criterion and concurrent validity
then enrolled until the study population for were demonstrated by the mean Child-OIDP
each school was reached. scores and overall impact scores discriminat-
Only children with dental caries who met ing in the expected direction to self-reported
the inclusion criteria and for whom informed oral health.
parental consent was provided were included
in the study. Children with other oral health Instrument administration. Study participants
problems that could affect QoL were excluded completed a self-administered questionnaire
from the study, including those with special that generated information on age, sex,
health needs or other oral health conditions father’s occupation, mother’s level of educa-
such as severe malocclusion, periodontal dis- tion, name of school and telephone number.
ease, trauma, hypoplasia or tumours. Chil- Child-OIDP data were generated for each
dren diagnosed with these lesions were child through face-to-face interviews con-
referred for treatment. ducted by five trained interviewers.

Child Oral Impact on Daily Performance Clinical examination

assessment
Calibration. One of the authors (NMC) was
Pilot testing of study tool. The English version calibrated prior to the study. Seven children
of the child version of Oral Impact on Daily who had dental caries but who were not part
Performance (Child-OIDP) questionnaire24 of the study were examined by NMC using
was used to collect data on QoL. A pilot study the WHO criteria for the diagnosis and coding
was performed prior to study implementation. of dental caries in epidemiological studies.
One hundred and twenty-seven children aged Examinations were performed by NMC in an
12–15 years attending two secondary schools environment that simulated the study envi-
not included in the study were enrolled in ronment (student classrooms, with the study
the pilot test. The questionnaire was adminis- participant seated on a chair facing the win-
tered to the students in a selected classroom dows to ensure a natural light source for in-
at each of the secondary schools 2 weeks traoral viewing). Standard examination tools
apart. Some minor rephrasing of some oral (dental mirror and ball tipped WHO dental

© 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
4 N. M. Chukwumah et al.

explorers) were used to examine and detect lip, cleft palate); erupting permanent tooth;
caries. The Decayed Missing and Filled Teeth and missing permanent tooth.
(DMFT/dmft) index was used to evaluate The second section measured the impact of
dental caries status. The intra-examiner reli- dental caries on the child’s daily performance
ability score was 0.89 according to kappa sta- using the Child-OIDP. The Child-OIDP
tistics. assessed the impact of caries on eating, speak-
ing, tooth cleaning, relaxing, emotional sta-
Clinical examination of study participants. All tus, smiling, studying, and social contact. If
students eligible to participate in the study an impact was reported, the child was asked
and who were present in class on the day of to grade the severity of the impact of oral
clinical examinations were recruited for the health problems on their daily life perfor-
study. Examinations were performed in the mance in each of the eight domains using a
students’ classroom with a teacher present. four-point Likert-like scale with scores rang-
Study participants were seated on a chair fac- ing from 0 to 3. A score of 0 meant no
ing the windows to ensure a natural light impact, 1 meant mild impact, 2 meant mod-
source for intraoral viewing). To ensure pri- erate impact, and 3 meant severe impact.
vacy, a corner was created in each classroom Children indicated the frequency of an oral
for the conduct of the clinical examination. health problem by assigning a score from 0 to
Standard examination tools (dental mirror 3 to each of the domains for which they indi-
and ball tipped WHO dental explorers) were cated that an oral lesion impacted their daily
used to examine and detect caries. life function. A score of 0 meant that no
All children with oral health problems were event occurred, 1 meant that the event
referred for treatment; however, those with occurred once or twice per month, 2 meant
only dental caries were referred to the Uni- that the event occurred once or twice per
versity of Benin Teaching Hospital for man- week, and 3 meant that the event occurred
agement. All referred patients were managed three or more times per week.
by the study investigator and trained team The oral impact score for each of the eight
members. All children treated for caries were daily life performance domains was obtained
visited again in their schools 1 month after by multiplying the severity and frequency
treatment, in accordance with the study scores. Scores ranged from 0 to 9 per domain.
design of Jabarifar et al.25 The overall impact score was the sum of all
eight domains (ranging from 0 to 72).
The intensity of the impact of caries on
Measuring oral impacts and calculating their
each of the eight daily life performance
severity
domains was assessed with the impact score.
A checklist of 17 oral conditions was used to The impact score was obtained for each par-
assess the child’s experience of oral disease in ticipant by regrading the impact scores for
the previous 3 months. Respondents were each of the eight daily life performance
instructed to answer ‘yes’ if they had experi- domains from 1 to 9, with 1 being very mild
enced any of the disease conditions in the and 9 being very severe. The intensity scores
previous 3 months, and ‘no’ if they had not. were then regrouped into six levels: (0) no
Oral conditions were described to the chil- intensity, (1) very little intensity, (2) little
dren. The 17 checklist conditions were tooth- intensity, (3–4) moderate intensity, (6–8)
ache; sensitive tooth; tooth decay or cavity; severe intensity, and (9) very severe inten-
loss of primary tooth; tooth space (due to sity26.
non-erupted permanent tooth); fractured per-
manent tooth; abnormal colour, shape or size
Measuring socio-economic status
of tooth; abnormal position of tooth (e.g.,
crooked or projecting, gap); bleeding gums; Socio-economic status was assessed with a
swollen gums; calculus; oral ulcers; bad multiple item index combining the mother’s
breath; deformity of mouth or face (e.g., cleft level of education with the father’s occupation.

© 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Impact of caries on QOL in adolescents 5

Each child was allocated into one of five A 95% confidence interval was set to con-
social classes (I–V), with V being the lowest. firm if a relationship truly existed within or
This index has been found to be valid and between variables. The predictor of improve-
reliable and has been used in a paediatric ment in the Child-OIDP scores post-treatment
dental population in Nigeria27. For ease of was also determined. The level for statistical
analysis, three socio-economic status groups significance was set at P < 0.05.
were established: high (children from the
upper and upper middle classes), middle
Results
(children from the middle), and low (children
from the lower middle and lower classes).
Sociodemographic profile of study participants
Although 2150 students were eligible for
Data analysis
study participation, only 1790 pupils agreed
The tests for data normalcy employed for this to participate, giving a response rate of
study were the Kolmogorov–Smirnov and 83.3%. The mean age  (SD) of participants
Shapiro–Wilk tests and both tests gave a was 13.59  (1.09) years. The mean age 
P-value of <0.001, respectively. Although this (SD) of the male participants was 13.47 
rejects the null hypothesis of the data being (1.08) years and that for females was
from a normally distributed population, the 13.73  (1.08) years. Fifty-three per cent of
test still is statistically significant being from a study participants were boys, 51.0% attended
large sample size and thus from a normally public schools, and 41.7% were of low socio-
distributed population. economic status.
Data were analysed using the statistical
package for social sciences (SPSS) version
Caries profile of study participants
17.0. Changes in pre- and post-treatment
Child-OIDP scores were calculated for each Only 392 study participants with caries (92.9%
child. A positive change in score indicated an of the proposed sample size of 422) were
improvement in the child’s QoL after treat- recruited, despite the 70% increase in the total
ment. A negative change in score indicated sample size. The prevalence of caries in the
deterioration in the child’s QoL. study population was 21.9%. The caries preva-
To quantify changes, effect-size statistics lence for 12-, 13-, 14-, and 15-year-olds was
were calculated by dividing the mean Child- 16.3%, 20.6%, 22.1%, and 26.9%, respec-
OIDP score change by the standard deviation tively. Table 1 shows the caries prevalence and
(SD) of the pre-treatment score17. An effect the mean dmft/DMFT of the study participants
size of < 0.2 indicated a small, clinically by age, sex, and socio-economic status.
meaningful magnitude of change; 0.2–0.7
indicated a moderate, clinically meaningful
Effect of dental caries on the QoL of study
magnitude of change; and > 0.7 indicated a
participants
large, clinically meaningful magnitude of
change17. The QoL of 56.5% of participants was affected
The mean DMFT/dmft score was calculated by caries. Eating and oral cleaning were the
for all children with dental caries. Associa- most commonly affected domains, whereas
tions between the presence of caries, the soci- speaking, smiling, and contact were the least
odemographic variables, and the pre- and affected, as shown in Table 2. The intensity of
post-treatment Child-OIDP scores were evalu- the impact of caries on QoL ranged from little
ated with bivariate and inferential analysis. to very little for 54.2% of study participants,
The difference in the pre- and post-treatment moderate for 30.8% of study participants, and
Child-OIDP scores was calculated using paired severe to very severe for 14.0% of study par-
t-tests. The McNemar chi-square test was used ticipants.
to assess the effect of treatment on the Child- There was no statistically significant associa-
OIDP scores. tion between demographic characteristics

© 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
6 N. M. Chukwumah et al.

Table 1. Mean dft, DMFT, DT, MT, and FT with SD among study participants with caries, by age, sex, and socio-economic
status.

Characteristics dft (SD) DMFT(SD) DT (SD) MT (SD) FT (SD)

Age (years)
12 0.31  0.57 1.76  1.72 2.07  1.46 0.00  0.00 0.00  0.00
13 0.14  0.44 1.77  1.12 1.89  1.21 0.04  0.28 0.03  0.18
14 0.06  0.44 2.37  1.81 2.40  1.73 0.13  0.45 0.00  0.00
15 0.01  0.09 2.65  1.94 2.59  1.78 0.052  0.33 0.01  0.09
Sex
Male 0.06  0.24 2.47  2.02 2.47  1.86 0.04  0.25 0.00  0.00
Female 0.13  0.50 1.96  1.36 2.07  1.28 0.07  0.39 0.02  0.16
Socio-economic status
High 0.11  0.44 1.89  1.10 2.04  1.08 0.12  0.45 0.01  0.11
Middle 0.14  0.50 1.96  1.69 2.02  1.54 0.08  0.40 0.03  0.17
Low 0.06  0.24 2.57  1.95 2.59  1.80 0.01  0.11 0.00  0.00

Table 2. Prevalence of impact and intensity of impact of caries on each quality of life domain (n = 392).

Overall
Oral impacts C-OIDP Eating Speaking Cleaning Relaxing Emotion Smiling School Contact
on domains (%) (%) (%) (%) (%) (%) (%) (%) (%)

Impact (%) 56.5 47.6 6.4 42.2 15.9 18.9 5.4 14.6 5.4
No impact (%) 43.5 52.4 93.6 57.8 84.1 81.1 94.6 85.4 94.6
Impact intensity (% of children with impacts)
Very little 23.1 18.2 36.0 27.1 24.2 25.7 42.8 35.1 42.9
Little 32.1 23.5 8.0 25.3 35.5 20.3 38.1 24.6 33.3
Moderate 30.8 20.9 40.0 24.7 14.5 20.3 4.8 15.7 14.3
Severe 11.3 11.2 8.0 13.3 21.0 27.0 4.8 12.3 9.5
Very severe 2.7 26.2 8.0 9.6 4.8 6.7 9.5 12.3 0.0

C-OIDP, child Oral Impact on Daily Performance.

(age, socio-economic status), QoL domains, pants, especially with respect to eating, tooth
and overall pre-treatment QoL. More boys cleaning, emotional stability, doing school-
than girls reported that their emotional stabil- work, and relaxing. Dental caries and its dif-
ity was affected by caries (P = 0.03). These ferent sequelae had a negative impact on the
results are shown in Table 3. QoL of 75–100% of children.
Table 4 shows the difference in the pre-
and post-treatment scores for each of the
Effect of treatment of dental caries on the QoL of
eight daily life performance domains. Only
study participants
the 247 children who completed treatment
Although 392 study participants were referred and filled the pre- and post-treatment Child-
for treatment of dental caries, only 247 com- OIDP questionnaires were analysed. The dif-
pleted the pre- and post-treatment QoL ferences between the pre- and post-treatment
assessment. This represented 63% of the Child-OIDP scores were statistically significant
study population with caries and 58.5% of (9.23 vs 0.22; P < 0.0001). The overall effect
the required minimum sample size for this size in the score change for each of the eight
study. domains assessed was also large (0.9). For
Treatment of dental caries and its sequelae each of the eight daily life performance
resulted in improvement in severity of impact domains assessed, the difference between the
of caries on each of the eight domains pre- and post-treatment scores ranged from
assessed as well as on the Child-OIDP scores. 0.2 to 0.9, meaning that treatment resulted in
Dental caries had a marked negative impact a moderate to large, clinically meaningful
on QoL in 40.3% of affected study partici- magnitude of change.

© 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Impact of caries on QOL in adolescents 7

Age-specific analysis revealed no signifi-

C-OIDP mean  SD
cant difference between the pre- and

10.40
11.20
10.00

8.82  10.67
8.00  10.02

9.19  10.34
7.85  10.73
post-treatment Child-OIDP scores for study

9.76

7.76  9.64
participants aged 12, 13, 14, and 15 years




8.27 with respect to smiling (P = 0.16, 0.06, 0.32,
8.72
9.22
7.66
0.72

0.43

0.43
and 0.06, respectively) and for 12-, 14-, and
15-year-olds with respect to contact
(P = 0.32, 0.08, and 0.052, respectively).
mean  SD

2.84
2.76
3.20
2.81

2.38  2.87
2.11  2.90

2.10  2.91

2.43  2.85
2.11  2.92
Cleaning

Treatment resulted in statistically signifi-






cant differences between the pre- and post-

2.36
2.17
2.37
2.17
0.94

0.35

0.56
treatment Child-OIDP scores for each of the
eight daily life performance domains for
both boys and girls, except in the contact
mean  SD

1.88
2.22
2.27
1.75

1.02  2.22
0.65  1.84

0.80  2.12

0.93  2.13
0.73  1.89
Table 3. Mean Child-OIDP scores of study participants with dental caries before treatment by age, sex, and socio-economic status.

domain for boys (P = 0.06).

Relaxing






Treatment also resulted in statistically sig-

0.95
1.00
1.05
0.49
0.13

0.07

0.68
nificant improvement in the Child-OIDP
scores for each of the eight daily life perfor-
mean  SD

2.29
2.31
2.10
2.26

1.26  2.42
0.78  2.02

0.67  2.05

1.14  2.36
1.05  2.19

mance domains for children in each of the

Emotion

socio-economic groups, except in the speak-






ing, smiling, and contact domains for those

1.20
1.13
0.86
0.93
0.73

0.03

0.29

of high socio-economic status (P = 0.10,

0.16, and 0.052, respectively) and in the
mean  SD

0.69
1.25
0.75
1.33

0.26  1.08
0.23  1.16

0.24  1.13

0.26  1.21
0.23  1.02

smiling domain for those of middle socio-

economic status (P = 0.10).
Smiling





0.16
0.27
0.16
0.31
0.74

0.84

0.98

Tables 5 and 6 show the impact of age,

sex, and socio-economic status on the pre-
Bold value shows the emotion domain was statistically significant between males and females.

and post-treatment Child-OIDP scores. Age,

mean  SD

1.74
1.70
2.60
1.60

0.75  1.86
0.71  1.98

0.33  1.22

0.90  2.09
0.76  2.01

sex, and socio-economic status had no signif-

icant impact on the Child-OIDP scores of
School





0.62
0.63
1.22
0.54
0.59

0.83

0.08

study participants before or after treatment

of caries.
mean  SD

0.57
1.42
0.71
1.22

0.24  1.15
0.26  1.11

0.24  1.00

0.23  1.21
0.27  1.11

Discussion
Contact





0.11
0.35
0.17
0.26
0.55

0.84

0.93

This study showed that untreated caries neg-

atively affected the QoL of a moderate num-
ber (56.5%) of affected adolescents, with
mean  SD

0.54
1.53
1.18
1.41

0.28  1.21
0.37  1.40

0.23  1.06
0.33  1.25
0.37  1.47

Child-OIDP, child Oral Impact on Daily Performance.

14% of participants rating the intensity of

Speaking

the impact of caries on their QoL as severe





0.07
0.40
0.34
0.35
0.48

0.50

0.74

to very severe. Children with untreated

sequelae of dental caries also experienced
greater impact on their QoL. Within 4 weeks
mean  SD

3.03
3.24
3.47
3.23

 3.04
 3.44

 3.53
 3.08
 3.23

of treatment, significant changes in QoL





Eating

were observed, with the effect size of treat-

2.80
2.78
3.05
2.60
0.81

2.65
2.90
0.46

3.16
2.37

0.15
2.94

ment ranging from moderate clinically

Socio-economic status

meaningful change to large clinically mean-

ingful change in each of the eight daily life
Characteristics

performance domains assessed. The most

Age (years)

commonly affected domains were eating,

P-value

P-value
Female

Middle
P-value
Male

High

Low

tooth cleaning, and emotional stability.

12
13
14
15

Sex

Age, sex, and socio-economic status had no

© 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
8 N. M. Chukwumah et al.

Table 4. Mean Child-OIDP score change and effect size following treatment of dental caries (n = 247).

Pre-treatment Post-treatment Change Effect

score (SD) scores (SD) P-value score (SD) size

Eating 3.22  3.45 0.13  0.62 <0.0001 3.09  3.37 0.9

Speaking 0.35  1.30 0.00  0.00 <0.0001 0.35  1.30 0.3
Cleaning 2.38  2.97 0.85  0.50 <0.0001 2.29  2.92 0.8
Relaxing 1.08  2.30 0.00  0.00 <0.0001 1.08  2.30 0.5
Emotion 1.04  2.29 0.00  0.00 <0.0001 1.04  2.29 0.5
Smiling 0.17  0.82 0.00  0.00 0.001 0.17  0.82 0.2
School 0.73  1.98 0.00  0.00 <0.0001 0.73  1.98 0.4
Contact 0.26  1.10 0.00  0.00 <0.0001 0.26  1.10 0.2
C-OIDP 9.23  10.27 0.22  0.91 <0.0001 9.01  10.08 0.9

C-OIDP, child Oral Impact on Daily Performance.

Table 5. Logistic regression analysis of impact of caries on Table 6. Logistic regression analysis of impact of caries on
the Child-OIDP scores before treatment (n = 247). the Child-OIDP scores after treatment (n = 247).

Multivariate Multivariate
Variable adjusted OR 95% CI P-value Variable adjusted OR 95% CI P-value

Age Age
12 – 1.00 12 – 1.00
13 1.64 0.70–3.85 0.25 13 4.08 0.64–25.92 0.14
14 1.70 0.83–3.47 0.14 14 2.72 0.48–15.62 0.26
15 1.70 0.79–3.65 0.17 15 2.83 0.46–17.36 0.26
Sex Sex
Male – 1.00 Male – 1.00
Female 0.73 0.42–1.26 0.26 Female 1.38 0.45–4.20 0.58
Socio-economic status Socio-economic status
High – 1.00 High – 1.00
Middle 1.63 0.73–3.67 0.24 Middle 1.39 0.31– 6.23 0.67
Low 0.67 0.37–1.22 0.19 Low 0.62 0.18–2.16 0.45
Constant 1.48 0.26 Constant 0.03 0.00

OR, odds ratio; CI, confidence interval; Child-OIDP, child Oral OR, odds ratio; CI, confidence interval; Child-OIDP, child Oral
Impact on Daily Performance. Impact on Daily Performance.
Adjusted R = 0.291 Adjusted R = 0.100.

More than half of the children with caries

significant impact on pre- or post-treatment in this study (56.5%) were negatively affected
QoL in study participants. Prior studies28,29 by their caries experience. The proportion of
have shown that caries has a negative impact children whose QoL was affected by caries in
on QoL in children. The scores reported in this study is lower than that reported among
this study (9.23) were higher than scores children with caries in Thailand (89.9%)32,
reported in Brazil (3.95)2 and Italy (1.9)29. France (73.2%)33, Peru (82.0%)26, and Brazil
The high score in this study may reflect the (80.7%)34; however, the percentage is higher
impact of delayed treatment and the resulting than that in England (40%)3. Compared with
sequelae on the QoL of children in Nigeria. results from other African countries, our
Prior studies have found that children with results were comparable to those from Sudan
dental caries receive delayed treatment30,31. (54.6%)16 but higher than reports from Tan-
This study found that many children had zania (36.2%)35 and lower than those from
dental caries sequelae and that the sequelae Uganda (62%)36. This variability may result
had a marked negative impact on QoL, espe- from differences in the age of participants in
cially with respect to eating, tooth cleaning, the various studies. We observed no regional
emotional stability, doing schoolwork, and differences or observable trends in the statis-
relaxing. tics reported.

© 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Impact of caries on QOL in adolescents 9

The domains most commonly affected by In their study of the determinants of QoL in
untreated caries in this study were similar to adolescents, Foster-Page et al.41 clearly dem-
those observed in prior studies16,26,29,32. Diffi- onstrated that psychosocial factors were the
culty eating and cleaning teeth may result most important contributors to oral health-
from the carious process itself or from its related QoL. A better understanding of factors
sequelae. The child’s inability to perform that predict the oral health-related QoL of
these activities may represent either a mea- adolescents with caries would help the field
sure to prevent pain or may arise because of paediatric dentistry understand how to pri-
pain prevents the child from performing these oritize the management of oral health needs
functions. One potential impact of difficulty in adolescents.
with eating and tooth cleaning is develop- The study highlights the fact that untreated
mental and growth retardation in children caries and its sequelae negatively affect the
affected by caries, which has been reported in QoL of adolescents in Nigeria. Dental caries
prior studies37,38. These domains showed the had a severe impact on the pre-treatment
most significant improvement after treatment. QoL of adolescents in this study population,
Our findings are also significant because with eating and tooth cleaning being the
they affect the interpretation of the reported most commonly affected domains. The treat-
association between caries and poor oral ment of dental caries in this study population
hygiene in Nigeria39. This study’s findings had a significant impact on each of the eight
imply that the observed association results domains assessed and on the overall QoL of
from the inability of children to perform rou- study participants, irrespective of age, sex or
tine teeth cleaning as a result of caries and socio-economic status. Age, sex, and socio-
not that caries results from poor oral hygiene. economic status had no influence on the QoL
This does not preclude the fact that poor oral of this study population before or after treat-
hygiene may result in caries formation, as ment of their carious lesions.
prior studies have established a causal rela-
tionship between poor oral hygiene and car-
ies40. Our findings suggest the need for Why this paper is important to paediatric dentists
further studies to explore the relationship • It discusses the impact of dental caries on the quality
between oral hygiene and caries in children of life of adolescents.
• It highlights the effect of caries treatment on oral
in Nigeria. health-related quality of life.
Treatment of dental caries resulted in signif- • It highlights the associations between age, sex, socio-
icant improvement in each of the eight economic status, caries, and oral health-related quality
of life of adolescents.
domains assessed and in the overall QoL of
study participants. This finding is similar to
the result of a study conducted in Tanzania17.
Acknowledgements
The significant improvement in the QoL of
study participants following treatment further The authors acknowledge the contributions
highlights the major impact of dental caries of Prof A.O Fatusi and Dr T.O Afolabi of the
on the overall health and well-being of chil- College of Health Sciences, Obafemi Awo-
dren. Caries is associated with multiple mor- lowo University, Ile-Ife in helping with
bidities, all of which have social, determining the sample size calculation for
psychological, health, and economic conse- this study; Dr C.C Azodo of the College
quences22. Health Sciences, University of Benin; and Dr
Logistic regression analysis revealed that A.B Oginni of the National Population Coun-
the impact of caries treatment was greater in cil, Abuja, Nigeria, who gave guidance on
older children and in girls, although these statistical analysis.
findings were not statistically significant. This
difference may have resulted from an
Conflict of interest
improvement in the children’s self-esteem
and self-perception as a result of treatment. The authors declare no conflict of interest.

© 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
10 N. M. Chukwumah et al.

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