Impact of dental treatment on the oral health-related quality of life of Brazilian schoolchildren

Mendonça, Jordanna Guedes Amorim; Almeida, Raquel Francis; Leal, Soraya Coelho; Bernardino, Ítalo de Macedo; Hilgert, Leandro Augusto; Ribeiro, Ana Paula Dias

doi:10.1590/1807-3107bor-2021.vol35.0125

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Original Research, Community Dental Health • Braz. oral. res. 35 • 2021 • https://doi.org/10.1590/1807-3107bor-2021.vol35.0125 copy

Impact of dental treatment on the oral health-related quality of life of Brazilian schoolchildren

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

This before-after experimental study evaluated the impact of dental treatment on the oral health-related quality of life (OHRQoL) in children aged 6–8 years from Paranoá, DF, considering the presence or absence of cavitated dentin carious lesions pre- and post-treatment. The responsiveness and sensitivity of the questionnaires were also investigated. Caries was detected by using the Caries Assessment Spectrum and Treatment (CAST) instrument, while the impact of oral health on the children's health-related quality of life was assessed using the Brazilian version of the Child Perceptions Questionnaire (CPQ_8-10), which was completed by the children and the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS), which was completed by their parents. Sociodemographic characteristics were also assessed. After the examinations, the children were categorized into two groups according to the presence (treatment/n = 34) or absence (control/n = 34) of cavitated dentin carious lesions. Restorative/curative care was provided to the treatment group, while the control group received preventive measures. OHRQoL was assessed at baseline and at four weeks post-treatment. No significant sociodemographic differences were observed between the groups. In the treatment group, the children and their families reported a greater impact of oral health on their OHRQoL in both questionnaires (p < 0.05). However, there was a significant reduction in the impact of oral health, with differences between the pre-treatment and post-treatment phases (p = 0.001). Good sensitivity and responsiveness were observed for both questionnaires. Dental treatment was found to reduce the negative impact of dental caries on OHRQoL in 6–8-year-old children, which was detected by both questionnaires (B-ECOHIS and CPQ_8-10).

Keywords:
Quality of Life; Dental Caries; Child; Pain; Sensitivity and Specificity

Variables		Control group	Treatment group	Total
Variables		n (%)	n (%)	n (%)	p-value
Sex					0.225^a a Pearson chi-square test
	Male	14 (41.2)	19 (55.9)	33 (48.5)
	Female	20 (58.8)	15 (44.1)	35 (51.5)
Age					0.332^b b Fisher's exact test.
	6 years	0 (0.0)	3 (8.8)	3 (4.4)
	7 years	28 (82.4)	24 (70.6)	52 (76.5)
	8 years	6 (17.6)	7 (20.6)	13 (19.1)
Lived with					0.783^b b Fisher's exact test.
	Father	13 (38.2)	9 (26.5)	22 (32.4)
	Mother	16 (47.1)	20 (58.8)	36 (52.9)
	Grandparent	4 (11.8)	4 (11.8)	8 (11.8)
	Other	1 (2.9)	1 (2.9)	2 (2.9)
Guardian's education					0.705^a a Pearson chi-square test
	≤ 8 years	15 (50.0)	14 (45.2)	29 (47.5)
	> 8 years	15 (50.0)	17 (54.8)	32 (52.5)
Monthly family income					1.000^a a Pearson chi-square test
	< 1 x minimum monthly wage	9 (26.5)	9 (26.5)	18 (26.5)
	1–2 x minimum monthly wage	20 (58.8)	20 (58.8)	40 (58.8)
	≥ 3 x minimum monthly wage	5 (14.7)	5 (14.7)	10 (14.7)
Parent believes that the child needs dental treatment					0.053^a a Pearson chi-square test
	No	5 (14.7)	0 (0.0)	5 (7.5)
	Yes	29 (85.3)	33 (100.0)	62 (92.5)
The child has been to the dentist at least once in his or her life					0.231^a a Pearson chi-square test
	No	14 (41.2)	9 (27.3)	23 (34.3)
	Yes	20 (58.8)	24 (72.7)	44 (65.7)
Toothache in the last three months					< 0.001^b b Fisher's exact test.
	No	31 (91.2)	14 (41.2)	45 (66.2)
	Yes	3 (8.8)	20 (58.8)	23 (33.8)

Variables		Control group	Treatment group	Total
Variables		n (%)	n (%)	n (%)
Toothache (phase 1)
	Absent	31 (91.2)	24 (70.6)	55 (80.9)
	Present	3 (8.8)	10 (29.4)	13 (19.1)
Toothache (phase 2)
	Absent	32 (94.1)	33 (97.1)	65 (95.6)
	Present	2 (5.9)	1 (2.9)	3 (4.4)
Dentin caries (phase 1)
	Absent	34 (100)	0 (0.0)	34 (50)
	Present	0 (0.0)	34 (100)	34 (50)
Dentin caries (phase 2)
	Absent	34 (100.0)	34 (100)	68 (100)
	Present	0 (0.0)	0 (00.0)	0 (0.0)
Maximum CAST score (phase 1)
	Healthy	28 (82.4)	0 (0.0)	28 (41.2)
	Restauration	2 (5.9)	0 (0.0)	2 (2.9)
	Enamel	4 (11.8)	0 (0.0)	4 (5.9)
	Dentin (clear cavitation in the dentin)	0 (0.0)	4 (11.8)	4 (5.9)
	Pulp	0 (0.0)	13 (38.2)	13 (19.1)
	Abscess/fistula	0 (0.0)	1 (2.9)	1 (1.5)
	Lost	0 (0.0)	16 (47)	16 (23.6)
Maximum CAST score (phase 2)
	Healthy	28 (82.4)	0 (0.0)	28 (41.2)
	Restauration	2 (5.9)	5 (14.7)	7 (10.3)
	Enamel	4 (11.8)	0 (0.0)	4 (5.9)
	Lost	0 (0.0)	29 (85.3)	29 (42.6)

Variable			Point in time
			Phase 1			Phase 2
			Mean (SD)	Median	IQR	Mean (SD)	Median	IQR
Control group
	B-ECOHIS
		Overall score	4.35 (5.01)	2.00	1.50–6.25	2.18 (2.62)	1.50	0.00–3.25
	Child Section (subscale)
		1. Symptom domain	0.59 (0.96)	0.00	0.00–1.00	0.29 (0.63)^b b Significant difference between control and treatment groups at phase 2 (Mann–Whitney U-test, p < 0.05);	0.00	0.00–0.00
		2. Function domain	1.35 (1.67)	0.50	0.00–2.25	0.94 (1.58)^b b Significant difference between control and treatment groups at phase 2 (Mann–Whitney U-test, p < 0.05);	0.00	0.00–2.00
		3. Psychological domain	0.44 (0.99)	0.00	0.00–0.00	0.18 (0.76)	0.00	0.00–0.00
		4. Self-image/social interaction domain	0.38 (0.89)	0.00	0.00–0.00	0.12 (0.48)	0.00	0.00–0.00
	Family Section (subscale)
		5. Parent distress domain	1.03 (1.88)	0.00	0.00–2.00	0.41 (1.08)	0.00	0.00–0.00
		6. Family function domain	0.56 (1.50)	0.00	0.00–0.25	0.24 (0.61)	0.00	0.00–0.00
Treatment group
	B-ECOHIS
		Overall score	14.94 (8.84)^a a Significant difference between control and treatment groups at phase 1 (Mann–Whitney U-test, p < 0.05);	14.00	6.75–21.25	1.41 (1.83)^c c Significant difference between Phase 1 and Phase 2 in the treatment group (Wilcoxon signed-rank test, p < 0.001);	1.00	0.00–2.00
	Child section (subscale)
		1. Symptom domain	1.85 (1.10)^a a Significant difference between control and treatment groups at phase 1 (Mann–Whitney U-test, p < 0.05);	2.00	1.00–2.00	0.03 (0.17)^c c Significant difference between Phase 1 and Phase 2 in the treatment group (Wilcoxon signed-rank test, p < 0.001);	0.00	0.00–0.00
		2. Function domain	3.94 (3.41)^a a Significant difference between control and treatment groups at phase 1 (Mann–Whitney U-test, p < 0.05);	3.50	1.50–6.25	0.18 (0.58)^c c Significant difference between Phase 1 and Phase 2 in the treatment group (Wilcoxon signed-rank test, p < 0.001);	0.00	0.00–0.00
		3. Psychological domain	2.26 (1.85)^a a Significant difference between control and treatment groups at phase 1 (Mann–Whitney U-test, p < 0.05);	2.00	0.00–4.00	0.21 (0.54)^c c Significant difference between Phase 1 and Phase 2 in the treatment group (Wilcoxon signed-rank test, p < 0.001);	0.00	0.00–0.00
		4. Self-image/social interaction domain	1.32 (1.74)^a a Significant difference between control and treatment groups at phase 1 (Mann–Whitney U-test, p < 0.05);	0.00	0.00–2.00	0.03 (0.17)^c c Significant difference between Phase 1 and Phase 2 in the treatment group (Wilcoxon signed-rank test, p < 0.001);	0.00	0.00–0.00
	Family section (subscale)
		5. Parent distress domain	3.82 (1.88)^a a Significant difference between control and treatment groups at phase 1 (Mann–Whitney U-test, p < 0.05);	4.00	2.00–5.00	0.79 (1.37)^c c Significant difference between Phase 1 and Phase 2 in the treatment group (Wilcoxon signed-rank test, p < 0.001);	0.00	0.00–1.00
		6. Family function domain	1.74 (1.76)^a a Significant difference between control and treatment groups at phase 1 (Mann–Whitney U-test, p < 0.05);	2.00	0.00–2.25	0.18 (0.63)^c c Significant difference between Phase 1 and Phase 2 in the treatment group (Wilcoxon signed-rank test, p < 0.001);	0.00	0.00–0.00

Variable			Point in time
			Phase 1			Phase 2
			Mean (SD)	Median	IQR	Mean (SD)	Median	IQR
Control group
	CPQ_8-10
		Overall score	12.21 (12.83)	7.50	2.00–19.00	8.85 (8.75)^b b Significant difference between control and treatment groups in phase 2 (Mann–Whitney U-test, p < 0.05)	6.00	3.75–12.25
	Subscale
		1. Oral symptoms	4.00 (3.73)	2.50	1.75–6.00	2.94 (2.95)	2.00	0.75–4.25
		2. Functional limitations	3.21 (3.92)	2.00	0.00–5.25	2.88 (2.77)^b b Significant difference between control and treatment groups in phase 2 (Mann–Whitney U-test, p < 0.05)	2.00	0.00–4.00
		3. Emotional well-being	2.29 (3.23)	1.00	0.00–2.50	1.74 (3.02)	0.00	0.00–2.00
		4. Social well-being	2.71 (4.15)	0.50	0.00–4.00	1.29 (2.11)	0.00	0.00–2.00
Treatment group
	CPQ_8-10
		Overall score	20.79 (14.92a	16.50	9.00–32.50	5.35 (7.98)^c c Significant difference between Phase 1 and Phase 2 surveys in the treatment group (Wilcoxon signed-rank test, p < 0.001)	2.00	0.75–7.00
	Subscale
		1. Oral symptoms	6.68 (4.18)^a a Significant difference between control and treatment groups at phase 1 (Mann–Whitney U-test, p < 0.05)	6.00	4.00–9.00	2.03 (2.67)^c c Significant difference between Phase 1 and Phase 2 surveys in the treatment group (Wilcoxon signed-rank test, p < 0.001)	2.00	0.00–2.00
		2. Functional limitations	4.44 (3.66)	4.00	1.00–6.50	1.12 (2.28)^c c Significant difference between Phase 1 and Phase 2 surveys in the treatment group (Wilcoxon signed-rank test, p < 0.001)	0.00	0.00–2.00
		3. Emotional well-being	4.94 (4.40)^a a Significant difference between control and treatment groups at phase 1 (Mann–Whitney U-test, p < 0.05)	4.00	1.00–9.00	1.21 (2.93)^c c Significant difference between Phase 1 and Phase 2 surveys in the treatment group (Wilcoxon signed-rank test, p < 0.001)	0.00	0.00–1.00
		4. Social well-being	4.74 (5.76)^a a Significant difference between control and treatment groups at phase 1 (Mann–Whitney U-test, p < 0.05)	3.00	0.75–6.50	1.00 (1.86)^c c Significant difference between Phase 1 and Phase 2 surveys in the treatment group (Wilcoxon signed-rank test, p < 0.001)	0.00	0.00–2.00

Group			Mean score change (SD)	Cohen's d^a a effect size	SRM^b b SRM: standardized response mean	MID^c c MID: minimally important difference.
Control group
	B-ECOHIS
		Overall score	2.18 (5.09)	0.44	0.43	–
	Child section (subscale)
		1. Symptom domain	0.29 (0.84)	0.30	0.35	–
		2. Function domain	0.41 (1.23)	0.25	0.33	–
		3. Psychological domain	0.26 (0.86)	0.26	0.30	–
		4. Self-image/social interaction domain	0.26 (0.79)	0.29	0.33	–
	Family section (subscale)
		5. Parent distress domain	0.62 (1.88)	0.33	0.33	–
		6. Family function domain	0.32 (1.59)	0.21	0.20	–
Treatment group
	B-ECOHIS
		Overall score	13.53 (8.05)	1.53	1.68	0.92
	Child section (subscale)
		1. Symptom domain	1.82 (1.11)	1.65	1.64	0.09
		2. Function domain	3.76 (3.34)	1.10	1.13	0.29
		3. Psychological domain	2.06 (1.74)	1.11	1.18	0.27
		4. Self-image/social interaction domain	1.29 (1.73)	0.74	0.75	0.09
	Family section (subscale)
		5. Parent distress domain	3.03 (1.85)	1.61	1.64	0.69
		6. Family function domain	1.56 (1.69)	0.89	0.92	0.32

Group			Mean score change (SD)	Cohen's d^a a effect size	SRM^b b SRM: standardized response mean	MID^c c MID: minimally important difference.
Control group
	CPQ_8-10
		Overall score	3.35 (8.76)	0.26	0.38	–
	Subscale
		1. Oral symptoms	1.06 (3.14)	0.28	0.34	–
		2. Functional limitations	0.32 (2.17)	0.08	0.15	–
		3. Emotional well-being	0.56 (2.36)	0.17	0.24	–
		4. Social well-being	1.41 (4.36)	0.34	0.32	–
Treatment group
	CPQ_8-10
		Overall score	15.44 (13.28)	1.03	1.16	3.99
	Subscale
		1. Oral symptoms	4.65 (4.14)	1.11	1.12	1.34
		2. Functional limitations	3.32 (3.03)	0.91	1.10	1.14
		3. Emotional well-being	3.74 (4.53)	0.85	0.83	1.47
		4. Social well-being	3.74 (4.94)	0.65	0.76	0.93

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[1] Corresponding Author: Ana Paula Dias Ribeiro, E-mail: aribeiro@dental.ufl.ed