Oral health-related quality of life of children and teens with sickle cell disease

Fernandes, Maria Luiza da Matta Felisberto; Kawachi, Ichiro; Fernandes, Alexandre Moreira; Corrêa-Faria, Patrícia; Paiva, Saul Martins; Pordeus, Isabela Almeida

doi:10.1016/j.bjhh.2016.01.004

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ORIGINAL ARTICLES • Rev. Bras. Hematol. Hemoter. 38 (2) • Apr-Jun 2016 • https://doi.org/10.1016/j.bjhh.2016.01.004 copy

Oral health-related quality of life of children and teens with sickle cell disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

Children with sickle cell disease may have their quality of life affected by oral alterations. However, there is still little data on oral health-related quality of life in these children. The aim of this study was to investigate the influence of sickle cell disease, socioeconomic characteristics, and oral conditions on oral health-related quality of life of children and teens.

METHOD:

One hundred and six children and teens with sickle cell disease were compared to a similar sample of 385 healthy peers. Data were collected through oral examinations, interviews to assess quality of life (Child Perceptions Questionnaire for children aged 8-10 and 11-14) and questionnaires containing questions on socioeconomic status.

RESULTS:

There were no statistically significant differences in the total scores of the Child Perceptions Questionnaires or domain scores comparing sickle cell disease patients to control subjects. When sub-scales were compared, oral symptoms and functional limitations had a greater negative impact on the quality of life of adolescents with sickle cell disease (p-value <0.001 and p-value <0.01, respectively) when compared to healthy controls. The only statistically significant determinants of negative impact on oral health-related quality of life in the overall sample was home overcrowding (more than two people/room) in the younger children's group, and dental malocclusion among teens.

CONCLUSION:

There was no significant difference in the negative impact on the oral health-related quality of life between the group with sickle cell disease and the control group. Of the oral alterations, there was a significant difference in the oral health-related quality of life between adolescents with sickle cell disease and controls only in relation to malocclusion. Among the socioeconomic characteristics, only overcrowding was significantly associated with a negative impact on oral health-related quality of life.

Keywords:
Sickle cell; Quality of life; Child; Oral health; Malocclusion

	Children SCD (n = 56)	Children control group (n = 205)
Individual characteristics
Gender – n (%)
Male	31 (55.3)	112 (54.6)
Female	25 (44.7)	93 (45.4)
Child living with biological parents – n (%)
No	21 (41.1)	46 (29.0)
Yes	30 (58.9)	113 (71.0)
Factors related to the disease
Religiosity – n (%)
No	6 (10.7)
Sometimes	7 (12.5)
Frequently	43 (76.8)
Race – n (%)
White	9 (16.0)
Black	19 (34.0)
Mixed	28 (50.0)
Age at diagnosis of SCD – n (%)
<7 months old	52 (95.5)
7 months – 3 years	3 (5.0)
Socioeconomic factors
Home overcrowding – n (%)
≤2 people/room	32 (57.0)	101 (49.3)
>2 people/room	24 (43.0)	104 (50.7)
Mother's education^a – n (%)
≤8 years	44 (86.0)	99 (66.5)
>8 years	7 (14.0)	57 (36.5)
Father's education^a – n (%)
≤8 years	35 (83.0)	89 (60.5)
>8 years	7 (17.0)	58 (39.5)
Own house – n (%)
No	32 (63.0)	100 (62.9)
Yes	19 (37.0)	59 (37.1)
Own car^a – n (%)
No	47 (92.0)	117 (73.6)
Yes	4 (8.0)	42 (26.4)
Family income US$/month – mean (SD)	584.4 (245.2)	615.8 (274.7)
Oral conditions
DMFT/DMFT – mean (SD)^b	1.3 (2.1)	1.8 (2.0)
Decayed – mean (SD)	0.9 (1.8)	1.1 (1.5)
Missing – mean (SD)	0	0.2 (0.6)
Filled – mean (SD)	0.4 (1.2)	0.5 (1.0)
DAI^c	32.2 (10.6)	25.5 (7.4)
Gingival bleeding – n (%)
No	47 (84.0)	182 (88.8)
Yes	9 (16.0)	23 (11.2)

	Maximum score	Children SCD (n = 56) Mean (SD)	Children control group (n = 205) Mean (SD)
Score CPQ8-10	100	14.5 (12)	17.9 (15)
Oral symptoms	20	5.5 (3.6)	5.9 (3.8)
Functional limitation	20	2.8 (3.1)	3.5 (4.7)
Emotional well-being	20	3.3 (4.5)	3.9 (4.7)
Social well-being	40	2.9 (3.6)	4.6 (6.2)

	Teens SCD (n = 50)	Teens control-group (n = 180)
Individual characteristics
Gender – n (%)
Male	30 (60.0)	106 (58.9)
Female	20 (40.0)	74 (41.1)
Child living with biological parents^a – n (%)
No	30 (73.0)	56 (38.9)
Yes	11 (27.0)	88 (61.1)
Factors related to the disease
Religiosity (frequent church) – n (%)
Never	9 (18.0)
Sometimes	14 (28.0)
Frequently	27 (54.0)
Race – n (%)
White	6 (12.0)
Black	19 (38.0)
Mixed	25 (50.0)
Age at diagnosis of SCD – n (%)
<7 months old	47 (94.0)
7 months – 3 years	3 (6.0)
Socio-economic factors
Home overcrowding – n (%)
<2 people/room	25 (64.0)	90 (62.0)
>2 people/room	14 (36.0)	55 (38.0)
Mother's education^a – n (%)
≤8 years	22 (58.0)	132 (91.7)
>8 years	16 (42.0)	12 (8.3)
Father's education^a – n (%)
≤8 years	14 (61.0)	120 (83.3)
>8 years	9 (39.0)	24 (16.7)
Own house – n (%)
No	31 (76.0)	91 (85.9)
Yes	10 (24.0)	53 (14.1)
Own car – n (%)
No	40 (98.0)	128 (88.9)
Yes	2 (1.0)	18 (11.1)
Family income US$/month (mean ± SD)^a	1463 (671)	628 (257)
Oral conditions
DMFT/DMFT – mean (SD)^b	1.5 (1.9)	2.1 (2.8)
Decayed – mean (SD)	1.0 (1.4)	1.0 (1.7)
Missing – mean (SD)	0.1 (0.6)	0.2 (0.7)
Filled – mean (SD)	0.4 (0.8)	0.8 (1.7)
DAI	32 (10.3)	29.2 (10.6)
Gingival bleeding^a – n (%)
No	23 (46.0)	152 (84.4)
Yes	27 (54.0)	28 (15.6)

Domains – CPQ₁₁–₁₄	Total possible score	SCD teens (n = 50) Media (SD)	Control teens (n = 180) Media (SD)
Oral symptoms	16^a	5.38 (3.40)	4.89 (2.82)
Functional limitations	16^b	4.68 (3.62)	3.33 (2.96)
Emotional well-being	16	3.22 (3.23)	3.71 (3.95)
Social well-being	16	2.78 (3.49)	2.52 (3.43)
Overall CPQ11-14	64	16.06 (11.65)	14.37 (9.73)

CPQ score (negative impact on OHRQoL)	Children SCD (n = 56) Controls (n = 205)		Teens SCD (n = 50) Controls (n = 205)
Predictors	ß	SE	ß	SE
Individual characteristics
Age (in years)	-1.35	1.2	-0.64	0.83
Gender boy (0/1)	0.197	2.03	2.34	1.72
Child living with both biological parents: No-0/Yes-1	-3.36	2.54	2.31	1.94
Factors related to the disease
SCD (0/1)	-4.80	2.60	-2.41	3.69
Resources
Family income (US$/month)	0.004	0.004	0.003	0.89
Home overcrowding (>2 people/room): No/Yes	9.56	2.51^a	2.26	1.73
Mother education: >8/≤8 years	-1.33	2.43	-0.156	2.75
Father education: >8/≤8 years	-0.474	2.4	-3.05	2.27
Own house: No/Yes	0.629	2.46	-0.09	1.81
Own car: No/Yes	0.302	2.65	2.61	1.15
Oral conditions
DAI	0.128	0.148	0.165	0.08^*
DMFT	0.133	0.57	0.57	0.04
Gum bleeding: No-0/Yes-1	0.4	2.83	0.88	2.03

Score CPQ (negative impact on OHRQoL)	Children SCD (n = 56)		Teens SCD (n = 50)
Predictors	ß	SE	ß	SE
Individual characteristics
Age (in years)	2.81	1.89	7.88	4.11
Gender boy (0/1)	-1.33	2.86	9.66	7.88
Child living with both biological parents: No/Yes	-2.36	3.45	19.92	7.46
Factors related to the disease
Religiosity: Never/Sometimes/Frequently	-8.96	3.73^a	-21.09	10.78^a
Race: White/Mixed/Black	-4.52	2.12^a	-4.18	4.37
Age at diagnosis SCD: <7 months old/7 months–3 years	6.59	10.2	1.034	7.03
Disease severity	1.62	0.95	1.192	2.58
Resources
Family income (US$/month)	-.006	0.06	-0.016	0.009
Home overcrowding (>2 people/room): No/Yes	0.941	3.48	16.7	7.43
Mother education: >8/≤8 years	-2.99	5.89	-10.2	10.35
Father education: >8/≤8 years	-4.1	5.83	-15.09	8.86
Own house: No/Yes	-2.2	3.15	-6.99	10.47
Own car: No/yes	-3.37	4.66	7.92	23.47
Oral conditions
DAI	0.36	0.2	0.048	0.31
DMFT	0.27	0.88	5.049	2.32
Gum bleeding: No/Yes	5.41	4.36	13.99	10.31

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[1] * Corresponding author at: Faculdade de Odontologia, Universidade Federal de Minas Gerais (UFMG), Av. Antônio Carlos, 6627, Campus Universitário, 31270-901 Belo Horizonte, MG, Brazil. E-mail address: marialuizadamatta@gmail.com (M.L. da Matta Felisberto Fernandes)