Impact of Traumatic Dental Injuries and Malocclusions On Quality of Life of Preschool Children: A Population-Based Study
Impact of Traumatic Dental Injuries and Malocclusions On Quality of Life of Preschool Children: A Population-Based Study
Impact of Traumatic Dental Injuries and Malocclusions On Quality of Life of Preschool Children: A Population-Based Study
12092
1
Department of Pediatric Dentistry and Orthodontics Department, Dental School, University of S~
ao Paulo-USP, S~
ao Paulo,
Brazil, and 2Department of Pediatric Dentistry, S~
ao Leopoldo Mandic School of Dentistry, Campinas, Brazil
International Journal of Paediatric Dentistry 2015; 25: 18–28 examinations for TDI and malocclusions. Poisson
regression models adjusted by dental caries associ-
Background. Few studies assessed the impact of ated the clinical and socio-demographic conditions
traumatic dental injuries (TDI) and malocclusions with the outcome.
on the oral health-related quality of life (OHR- Results. The multivariate adjusted models showed
QoL) in preschool children. associations between some individual domains of
Aim. To assess the impact of the presence of TDI the B-ECOHIS and clinical and socio-demographic
and malocclusions, as well as its severity and conditions (P < 0.05). The severity of TDI showed
types, respectively, on the OHRQoL of preschool a negative impact on the symptoms domain and
children. self-image/social interaction domain (P < 0.05).
Design. The study was conducted in 1215 chil- Children with complicated TDI were more
dren aged 1–4 years old who attended the likely to experience a negative impact on total
National Day of Children Vaccination in Diadema, B-ECOHIS scores (PR = 2.10; P = 0.048).
Brazil. Parents answered the Brazilian version of Conclusions. The presence of complicated TDI and
the Early Childhood Oral Health Impact Scale dental caries were associated with worse OHRQoL
(B-ECOHIS) and socio-demographic conditions. of Brazilian preschool children, whereas malocclu-
Calibrated dental examiners performed the oral sions do not.
18 © 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Complicated dental trauma harms quality of life 19
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
26 J. Abanto et al.
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
28 J. Abanto et al.
21 Vasconcelos FM, Massoni AC, Heimer MV, Ferreira of quality of life. Health Qual Life Outcomes 2012; 13:
AM, Katz CR, Rosenblatt A. Non-nutritive sucking 6.
habits, anterior open bite and associated factors in 25 B€onecker M, Marcenes W, Sheiham A. Caries reduc-
Brazilian children aged 30–59 months. Braz Dent tions between 1995, 1997 and 1999 in preschool
J 2011; 22: 140–145. children in Diadema, Brazil. Int J Paediatr Dent 2002;
22 Locker D. Disparities in oral health-related quality of 12: 183–188.
life in a population of Canadian children. Community 26 Barbosa TS, Gavi~ ao MB. Oral health-related quality
Dent Oral Epidemiol 2007; 35: 348–356. of life in children: part III. Is there agreement
23 Piovesan C, Antunes JL, Guedes RS, Ardenghi TM. between parents in rating their children’s oral heal-
Impact of socioeconomic and clinical factors on child th-related quality of life? A systematic review. Int J
oral health-related quality of life (COHRQoL). Qual Dent Hyg 2008; 6: 108–113.
Life Res 2010; 19: 1359–1366. 27 Abanto J, Tsakos G, Paiva SM et al. Cross-cultural
24 Paula JS, Leite IC, Almeida AB, Ambrosano GM, adaptation and psychometric properties of the Bra-
Pereira AC, Mialhe FL. The influence of oral health zilian version of the Scale of Oral Health Outcomes
conditions, socioeconomic status and home envi- for-5-year-old children (SOHO-5). Health Qual Life
ronment factors on schoolchildren’s self-perception Outcomes 2013; 11: 16.
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
22
Table 3. Univariate analysis of socio-demographic and clinical condition variables associated with total and each domain scores of the Brazilian version of the Early
Childhood Oral Health Impact Scale (B-ECOHIS).
Socio-demographic conditions
Child’s age
1 year
2 years 0.55 0.024 1.01 0.962 0.45 0.001 0.14 0.082 1.07 0.856 1.27 0.582 0.72 0.157
(0.33–0.92) (0.57–1.80) (0.27–0.73) (0.02–1.27) (0.52–2.15) (0.53–3.08) (0.46–1.13)
3 years 0.72 0.168 1.04 0.881 0.40 0.001 0.86 0.847 1.15 0.664 1.11 0.812 0.78 0.212
(0.45–1.15) (0.61–1.79) (0.24–0.67) (0.20–3.73) (0.59–2.26) (0.47–2.60) (0.53–1.15)
4 years 1.51 0.046 2.13 0.002 0.69 0.101 1.51 0.498 1.84 0.041 2.42 0.021 1.49 0.023
(1.01–2.25) (1.32–3.44) (0.45–1.07) (0.46–4.92) (1.03–3.32) (1.14–5.10) (1.06–2.09)
Child’s gender
Female
Male 0.72 0.043 1.20 0.290 1.08 0.656 0.61 0.333 1.05 0.800 1.31 0.317 1.03 0.806
(0.53–0.99) (0.86–1.68) (0.77–1.52) (0.22–1.66) (0.69–1.62) (0.77–2.22) (0.79–1.35)
Mother’s age
≤30 years
>30 years 1.01 0.914 1.06 0.733 0.95 0.789 0.74 0.576 0.86 0.348 0.92 0.743 0.96 0.782
(0.74–1.38) (0.75–1.49) (0.66–1.36) (0.25–2.16) (0.51–1.26) (0.53–1.57) (0.73–1.26)
Mother’s education
≤8 years
>8 years 0.94 0.759 0.65 0.028 1.39 0.143 1.14 0.817 0.74 0.225 1.04 0.886 0.87 0.400
(0.67–1.35) (0.45–0.95) (0.89–2.15) (0.36–3.63) (0.46–1.19) (0.55–1.97) (0.63–1.20)
Father’s age
≤30 years
>30 years 0.846 0.339 0.91 0.646 0.72 0.097 0.43 0.154 0.71 0.168 1.36 0.367 0.82 0.211
(0.59–1.19) (0.61–1.36) (0.48–1.06) (0.13–1.36) (0.43–1.15) (0.69–2.70) (0.60–1.11)
Father’s education
≤8 years
>8 years 1.02 0.907 0.86 0.461 1.21 0.408 0.80 0.749 0.95 0.855 0.23 0.642 1.01 0.934
(0.71–1.47) (0.58–1.28) (0.77–1.88) (0.41–2.70) (0.57–1.59) (0.64–2.59) (0.74–1.38)
Family structure
Live with mother and father
Live with mother 1.19 0.425 1.58 0.035 1.19 0.415 1.57 0.445 1.13 0.672 0.52 0.297 1.32 0.131
(0.77–1.83) (1.03–2.41) (0.77–1.84) (0.49–5.01) (0.63–2.01) (0.46–1.49) (0.91–1.92)
Live with father 0.73 0.745 0.45 0.401 1.67 0.328 3.76 0.125 2.58 0.346 0.51 0.925 0.71 0.501
(0.11–4.78) (0.07–2.93) (0.59–4.75) (0.66–8.52) (0.98–1.44) (0.12–1.02) (0.26–2.02)
Live with other 1.01 0.947 1.24 0.434 1.49 0.141 2.26 0.379 2.13 0.238 1.97 0.236 1.34 0.148
members of (0.58–1.78) (0.72–2.15) (0.87–2.56) (0.15–3.90) (0.10–3.13) (0.53–1.28) (0.89–2.01)
the family
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
(Continued)
Table 3 (Continued)
Number of children
One
Two or more 1.30 0.096 1.42 0.043 0.98 0.903 3.99 0.011 1.35 0.180 0.77 0.355 1.25 0.110
(0.95–1.78) (1.01–1.98) (0.69–1.39) (1.36–11.68) (0.87–2.07) (0.44–1.33) (0.95–1.62)
Family income (BMW per month)
Up to 2 BMW
>2 BMW 0.65 0.077 0.67 0.166 0.99 0.983 0.29 0.118 0.79 0.439 1.71 0.093 0.81 0.316
(0.40–1.05) (0.38–1.18) (0.59–1.66) (0.06–1.36) (0.44–1.41) (0.91–3.21) (0.54–1.21)
Clinical conditions
Severity of TDI
Absence
Uncomplicated 1.19 0.349 0.65 0.076 0.75 0.190 0.98 0.986 0.48 0.018 0.80 0.548 0.75 0.084
injuries (0.83–1.69) (0.41–1.05) (0.49–1.15) (0.29–3.26) (0.26–0.88) (0.39–1.64) (0.55–1.03)
Complicated 3.19 0.008 2.46 0.076 2.05 0.217 13.18 0.001 3.49 0.017 2.71 0.136 2.97 0.002
injuries (1.35–7.53) (0.91–6.63) (0.66–6.43) (2.98–8.13) (1.24–9.80) (0.73–10.06) (1.50–5.88)
TDI experience
Absence
Presence 1.29 0.142 0.75 0.201 0.82 (0.54–1.24) 0.349 1.63 0.354 0.64 0.122 0.90 0.765 0.87 0.392
(0.92–1.82) (0.48–1.17) (0.57–4.65) (0.37–1.12) (0.47–1.75) (0.64–1.18)
Types of malocclusion
Absent
Anterior open 0.88 0.504 0.98 0.920 0.73 0.170 1.58 0.399 0.86 0.619 0.42 0.034 0.84 0.334
bite (0.60–1.28) (0.66–1.44) (0.46–1.15) (0.55–4.53) (0.48–1.55) (0.19–0.94) (0.60–1.18)
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Anterior cross 1.03 0.938 0.99 0.995 0.73 0.371 1.92 0.245 1.14 0.702 0.19 0.103 0.86 0.604
bite (0.53–2.00) (0.45–2.17) (0.37–1.44) (0.35–3.93) (0.58–2.24) (0.03–1.39) (0.50–1.49)
Posterior cross 1.21 0.692 0.98 0.982 0.72 0.646 1.93 0.148 0.81 0.757 1.30 0.789 0.94 0.896
bite (0.47–3.09) (0.32–3.03) (1.84–2.85) (0.62–4.27) (0.21–3.11) (0.19–9.06) (0.43–2.07)
Increased 0.87 0.672 0.64 0.225 1.05 0.857 1.85 0.448 1.32 0.501 0.55 (0.21–1.43) 0.222 0.90 0.688
overjet (0.48–1.61) (0.32–1.31) (0.60–1.84) (0.37–9.18) (0.58–2.95) (0.54–1.48)
Malocclusion
Absence
Presence 0.915 0.584 0.91 0.602 0.79 0.193 1.29 0.607 0.99 0.975 0.45 0.013 0.86 0.294
(0.66–1.25) (0.64–1.28) (0.55–1.12) (0.48–3.46) (0.63–1.55) (0.24–0.85) (0.65–1.13)
Dental caries
Absence
Presence 3.22 <0.001 2.68 <0.001 2.11 <0.001 4.26 0.004 4.07 <0.001 3.86 <0.001 2.96 <0.001
(2.40–4.34) (1.90–3.77) (1.46–3.05) (1.59–11.40) (2.66–6.21) (2.28–6.53) (2.26–3.87)
Complicated dental trauma harms quality of life
PR, prevalence ratio; SD, symptom domain; FD, function domain; PD, psychological domain; SSD, self-image/social interaction domain; PDD, parent distress domain; FFD, family function
domain; TDI, traumatic dental injuries.
23
24 J. Abanto et al.
action domain, respectively (P < 0.05). The complicated TDI were more likely to have a
child’s age of the sample showed to have a negative impact on OHRQoL than those with-
positive impact on the psychological domain out TDI or those diagnosed with uncompli-
(P < 0.001). The presence of malocclusion cated TDI, when considering total B-ECOHIS
showed a positive impact on the family func- scores. This emphasises the need for using
tion domain (PR = 0.43; P = 0.009). For total similar clinical classifications, population-
B-ECOHIS scores, 2- and 3-year-old children based samples, and analysis in studies with
had a positive OHRQoL (PR = 0.65 and 0.56, the same purpose to confirm previous results
respectively; P < 0.05) compared with those and avoid methodological discrepancies that
who are 4 years old. Moreover, children with complicate comparisons.
complicated TDI were more likely to experi- Our study not only assessed the impact of
ence a negative impact on their OHRQoL TDI on total B-ECOHIS scores, but also on
(PR = 2.10; P = 0.048). The presence of den- individual domains. There is only one more
tal caries showed to have a negative impact study6 in the literature that also assessed the
for all the domains included in the children B-ECOHIS domains using regression analysis;
and family impact sections (P < 0.05) and for however, it considered only the presence of
total B-ECOHIS scores (PR = 3.09; P < 0.001). TDI, but not its severity. Despite that this latter
study found no associations between the vari-
ables, the present study showed that compli-
Discussion
cated TDI has a negative impact on the
This study evaluated the impact of TDI and symptoms and self-image/social interaction
malocclusions on the OHRQoL of Brazilian domains. Our results corroborate the findings
preschool children according to parental of another study4 that used mean comparisons
proxy reports. To the best of our knowledge, and found statistically negative differences for
this is the first study that also assessed the complicated TDI in the same domains. The
impact of the severity of TDI and different symptoms domain comprised an item related
types of malocclusions on the OHRQoL in a to pain because of dental problems, and, at this
population-based sample at this age. respect, it is expected that complicated TDI
The presence of TDI and different types of produce a great magnitude of discomfort con-
malocclusions may cause loss function, aes- sidering the involvement of the pulp tissue
thetics problems, and effect on emotional and and/or dislocation of the tooth. The negative
social well-being by themselves in preschool impact on the self-image/social interaction
children. Up to now, however, few studies domain can be explained as a result of some
can be found assessing the impact of TDI on dislocation of the tooth or dental avulsions that
preschool children’s OHRQoL3–6; however, can produce an aesthetic discomfort because
methodological differences regarding sam- they change or loss teeth position and damage
pling4, TDI classification criteria, and analy- the harmony of the smile avoiding smiling and
sis3,5,6 can be observed among them and our speaking. Furthermore, the child’s age of the
study. In line with our results, some of these sample showed to have a positive impact on
studies5,6 found no association between the the psychological domain. These results are in
presence of TDI and children’s OHRQoL in agreement with a previous study6, which dem-
total B-ECOHIS scores. Conversely, only one onstrated that child’s age (4 year old or more)
recent study3 reported a negative impact of was significantly associated with this domain.
the presence of this clinical condition on the In our study, this association remained also
OHRQoL. A potential explanation is partly significant for 2- and 3-year-old children.
due to the use of different TDI criteria diag- Three previous studies also assessed the
nosis among them. It is worth noting that the impact of malocclusions on the preschool
present study and a previous one4, which use children’s OHRQoL3,4,6, but only Kramer
the same classification for severity of TDI, et al.3 and Goettems et al.6 found some
however, in a convenience sample, confirmed associations on the OHRQoL. Kramer et al.3
in their multivariate adjusted models that found a negative impact of the presence of
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Table 4. Multivariate adjusted model of socio-demographic and clinical condition variables associated with total and each domain scores of the Brazilian version of the
Early Childhood Oral Health Impact Scale (B-ECOHIS).
Socio-demographic conditions
† † † † †
Child’s age
1 year
2 years 0.39 <0.001 0.65 0.047
(0.24–0.62) (0.42–0.99)
3 years 0.29 <0.001 0.56 0.003
(0.18–0.48) (0.38–0.82)
4 years 0.42 <0.001 0.89 0.559
(0.26–0.68) (0.62–1.29)
Clinical conditions
† † † †
Severity of TDI
Absence
Uncomplicated 1.11 0.555 0.91 0.882 0.75 0.068
injuries (0.78–1.56) (0.27–3.08) (0.55–1.03)
Complicated 2.47 0.032 9.71 0.007 2.10 0.048
injuries (1.08–5.63) (1.86–50.59) (1.01–4.39)
† † † † †
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Malocclusion
Absence
Presence 0.43 0.009 0.87 0.319
(0.23–0.80) (0.67–1.13)
Dental caries
Absence
Presence 3.15 <0.001 2.68 <0.001 2.96 <0.001 3.11 0.069 4.08 <0.001 3.97 <0.001 3.09 <0.001
(2.35–4.24) (1.92–3.77) (1.96–4.47) (0.92–10.54) (2.65–6.29) (2.33–6.75) (2.28–4.20)
PR, prevalence ratio; SD, symptom domain; FD, functional domain; PD, psychological domain; SSD, self-image/social interaction domain; PDD, parent distress domain; FFD, family function
domain; TDI, traumatic dental injuries.
†
Variables not associated with the respective domains in the final multivariate model after the adjustment.
Complicated dental trauma harms quality of life
25
26 J. Abanto et al.
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Complicated dental trauma harms quality of life 27
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
28 J. Abanto et al.
21 Vasconcelos FM, Massoni AC, Heimer MV, Ferreira of quality of life. Health Qual Life Outcomes 2012; 13:
AM, Katz CR, Rosenblatt A. Non-nutritive sucking 6.
habits, anterior open bite and associated factors in 25 B€onecker M, Marcenes W, Sheiham A. Caries reduc-
Brazilian children aged 30–59 months. Braz Dent tions between 1995, 1997 and 1999 in preschool
J 2011; 22: 140–145. children in Diadema, Brazil. Int J Paediatr Dent 2002;
22 Locker D. Disparities in oral health-related quality of 12: 183–188.
life in a population of Canadian children. Community 26 Barbosa TS, Gavi~ ao MB. Oral health-related quality
Dent Oral Epidemiol 2007; 35: 348–356. of life in children: part III. Is there agreement
23 Piovesan C, Antunes JL, Guedes RS, Ardenghi TM. between parents in rating their children’s oral heal-
Impact of socioeconomic and clinical factors on child th-related quality of life? A systematic review. Int J
oral health-related quality of life (COHRQoL). Qual Dent Hyg 2008; 6: 108–113.
Life Res 2010; 19: 1359–1366. 27 Abanto J, Tsakos G, Paiva SM et al. Cross-cultural
24 Paula JS, Leite IC, Almeida AB, Ambrosano GM, adaptation and psychometric properties of the Bra-
Pereira AC, Mialhe FL. The influence of oral health zilian version of the Scale of Oral Health Outcomes
conditions, socioeconomic status and home envi- for-5-year-old children (SOHO-5). Health Qual Life
ronment factors on schoolchildren’s self-perception Outcomes 2013; 11: 16.
© 2014 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd