final chapter 1-5
TRANSCRIPT
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Chapter 1
INTRODUCTION
The word health was derived from Old English hl. Ultimately from a
prehistoric Germanic base that is also the ancestor of English HEAL and WHOLE, the
underlying idea being of wholeness. General well-being of a person is devoted not
only to the maintenance of physical and mental function, but also to the uplifting of
social and spiritual well-being.
Oral health is an integral part of general health that contributes to overall
health. When oral health is compromised, overall health may be diminished. (Gift,
1995) But it seems we are more focused on our medical health and neglecting our
dental health. Literally speaking, an exactly opposite practice against the old Filipino
proverb, Ang sakit ng kasu-kasuan ay ramdam ng buong katawan. Thus, no matter
how agile or strong we are physically, a tooth can weaken and prevent us from doing
our usual activities.
In the medical field, emphasis is given on the quality of life before, during and
after treatment. In dentistry, measures of the oral diseases present diminutive insighton the impact of disorders in the mouth that can affect daily living.
The use of professional dental health services in the Adventist University of
the Philippines-College of Dentistry is mainly limited to the socio-economically
disadvantaged patients. This, however, affects the daily living attributed to oral
diseases and disorders leading to compromised physical and psychosocial functioning
consequently posed by non health services utilization.
Statement of the Problem
The Adventist University of the Philippines College of Dentistry provides
dental services to the community as part of its outreach program. The community also
serves as the main pool of dental patients for the student clinicians of the college. In
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order to provide the patients with better service, there is a need to understand how
oral diseases and disorders affect their daily living. This information can be used for
the development of appropriate oral health programs and services for the patients of
the AUP-College of Dentistry as well as a baseline for outcome evaluation of the
outreach to the community.
General Objectives
To determine the social impact of oral health among Adventist University of
the Philippines- College of Dentistry patients seen from March to May 2007.
Specific Objectives
To determine the prevalence of impact of oral conditions among AUP patients
To determine the severity of impact of oral condition using mean OHIP scores
To compare OHIP score by education, age and gender
To determine the association of OHIP scores and oral conditions (DMFT).
Conceptual Framework
Figure 1.1 Conceptual Framework
2
Oral health status
(DMFT)
Demographic Variable
(age, gender & education)
Outcome of Oral Health on
Daily Living
(OHIP)
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Scope and Limitation
This study was conducted to determine the impact of oral health conditions on
the daily living of Adventist University of the Philippines-College of Dentistry
patients from March to May 2007. Oral health status was measured using the DMFT
index and does not include any indicators for periodontal and prosthetic problems.
Significance of the Study
This study will benefit the following:
1. This study will add to existing information that has been gathered
on the effects of oral diseases on daily living among Filipinos. So far, two social
impact studies have been conducted in the Philippines (Yanga-Mabunga, 1999
and Yanga-Mabunga and Serraon 2002) and will provide better understanding
on the social implications of oral health on Filipino populations. The Adventist
University of the Philippines College of Dentistry can utilize this initial study as
baseline data, and will allow for the planning and provision of oral health
services for the college.
2. In community, this study documents burden of illness and
provide evidence for the advocacy for higher priority on oral health and
demonstrates the effect of oral diseases on daily living of Filipinos. It
emphasizes importance of oral health even if most dental conditions do not have
fatal outcomes.
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Definition of Terms
Discomfort- Restrictions in activity and subjective appraisals of well beings.
Discomfort treated as a socio-medical measure because it is subjectively perceived
and may be experienced in the absence of underlying clinical indications.
Disability-A behavior concept defined as any limitation in or lack of ability to
perform the activities of daily living, physically, psychological, or socially (e.g.
activity restrictions, limitation in usual social roles, anxiety, and depression).
DMFT- It is an abbreviation for Decayed Missing Filled Teeth. It is a dental indices
that measures decayed, missing, and filled tooth by intraoral examination of all teeth
with the use of mouth mirror and explorer. Its main interest is to find out decay.
Functional Limitation- Restriction in the functions customarily expected of the body
or its organ components or system (e.g. assessment of jaw mobility, chewing
efficiency).
Health- It is the general condition of the body, mind and spirit, especially in terms of
the presence or absence of illness, injuries, problems and impairments.
Oral Health- A standard of health of the oral tissues that contributes to overall
physical, mental and social wellbeing by enabling individuals to eat, communicate
and socialize without discomfort or embarrassment and which allows them to
continue in their chosen social roles.
Oral Health Impact Profile- A self administered questionnaire intended to measures
people's perceptions of the social impact of oral disorders on their well-being. It
contains questions that capture seven conceptually formulated dimensions based on
Locker's theoretical model of oral health adapted from the WHO framework used to
classify impairments, disabilities and handicaps.
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Handicap- It is one of the disadvantages due disease either as loss of opportunities,
actual material and social deprivation and dissatisfaction.
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Chapter 2
REVIEW OF RELATED LITERATURE
The Oral Health Impact Profile
The Oral Health Impact Profile (OHIP) is a subjective dental measurement
that looks into the impact of oral health on individual (Mabunga, 2002). Its scale is
one of the dental families of health 'quality of life' scales that span the whole range of
medical conditions. These try to put some sort of numerical value on different health
states or outcomes. OHIP is based on a model of oral health adapted for dentistry by
Lockerfrom one proposed by the World Health Organization for general health. The
model proposes that a hierarchy of impacts can arise from oral disease.
Figure 2.1 Lockers Conceptual Model of Oral Health
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DISEASE
IMPAIRMENT
FUNCTIONAL
LIMITATIONPAIN &
DISCOMFORT
DISABILITYPHYSICAL, PSYCHOLOGICAL, SOCIAL
HANDICAP
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OHIP is a 49 item measure, with statements divided into seven theoretical
domains, namely functional limitation, pain, psychological discomfort, physical
disability, psychological disability, social disability and, handicap. An example on an
OHIP statement is have you had to interrupt meals because of problems with your
teeth, mouth or denture. Likert response format (0 = never, 1 = hardly ever, 2 =
occasionally, 3 = fairly often, 4 = very often) is used. Frequency of impacts is
calculated by summing the reported negative impacts (i.e. fairly often or very often)
across the 49 statement. To facilitate assessment of perceived severity of impacts,
each statement has a weight derived using the Thurstones paired comparison
technique. Both overall profile scores and individual sub-scale scores may be
calculated. A major advantage of this measure is that the statements were derived
from representative patient group, and were not conceived by dental research
workers. This increases the possibility of the measure tapping into social
consequences of oral disorders considered important by patients, and is considered to
be the most sophisticated measure of oral health. (Locker 1998)
Table2.1. OHIP-14 questions and its corresponding subscales
Dimension OHIP Question Item
Functional limitations
Have you had any difficulty pronouncing any words
because of problems with your teeth, mouth or dentures?
Have you felt that your sense of taste have worsened
because of problems with your teeth, mouth or dentures?
Physical pain
Have you hadpainful achingin your mouth?
Have you found it uncomfortable to eatany food because
of problems with your teeth, mouth or dentures?
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Psychological discomfort
Have you been self conscious because of your teeth,
mouth or dentures?
Have youfelt tense because of problems with your teeth,
mouth or dentures?
Physical disability
Has your diet been unsatisfactory because of problems
with your teeth, mouth or dentures?Have you had to interrupt meals because of problems
with your teeth, mouth or dentures?
Psychological Disability
Have you found it difficult to relax because of your teeth,
mouth or dentures?
Have you been embarrassed because of problems with
your teeth, mouth or dentures?
Social Disability
Have you been irritable with other people because of
problems with your teeth, mouth or dentures?
Have you had difficulty doing your usual job because of
problems with your teeth mouth or dentures?
Handicap
Have felt that life was less satisfyingbecause of problemswith your teeth, mouth or dentures?
Have you totally unable to function because of problemswith your teeth, mouth or dentures?
The original OHIP scale consisted of 49 questions organized into seven
categories or dimensions. This long form of the OHIP scale would be suitable for use
in clinical practice where a practitioner might want to establish an objective baseline
against which to assess the impact of a course of dental care. A complex course of
restorative treatment can be assessed on a variety of criteria from a technical point of
view but it is less straightforward to assess the effect of it on a patient. One approach
would be to ask the patient to complete the OHIP scale before and after treatment.
This would get round the problems associated with direct questioning, where a patient
may feel constrained about being objective with the dentist who has carried out the
work, or where they may simply be unable to decide whether they feel any better than
in the past. (Nutthal et al, 2001)
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A shorter version of the scale consisting of 14 questions (OHIP-14) was later
developed by Slade. The first step in deriving the shorter form was to eliminate
items that applied only to denture wearers and items where 5% or more responses
were left blank or marked dont know. This percentage of non-response was
selected to identify questions that caused respondents the greatest problems with
interpretation or completion. Statistical procedures (interval reliability analysis, factor
analysis and regression analysis) were then used with the intention of deriving a
subset of approximately 10-15 questions that would capture as much information as
possible from the 49-item OHIP questionnaire. (Slade, 1997)
In the study of Mason et al (2006), factors from early and adult life
contributed to the OHIP scores, but in men, self-perceived oral health was mostly
explained by factors operating early in life. In women, the number of teeth retained in
adulthood had a more prominent impact. Life course influences on oral-health-
related quality of life appear different for men and women, which may have
implications for the effectiveness of public health interventions and health promotion.
According to the Patient-Reported Outcome and Quality of Life Instruments
Database website, several existing OHIP translation had already done. The following
studies of the original OHIP has been in these languages: Chinese for Hong Kong,
French, German, Hebrew, Hungarian, Italian, Japanese, Malay, Portuguese for Brazil,
Spanish and Sweden. The short version (OHIP-14) was also translated in these
languages: Chinese, English for UK, Finnish, German, Portuguese for Brazil and
Sinhalese for Sri Lanka. Still, other languages was not mentioned but there is a vast
translation of this subjective measure which proves it s the most sophisticated, valid
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and reliable instrument to measure oral health related quality of life and it is
applicable for all ages.
Results of Previous Studies
Cross-Cultural studies
A study was therefore undertaken to compare item weights generated by an
Australian sample with those generated by a sample of English-speaking Canadians
and another of French-speaking Canadians. In addition, within-group comparisons by
age were performed. The items and subscales used for the 2 Canadian samples were
identical to those developed in Australia, although a formal French translation was
used for the French-speaking sample. Comparisons were made by means of intra-
subscale weight rankings and magnitude. Spearman's rank correlations of r 2 0.6 were
found for 16/21 between group comparisons and for 12/21, 19/21, and 8/21 within
group comparisons made by age in Australia, Ontario, and Quebec, respectively.
Comparisons of the magnitudes of weights found that, even when items were ranked
similarly, magnitudes could be quite different. These results suggest a reasonable
degree of cross-cultural consistency, and hence validity, for the OHIP. (Allison et Al.
1999)
Spanish Version
A Chilean dentist proficient in Spanish and English translated the 49 items of
the original version of OHIP into Spanish. Special attention was given to develop a
questionnaire conceptually equivalent to the original version in order to maintain
cross-cultural equivalence. The translation was then revised independently by two
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bilingual dentists, fluent in both Spanish and English, who gave feedback regarding
the understanding and semantics of the translation. Following revision, the Spanish
version was back-translated to English by an independent bilingual dentist (PS) who
had never seen the original version of the OHIP. The back translation (OHIP-Sp) and
the original version of OHIP were then compared in order to identify conceptual
differences.
To compare the validity of OHIP-Sp in discriminating between groups with
and without oral conditions, the mean OHIP-Sp scores were compared between
subjects with and without the four oral health outcomes investigated using the Mann-
Whitney test. We hypothesized that subjects with poor oral health outcomes would
have higher OHIP-Sp scores.
The comparison between the original OHIP questionnaire and the back
translated English version did not reveal conceptual content differences. The
participation rate was high (99.9%) and the completeness of the self-answered OHIP-
Sp questionnaire was high with about 99% of the students answering at least 44 items
and 87.2% of the subjects answering all 49 questions.
The translation process from English to Spanish was straightforward and the
comparison between the original OHIP questionnaire and the back translated English
version did not reveal conceptual content differences. The equivalent words needed
for translation of the questions were not difficult to find, and the grammar structure of
the sentences was not difficult to build during the translation process, possibly owing
to the fact that English and Spanish share a common Latin background.
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The OHIP-Sp revealed suitable convergent and discriminative validity and
appropriate internal consistency (Cronbach's ). Further studies on OHIP-Sp warrant
the inclusion of populations with a higher disease burden; and the use of test-retest
reliability exercises to evaluate the stability of the test.
German Version
Their study is to investigate the dimensional structure of Oral Health related
Quality of Life (QHRQoL) measured by the Oral Health Impact Profile- German
Version (OHIP-G) and to derive a summary score for the instrument. Their subjects
came from a national survey. We used rotated principal components analysis to
derive a summary score and to explore the dimensional structure of OHIPG. The first
principal component explained 50% of the variance in the data. The sum of OHIP-G
item responses was highly associated with the first principal component (r = 0.99).
This simple but informative OHIP-G summary score may indicate that simple sums
are also potentially useful scores for other OHRQoL instruments. Four dimensions
(psychosocial impact, orofacial pain, oral functions, and appearance) were found.
These OHIP-G dimensions may serve as a parsimonious set of OHRQoL dimensions
in general.
Finnish Version
They are trying to evaluate the reliability of the Finnish translation of the short
version of Oral Health Impact Profile (OHIP-14) and to report the impacts of oral
health among adults in three Finnish towns: Espoo, Jyvskyl and Kemi. Methods:
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Respondents (total n=311, persons aged 21-94 years) completed the 14-item Oral
Health Impact Profile questionnaire. Results: The percentages of people reporting to
have following item-specific conditions occasionally or more often (vs. never or
hardly ever) because of the problems with their teeth, mouth or dentures during the
last month were: trouble pronouncing words (12%), sense of taste worsened (11%),
painful aching (30%), uncomfortable to eat (30%), self-conscious (22%), feeling
tense (13%), unsatisfactory diet (8%), interrupted meals (11%), difficulties to relax
(11%), feeling embarrassed (13%), irritable with other people (7%), difficulties doing
usual jobs (3%), feeling that life in general is less satisfying (10%) and totally unable
to function (1%). The severity score of impact (computed by summing the ordinal
response code for all 14 items) was higher among people having no natural teeth
compared to people with natural teeth (means 10.6 vs. 4.9, p
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subjects by a trained interviewer. 585 individuals aged 60 years and above were their
respondents. The reliability of the translated scale was assessed in terms of internal
consistency using Cronbach's alpha. Construct validity was evaluated by examining
the associations between perceived oral health status, perceived need for dental care
and the OHIP scores. The translated scale was 0.93. Corrected item-total correlation
coefficients ranged from 0.53-0.80. The highly significant associations between
perceived oral health status, perceived need for dental care and the OHIP scores
support the construct validity of the translated scale. The Sinhalese translation of the
OHIP-14 is a valid and reliable instrument to measure oral health related quality of
life in older adults of Sri Lanka.
Malaysian Version
In their study, they describe the development of a short version of the
Malaysian Oral Health Impact Profile. The 45-item OHIP(M) was shortened using a
method known as the 'item frequency method'. Here, the two most frequently reported
items from each of the seven OHIP(M) subscales were chosen to form the short
version, designated as the S-OHIP(M). Field testing was conducted to assess the
effect of different modes of administration (mail versus interview) of the short form
and to test its measurement properties (reliability and validity). A total of 206
respondents completed the questionnaire. In order to carry out testretest analysis, a
second administration was carried out 15 days after the first administration on a
selected subsample. The mail questionnaire had a lower response rate and a higher
percentage of missing data than the interview administered questionnaire. However,
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the mail mode of administration resulted in higher scores than interview. Cronbach's
alpha was 0.89 and the ICC was also 0.89. All hypotheses developed to assess
validity were confirmed. The S-OHIP(M) was found to be valid and reliable and
appropriate for use in the cross-sectional studies in Malaysian adult populations.
Philippine Study
The initial study on the social impact of oral disorders among Filipino workers
employed by multinational companies done in 1996 by Mabunga yielded an overall
prevalence of impact of 29.8 per cent. The low intraclass correlation coefficient for
social disability and handicap was consistent with the findings of Slade and Spencer.
They attributed it to the low frequencies of reported impacts belonging to these two
subscales. The results of the 1996 study were assumed to be lower estimates of
impact of oral conditions among Filipino populations who have less access to oral
health care services.
Hence, the study of the University of the Philippines- College of Dentistry
patients was compared to the workers impact profile of oral health. Results indicate
that the patients seeking oral care at the University of the Philippines-College of
Dentistry dental clinic have worse oral conditions, have higher impact scores and
prevalence (42.4 percent). University of the Philippines- College of Dentistry had
higher OHIP scores or severity of impact compared to the 1996 study.
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Chapter 3
METHODOLOGY
Research Design
The cross-sectional study design was used. It involves observation of some
set of a population of items all at the same time. For this study, dental conditions and
socioeconomic variables were measured with OHIP scores at one time.
The Adventist University of the Philippines is the only private University in
the whole province of Cavite that offers Dentistry program. Like other dental schools
in the country, the Adventist University of the Philippines- College of Dentistry
accepts dental patients into the dental clinics to provide training for undergraduate
dental students. These services are ample and include all aspects of dental clinical
care and are usually provided at very minimal fees.
The sources of data in this research were based on patients chart as well as the
self administered survey questionnaires regarding Oral Health Impact Profile.
Only incoming patients ages 16 to 70 years old were included in the study.
Data Collection and Development of Instrument
Self administered survey forms were distributed to the incoming patients who
sought dental treatment at the AUP- College of Dentistry Clinic. The form contains
questions about patients socio-demographic profile, dental health seeking behavior,
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forms of restricted activities and the Oral Health Impact Profile 14. The first page of
the questionnaire contained information about the study as well as a request for their
voluntary participation to the study.
Clinical data was based on clinical records which were verified for case
approval by the Clinical Instructor.
Sampling Design
The population size was roughly estimated by looking at the flow of patients
in Adventist University of the Philippines- College of Dentistry Dental Clinic. It is
estimated that there were approximately 1600 patient attended per year.
Expected frequency of 42% (reported with impact) was based from the study
of Yanga-Mabunga and Serraon conducted among in the University of the
Philippines- College of Dentistry patients in 2002. From this information, a
sampling size of 97 was derived using the EPI Info Stat Calculator (EPI INFO 6).
A total of 97 self reported questionnaires and clinical form were included in
the study. Approximately 7 questionnaires were disregarded due to incomplete
answer or wrong age group
Statistical Treatment
In OHIP Measurements, missing values for the OHIP 14 items was replaced using
serial means. Weighted OHIP scores were derived by multiplying the OHIP
scores (very often = 4, fairly often = 3, occasionally = 2, hardly ever = 1,
never = 0), with predetermined OHIP 14 items weights. Dont know was
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likewise given a score of 0. Total OHIP scores will be computed by adding all
weighted OHIP scores for the 14 items.
Prevalence of impact was computed by counting the number of persons who
reported at least one impact experience very often and or fairly often.
Prevalence of impact and mean OHIP scores by subscales were also derived
by counting the number of persons who experience an impact of the tow items
per subscales at least once, and by adding the weighted OHIP scores by
subscales respectively.
For DMFT measurements, this was based on the patients chart approved by the
Clinical Supervisor in charge. The formula for the DMFT per person is equals
to the summed number of decayed, filled, missing teeth divided to the total
number of teeth.
The mean DMFT for the whole study population is the
sum of all DMFTs over the total number of persons examined a. The
formula for the individual components are enumerated below:
Decayed Percentage Component= Total Decayed/ Total DMFT x 100
Filled Percentage Component= Total Filled/ Total DMFT x 100
Missing Percentage Component= Total Missing/ Total DMFT x 100
Comparison of means and bivariate analysis of OHIP scores and DMFT were also
done.
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Chapter 4
RESULTS, ANALYSIS AND INTERPRETATION OF DATA
This chapter presents a detailed analysis and interpretation of the data used for
determining the oral health impact profile among Adventist University of the
Philippines- College of Dentistry patients. It also presents the discussion on the
analysis and interpretation of the collected data.
I. SOCIO-DEMOGRAPHIC PROFILE OF THE STUDY SAMPLE
Table 1 presents a summary of the sociodemographic profile of patients
included in the study.
Socio-Demographic profile Frequency Percentage
Age
16-26 45 50.0
27-37 19 21.138-48 20 22.2
49-59 4 4.4
60-70 2 2.2
Total 90 100%
Gender
Male 35 38.9
Female 55 61.1
Total 90 100%
Educational Attainment
Grade School 7 7.8High School 35 38.9
College Undergraduate 31 34.4
College Graduate 5 5.6
Vocational Graduate 12 13.3
Total 90 100%
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Age
Only 2.2 per cent or 2 respondents of the study sample( N=90) belonged to the
60 to 70 age group while another 50 per cent or 45 respondents belong to the 16-26
age groups. The remaining 47.7 per cent (43) belong to the 27 to 59 age group.
Figure 2. Age distribution in years of AUP- College of Dentistry patients
Gender
Figure 3 Shows that more than half (61.1 per cent) of the study sample are
females (55 respondents) while only 30.9 per cent of the study sample were males (35
respondents).
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Figure 3. Gender distribution of AUP- College of Dentistry patients
Educational Background
Some 38.9 per cent of all participants reported that they attended high school
(35 respondents), 34.4 per cent had college education (31 respondents), and 13.3 per
cent received college degree (5 respondents). Only 7.8 per cent had grade school
education (7 respondents), while 4.6 per cent had vocational training (12
respondents).
Figure 4. Educational attainment distribution of AUP- College of Dentistry patients
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II. CLINICAL PROFILE OF THE STUDY SAMPLE
Table 4.1 Mean DMFT Index
N Mean
Standard.
DeviationNumber of Decayed Teeth 90 10.68 5.45
Number of Filled Teeth 90 1.09 2.28
Number of Missing Teeth 90 5.38 7.00
DMFT 90 17.14 7.27
Table 4.1 presents the descriptive statistics for the DMFT. Each person in the
study has an average number of 10.68 decayed teeth (standard deviation=5.45). The
average number of filled teeth is 1.09 (standard deviation=2.27), and an average
number of missing teeth of 5.38 (standard deviation=7.00). The mean DMFT index
of the study sample was 17.14 (standard deviation=7.2) or each person in the study
had average of 17.14 decayed, filled or missing teeth.
Table 4.2 Percentage component of the DMFT Index
Frequency Percentage
Decayed Teeth 961 62.28
Missing Teeth 484 31.37
Filled Teeth 98 6.35
DMFT Total 1543 100
The decayed, missing and filled percentage components in table 4.2 indicate
that the study sample had very little filled teeth (6.35%) with 31.37 percent of missing
teeth and the highest was decayed teeth (62.28%). This indicates that the index of
care for this group of patients is very low. The relatively high number of missing
teeth may indicate a tendency to have teeth extracted rather than undergo other
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treatment modalities such as root canal therapy possibly due to economical reasons
and perceived pain of dental treatment.
Oral Health Impact Profile
Table 4.3 Prevalence of Impact
Prevalence
Frequency Percent
With no reported impact 50 55.6
With at least one reported impact
(fairly often and always)
40 44.4
Total 90 100
Table 4.3 presents the prevalence of impact of AUP-College of Dentistry
patients. 0.0 represents the number of individual who answered 3 or higher scores on
OHIP items. While those with reported prevalence represents cases who reported
impact scores fairly often and always. The prevalence of impact due to oral
conditions from this study is consistent with the University of the Philippines-
College of Dentistry study of 42.4 percent but much higher compared with the
original study among workers of 29.8 per cent.
Table 4.4 Prevalence of the oral health impact by OHIP item.
OHIP Items Prevalence of Impact
% Rank
Self conscious 26.7 1
Life less satisfying 16.7 2
Felt tense 16.6 3
A bit embarrassed 13.3 4Irritable with others 11.1 5
Uncomfortable to eat 7.8 6
Unsatisfactory diet 7.8 6
Difficulty to relax 7.8 6
Difficulty doing job 7.8 6
Unable to function 6.6 7
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Had to interrupt meals 4.4 8
Difficulty pronouncing words 3.3 9
Sense of taste affected 3.3 9
Painful aching 0 10
Table 4.4 presents the prevalence of impact for each question item. The five
most frequent impacts experienced due to problems with the teeth, mouth or dentures
are the following:
1. Self consciousness
2. Life less satisfying
3. Felt tense
4. A bit embarrassed
5. Irritable with others
Self-consciousness and felt tense are under the subscale of psychological
discomfort. Life less satisfying falls under the handicap. A bit embarrassed is
categorized as an item under psychological disability while being irritable to others
falls under the social disability subscale. The three least frequent impacts, on the
other hand are:
1. Painful aching
2. Difficulty pronouncing words
3. Had to interrupt meals
Mean OHIP scores
Table 4.5 the Oral Health Impact profile of the respondents
Mean Standard
Deviation
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Self conscious 1.59 1.35
Life less satisfying 1.29 1.24
Felt tense 1.24 1.18
Uncomfortable to eat 1.23 0.99
A bit embarrassed 1.18 1.21
Irritable with others 1.1 1.11Difficulty to relax 1.01 1.06
Difficulty doing job 1 1.1
Unsatisfactory diet 0.96 1.1
Had to interrupt
meals 0.92 1.07
Unable to function 0.87 1.05
Painful aching 0.8 0.82
Sense of taste
affected 0.69 0.92
Difficulty
pronouncing words 0.68 0.92
Table 4.5 presents the mean OHIP scores for each item in the OHIP-14
questionnaire. The result shows that impact item of Self-Conscious has the highest
mean followed by Felt Tense and Life Less Satisfying. Difficulty in Pronouncing
Words had the least mean OHIP scores.
Table 4.6 OHIP scores by subscale
Mean
Std.
Deviation
Psychological Discomfort 1.39 1.09
Physical Pain 1.12 0.82
Handicap 1.12 1.05
Psychological Disability 1.07 0.95
Social disability 1.06 0.97
Physical Disability 0.94 0.95
Functional Limitations 0.68 0.81Total OHIP 7.40 6.66
Table 4.6 presents the OHIP scores by subscale. Mean OHIP scores were
computed by multiplying the Likert scores with predetermined weights. The highest
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mean OHIP scores were for psychological discomfort followed by pain and handicap.
Lowest mean weighted scores were for functional limitation and physical disability.
Table 4.7 Prevalence of impact by subscales
OHIP Subscales Prevalence of Impact
Count %
Psychological Discomfort 29 32.2
Psychological Disability 16 17.7
Handicap 15 16.6
Social disability 11 12.2
Physical Pain 7 7.7
Physical Disability 7 7.7
Functional Limitations 6 6.6
Table 4.7 Prevalence of impact by subscales was also derived by getting the
number of persons who reported at least one impact experienced fairly often and very
often for the two question items per subscale. 32.2% (number = 29) of the study
sample experienced some form of psychological discomfort due to oral conditions.
This item had the highest percentage for all kinds of impact. Six (6.66%) reported at
least one impact experienced related to functional limitation.
Relationship of OHIP and sociodemographic variable
Table 4.8 Difference of the OHIP of male and female respondents
Gender N MeanStandard.Deviation
FunctionalFemale 55 0.80 0.85
Male 35 0.50 0.73
Physical PainFemale 55 1.11 0.85
Male 35 1.15 0.78
PsychologicalDiscomfort
Female 55 1.54 1.09
Male 35 1.19 1.09
Physical DisabilityFemale 55 1.01 1.03
Male 35 0.83 0.82
Female 55 1.10 1.02
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Psychological
Disability
Male35
1.04 0.86
Social Disability Female 55 1.17 1.04
Male 35 0.90 0.85
Handicap Female 55 1.34 1.11
Male 35 0.77 0.86
Table 4.8 presents the results of the T-test on independent samples comparing
the OHIP of female and male respondents. The results show that male and female
respondents does not differ on their impact experiences concerning functional
limitations, physical pain, psychological discomfort, physical disability,
psychological disability, social disability.
However, male and female significantly differed in the handicap subscale ( t =
2.597) at 0.05 p value. This implies that female respondents (mean = 1.34)
experienced handicap impact more often than male respondents (mean = .77). This
finding is also consistent with previous study by Mabunga and Serraon (2002) who
reported that female UPCD patients had higher impact scores than male UPCD
patients.
Table 4.9 Educational Background on OHIP subscales
N Mean
Standard
Deviation
Functional Grade school 7 1.07 0.98
High School 35 0.70 0.89
College
Undergraduate
31
0.60 0.74Vocational
Graduate5
0.70 0.76
College
Graduate12
0.63 0.74
Total 90 0.68 0.81
Physical Pain Grade school 7 1.42 0.83
High School 35 1.06 0.88
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College
Undergraduate31
1.14 0.88
Vocational
Graduate5
0.86 0.55
College
Graduate
12
1.19 0.56Total 90 1.12 0.82
Psychology
Discomfort
Grade school 7 1.11 0.91
High School 35 1.22 1.13
CollegeUndergraduate
311.63 1.13
Vocational
Graduate5
0.69 0.73
College
Graduate12
1.78 1.01
Total 90 1.40 1.10
PhysicalDisability
Grade school 7 1.07 0.93High School 35 0.89 1.00
College
Undergraduate31
0.92 1.01
VocationalGraduate
51.30 0.84
College
Graduate12
0.92 0.80
Total 90 0.94 0.95
PsychologicalDisability
Grade school 7 1.69 0.96
High School 35 1.06 0.94
CollegeUndergraduate
311.00 0.99
Vocational
Graduate5
0.80 1.02
CollegeGraduate
121.10 0.89
Total 90 1.08 0.96
Social
Disability
Grade school 7 1.64 1.08
High School 35 1.01 0.98College
Undergraduate31
1.16 1.06
VocationalGraduate
50.48 0.53
College
Graduate12
0.85 0.65
Total 90 1.06 0.97
Handicap
Grade school 7 1.23 1.17
High School 35 1.12 1.11
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College
Undergraduate31
1.12 1.09
Vocational
Graduate5
1.44 1.09
College
Graduate
12
0.90 0.81Total 90 1.12 1.05
Table 4.9 presents the analysis of variance comparing the OHIP across
educational backgrounds. Results show that respondents with different educational
background did not differ in their impact experiences.
Table 4.10 Sum of Ranks of DMFT in male and female respondents
Gender NMeanRank
Sum ofRanks
DMFT Female 55 48.42 2663.00
Male 35 40.91 1432.00
Total 90
No. of
DecayedTeeth
Female 55 45.67 2512.00
Male 35 45.23 1583.00Total
90
No. of
Missing
Teeth
Female 55 48.72 2679.50Male 35 40.44 1415.50
Total
90
No. of Filled
Teeth
Female 55 44.61 2453.50
Male 35 46.90 1641.50
Total 90
Table 4.10 presents the sum of ranks on the difference in DMFT of Male and
female respondents. Results show that male and female respondents do not differ in
the no. of decayed teeth no. of missing teeth and no. of filled teeth.
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OHIP and Dental Conditions
Table 4.11 Correlation Coefficients of DMFT and OHIP
Number of
Decayed
Teeth
Number of
Missing
Teeth
Number of
Filled Teeth DMFT
Pearson Correlation
Function Limitation 0.055 0.217* -0.026 0.242
Physical Pain 0.021 0.07 -0.058 0.064
Psychological
Discomfort 0.024 0.107 0.03 0.13
Physical Disability 0.125 0.052 -0.041 0.131
Psychological Disability 0.01 0.219* 0.046 0.233
Social Disability 0.132 0.102 -0.113 0.163
Handicap 0.06 0.045 -0.055 0.071** Correlation is significant at the 0.01 level (2-tailed).
* Correlation is significant at the 0.05 level (2-tailed).
Table 4.11 presents the correlation analysis on the DMFT and OHIP. Results
shows that the number of missing teeth is significantly related to functional
limitations (0.217) and psychological disability (0.219) at 0.05 level of significance.
This implies that a person with higher number of missing teeth experience functional
limitation and psychological disability more often than those with lesser no. of
missing teeth. Likewise, the overall DMFT score is also significantly related to
functional ability (0.242) and psychological disability (0.233) at 0.05 level of
significance. However, the number of decayed teeth and filled teeth is statistically
not related to any of the impact considered in this study.
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CHAPTER 5
SUMMARY, CONCLUSION & RECOMMENDATIONS
This chapter summarizes the findings of the OHIP-14 study conducted among
Adventist University of the Philippines- College of Dentistry patients in Silang,
Cavite. These summary findings are enumerated according to the following research
questions:
1. What is the prevalence of impact of oral conditions among Adventist
University of the Philippines- College of Dentistry patients?
Some 44.4 per cent of the entire study sample reported experiencing an
impact due to oral conditions during the past year. This represents a fairly
large number of individuals who have been affected by oral health
problems in their daily living.
The three most frequent impacts experienced due to problems with the
teeth, mouth or dentures are self consciousness (psychological
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discomfort), life less satisfying (handicap) and felt tense (psychological
discomfort).
The three less frequent impacts experienced are painful aching (pain),
Difficulty pronouncing words (functional limitation) and had to interrupt
meals (physical disability).
2. What is the severity of impact of oral condition using mean OHIP scores?
The result shows that impact item on self-conscious had the highest
mean followed by felt-tense and life less satisfying. Difficulty in
pronouncing words followed by sense of taste affected had the lowest
mean OHIP scores.
This study demonstrated that the Adventist University of the
Philippines- College of Dentistry patients experienced psychologic
disabilities and discomforts due to oral conditions. It also showed that
functional limitations have the least mean of OHIP scores in terms of
subscale dimension.
3. Will there be differences in the OHIP scores of Adventist University of the
Philippines- College of Dentistry patients by education, age and gender?
No differences were observed in the OHIP scores by education and
gender. However female patients reported higher handicap impact than
male respondents. This can not be attributed solely to oral conditions,
because there was no difference in the DMFT scores. Higher handicap
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experience among female may be due to other reasons aside from oral
condition.
4. Is there an association of OHIP scores and oral conditions thru DMFT?
The number of missing teeth is greatly related to functional limitations
and psychological disability. This shows that a person with higher number
of missing teeth experience functional limitation and psychological
disability more often than those with lesser number of missing teeth.
But the number of decayed and filled teeth is statistically not related to
any impacts considered in the study.
Conclusion
The psychological discomfort in terms of self-consciousness and less than
satisfying life in terms of handicap were the most observed impact of dental
conditions among Adventist University of the Philippines-College of Dentistry
patients. The study also documented fairly high prevalence of impact among AUP
patients and the need to provide for comprehensive holistic management of their
dental conditions.
Recommendation
This study provides evidence of the importance of psychological wellness in
oral health and stresses the need to consider psychological needs of patients in
clinical practice. There is also need to advocate for more priority for oral health since
almost half of patients seen in Silang, Cavite reported being affected by dental
conditions in their daily living.
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It is recommended that more studies related to patient perceived outcomes be
conducted among AUP patients to evaluate the effect of dental clinic to its clients,
and also to provide more evidence, data on the burden of illness due to oral
conditions.
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