Impact of oral conditions on quality of life in schoolchildren in urban area of Cuenca-Ecuador

Rev Estomatol Herediana. 2018 Jul-Set;28(3). 1 Universidad Técnica Particular de Loja. Loja, Ecuador. 2 Facultad de Estomatología Roberto Beltrán, Universidad Peruana Cayetano Heredia. Lima, Perú. a Doctor en Odontología. Maestría en Gerencia en Salud. Maestría en Estomatología. b Especialista en Carielogía y Endodoncia, Magister en Estomatologia, Docente del Departamento Académico de Medicina, Cirugía y Patología Oral. c Especialista en Salud Pública. Magíster en Estomatología. Magíster en Salud Pública. Docente del Departamento Académico de Odontología Social. Artículo Original / Original Article


INTRODUCTION
In Ecuador one of the goals established by the World Health Organization (WHO) and the International Dental Federation (FDI) for the year 2000 was that 50% of the population at the age of 6 years should be free of cavities.However, the National Epidemiological Study of Oral Health in Children under 15 years of Ecuador 2009 -2010 reveals that only 20.1% of schoolchildren in Ecuador at that age are healthy, so there is still a high Caries prevalence in Ecuadorian children (79.9% at 6 years and 88.2% in the school group from 6 to 15 years old) (1).Consequently, the Ecuadorian health system is focused on controlling the disease (2).In 2009, the Ministry of Public Health of Ecuador (MSP) approved the Standardization of the National Health System, Oral Health Area (3), and in 2013 the "National Plan for Good Living" (4).
In recent years, oral health and its deterioration have been related to emotional and social perceptions.In this sense, Quality of Life is defi ned as: "the perception of the individual about his position in life within the cultural context and the value system in which he lives and with respect to his goals, expectations, norms and concerns" (5), being the best way to measure and evaluate this relationship through a multidisciplinary approach (5), using instruments that integrate clinical and psychometric aspects through analog scales designed to measure HRQOL in children such as the Child OIDP index, instrument developed by Gherunpong et al., (6,7); validated in several countries and languages (8)(9)(10)(11) is an instrument that relates the impact of 17 oral conditions, on 8 habitual performances that characterize well-being and HRQOL in adolescents (6,7) ).
In the present study, the instrument validated in Peru was used in the same way that they used: Sánchez et al., (12); which evaluated the impact of oral conditions on quality of life in four public schools in Puente Piedra, Lima; fi nding that the prevalence of impacts of oral conditions on daily performances was 82.0% and the Index reached an average score of 7.77.On the other hand, Del Castillo (13) in the rural area of Piura, could determine that 88.7% of schoolchildren reported one or more of an impacted performance (Child-OIDP> 0) and the average of self-perceived oral conditions as a problem was 1.14 ± 0.66 conditions.Also, Paredes in a school in San Juan de Mira-fl ores, Lima; in 2013, in 169 schoolchildren, it was determined that the prevalence of the impact of oral conditions on the quality of life of 11-and 12-yearold school children was 100%, with at least one daily performance impacted, being the most affected: eating and smiling (14).
On the other hand, Ingunza in Callao, Lima, using the Child OIDP Index in 132 schoolchildren found that 100% of the schoolchildren interviewed reported at least one affected daily performance and the average of self-perceived oral conditions as a problem was 4.52 ± 1.96; fi nally the global Child-OIDP Index was 9.71 ± 7.63, where eating performance was the highest, mainly due to tooth pain (15).All these studies show self-perceived oral conditions that affect the quality of life related in oral health.
The objective of this study was to determine the impact of oral conditions on the quality of life of 11and 12-year-old schoolchildren in public elementary schools Ulises Chacón and Ezequiel Crespo Ambrosi, located in the urban area of the city of Cuenca.Ecuador, the year 2015.

MATERIALS AND METHODS
Descriptive and cross-sectional study, the population consisted of 284 schoolchildren from two public, urban schools in the city of Cuenca, Ecuador.Simple random sampling was used and 106 schoolchildren were sampled, however the sample was fi nally made up of 208 schoolchildren of 11 and 12 years old, of both sexes.An average age of 11.48 ± 0.501 was determined, where 159 (76.44%) were male and 49 (23.56%) were female.This was handled and was approved by the Institutional Ethics Committee of the Universidad Peruana Cayetano Heredia No. 118-07-15 (from March 22, 2015); for conducting the research was calibrated by an expert, it was approved of the school authorities, the informed consent of the parents and the informed consent of the schoolchildren; in addition, the respective selection criteria were considered.The questionnaire was administered individually, using a school time of 8 to 10 minutes, in the fi rst hours of the school day.
The data collection was carried out in two stages: In the fi rst stage, the students were asked to identify from a list of the 17 oral conditions, those that produ-ced oral health problems in the last three months, and for a positive response they were asked which of these problems made it diffi cult for them to perform any of the eight daily tasks: eating, talking, cleaning their mouths, sleeping, emotion, smiling, studying and socializing.For frequency the student was asked that according to the problems he pointed out in the mouth or teeth, the diffi culty for (performance) has been presented to him: once or twice in a month?(which corresponds to value 1); three or more times in a month?(for value 2) or more than three times in the last three months?(according to the scale corresponds to value 3).The second part, following the scheme suggested by Gherunpong et al (7); allowed to determine: Severity, intensity and extent of the impact.In severity, a sheet with a growing arrow was presented to the scholar where, he identifi ed, the severity with ranges corresponding to (1 little, 2 regular, 3 a lot).
The scores of the Child-OIDP Index or the impact of the oral conditions on each daily performance were calculated by multiplying the severity of the impact by frequency (1,2,3) of the impact for each habitual performance (range 0 to 9) and obtaining the average score for each performance and for the total performance (range 0 to 72) then multiplying by 100; and dividing it by 72; from which the overall score of the Child-OIDP Index is extracted whose highest values indicate a greater change in quality of life.
To determine the intensity, it was necessary to count on the frequency, and this is valued in fi ve categories, from "very low intensity", "low", "moderate", "severe", to "very severe intensity" and fi nally; extension of the impact of oral conditions on performance, corresponded to the number of daily performances affected, which could range from the value 0 (which means no performance impacted) to the value 8 (all performances impacted) and averaged the number of performances impacted among school children.
Absolute and relative frequency distribution tables are presented, means and standard deviations were calculated.The bivariate analysis was carried out using the Chi-Square test and Mann-Wihtney U test to associate HRQoL with sex.For the analysis of the extension according to covariates, the Test T test was used.The p value, or value of statistical signifi cance, was extracted and the study had a confi dence level of 95%.

RESULTS
In the present cross-sectional study carried out in the urban area of Cuenca, Ecuador, a sample of 208 schoolchildren aged 11 and 12 years was compiled, who met the selection criteria and their parents gave their informed consent and the schoolchildren gave their assent.It was determined that of the 17 oral conditions self-perceived as problems, (Frequency of schoolchildren with one or more impacts of oral conditions) the most frequent conditions were: Position of teeth with 113 schoolchildren (54.3%), decayed tooth 109 schoolchildren (52%) and with the same number of sensitive tooth and color of the teeth with 97 schoolchildren (47%); It is important to mention that 90 schoolchildren manifested gum bleeding (43%); while the less frequent ones were: tooth fracture and tooth loss; likewise none reported self-perceived deformity of the mouth.No statistically signifi cant association was found between sex and self-perceived oral conditions as a problem (table 1).
Regarding the daily performances that suffer impact, the most impacted and important were: smiling (38%), then eating (36%), cleaning the mouth (24%) and interact with friends (22%).It is important to mention that it was determined that for smiling performance, the highest frequency occurred in the group of women (43%) compared to that of men (36%), however, no statistically signifi cant association was found (Table 2).The prevalence of school children who indicated some impact of oral conditions on their daily performances was high (79%) (table 2); when determining the severity of the impact (or degree of diffi culty to develop the daily performances) in a global way, the performance that presented the highest value was: smiling 1.17 (± 1.024); then eating 1.09 (± 0.934), and then cleaning the mouth 0.79 (± 0.95).Only for performance, speaking 0.21 (± 0.632); a statistically signifi cant difference was found between both sexes (table 3).When comparing severity according to sex, the highest was found coincidentally for women to smile at 1.31 (± 1.14) and 1.13 (± 0.98) (Table 3).
The overall average of the Child-OIDP Index was determined, which was 9.79 (± 7.020); the highest values of the global average in the daily activities were for smiling 2.75 (± 2.88); followed by eating 1.94 (± 2.07); with values ranging from 0 to 9; the least impacted was studying 0.03 (± 0.317) (table 4).
With regards to the intensity of impact, the majority was located in "very little" (44.90%) followed by the "little" level (table 5).The extent of the impact presented a mean of 2.69 (S.D. 1,118 males) with a mi-nimum of 1 affected performance and a maximum of 6, without fi nding statistically signifi cant differences between both sexes (p ˃0.05) (table 6).The participants in this study reported 16 of the 17 oral conditions, consistent with Ingunza (15), and indicated in order: position of the teeth, decayed tooth, sensitive tooth, color of the teeth.Coinciding with the studies of Del Castillo (13); who reports sensitive tee-th and decayed teeth as the second and third most frequent conditions; and Paredes (14) and Ingunza (15), sensitive tooth.Regarding the daily performances for both sexes, the most affected found in the present study was smiling (38%), eating (36%) and cleaning the mouth (24%); agreeing with Del Castillo (13) on the impact of eating (62.7%) and Paredes (14) sequentially found eating, smiling and cleaning, and Ingunza (15) eating and cleaning the mouth.
In severity of the impact, higher averages were found for smiling 1.17The fi ndings in intensity were located at a global level in "very low intensity" for men in (43.4%) and (44.9%) for women; "low intensity" (41.5%) in men and (32.7%) in women being higher for smiling, then eating and cleaning their teeth; with signifi cant differences according to sex for speech performance, having a greater impact on women with a p = 0.006 value.In this variable, Del Castillo (13)  In the extension of the impact, in the present study it was evident that all the students showed a minimum of one and a maximum of six, of eight performances, which differs with the studies of Del Castillo (13), Paredes (14) and Ingunza (15), who obtained averages that varied between zero and eight.No statistically signifi cant differences were obtained.
In this study, the global average of the Child-OIDP Index was high, of 9.79 (± 7.020); similar to Ingunza (15) 9.71; the lowest found was that of Del Castillo (13) 7.05, in the range of 1 to 35.It was found in performances, smiling 2.75 (± 2.88); followed by eating 1.94 (± 2.07) and cleaning the mouth 1.70 (± 2.54); with values ranging from 0 to 9 in all three cases, close to the fi ndings obtained by Del Castillo (13); eating 1.59 (± 1.77) and cleaning the mouth 1.43 (± 1.61) in ranges from 0 to 9 and from 0 to 6, respectively.It is important to mention that Piaget (32,33); considers that in this age (11 and 12 years), the participants already consolidate the abstract thought, therefore; they perceive their poor dental position, this affects the aesthetic image and affects their self-esteem.
In conclusion, the impact of oral conditions on the quality of life related to oral health in urban schoolchildren in Cuenca, Ecuador; it is high with a prevalence of 79% of school children.The oral condition most indicated by the schoolchildren was the positioning of the teeth and by relating the oral conditions with the daily performances and determining the impacts; smiling, the most affected performance.The average severity of the highest impact was found in eating performance.The overall average of the Child-OIDP Index was high, when compared with other investigations.The severity of the impact for schoolchildren of both sexes was found mostly in "moderate" or "regular".The intensity of the impact for schoolchildren of both sexes was found mostly in "very little" and "little".An average considered low was reached for the extension of impacts; coinciding in men and women.
Consequently, it allows us to recommend the urgent need to understand that the measurement of the physical affectation in the oral cavity is not complete when not considering the psychosocial dimension of the person.

Table 1 .
Frequency of Oral Conditions on the Quality of Life Related to Oral Health in schoolchildren in Cuenca, Ecuador.2015 * Chi-Square Test of Homogeneity or Correction by continuity.Impact of oral conditions on quality of life in schoolchildren in urban area ofCuenca-Ecuador Tabla 3. Impact of Oral Conditions on Daily Performance in the Quality of Life Related to Oral Health according to sex in schoolchildren in Cuenca, Ecuador, 2015.* Mann Whitney U test.

Table 2 .
Impact of oral conditions on daily performance on quality of life related to oral health in schoolchildren in Cuenca, Ecuador, 2015 * Chi-Square Test of Homogeneity or Correction by continuity.

Table 4 .
Child OIDP Index by Daily performance in schoolchildren in Cuenca, Ecuador 2015.

Table 5 .
Intensity of the Impact of Oral Conditions on Daily Performance in the Quality of Life Related to Oral Health according to sex in schoolchildren in Cuenca, Ecuador 2015.Impact of oral conditions on quality of life in schoolchildren in urban area of Cuenca-Ecuador

Table 6 .
Extent of the Impact of Oral Conditions in the Quality of Life Related to Oral Health according to sex in schoolchildren in Cuenca, Ecuador.2015