Study regarding the correlation between the Child-OIDP index and

the dental status in 12-year-old children from Harsova, Constanta

county

Cristina Nuc, Corneliu Amariei, Elisabeth Martoncsak, Dan Dumitru Tomi

Constana, Romnia

Summary

The assessment of the individuals' Oral Health Related Quality of Life is commonly made by the
socio-dental indices, used in the same time and compared with the clinical indices of oral health.
The Child Oral Impacts on Daily Performance Index is used for planning the community oral health
programs for children.
The aim of this study is the evaluation of the Oral Health Related Quality of Life in the 12-year-old
children from Harsova (Constanta district), by the use of Child-OIDP Index, and to compare this
relation with the real oral health status of the subjects, appreciated by the DMFT and OHI-S
indices, and by the registration of the dento-maxillary anomalies and the presence of fluorosis.
The results of the study show that the general score of the impacts of the oral condition on the life
quality of the subjects is 64.95%. Even though this value seems not to be related with the DMFT
index (2.59), it is related with the poor oral hygiene (OHI-S = 2.8) and the high prevalence of the
dento-maxillary anomalies (58.97%).
To conclude, we can say that the prevalence of the impacts of the oral condition on the daily per-
formances of children increases with the decrease of their severity. In the same time, the impacts
intensity decreases with the increase of the number of the affected performances.

Keywords: socio-dental indices, oral health related quality of life, child-oral impact on daily
performances.

Introduction a major issue in the health policies of the

developed countries [10].
Only in recent years, the relationship The quality of life sums up several fac-
between the quality of life and oral health tors and variables, both medical and non-
was given the attention it deserves. medical.
Oral Health Related Quality of Life has The relation between the quality of life
become a priority for specialists as late as and oral health is defined as the evaluation,
the 1980s, and then they focused on evalu- both from a personal and a medical point of
ating the consequences of oral disease on view, of the way in which functional, psy-
the life of the individual and the establish- chological (the looks and the self esteem),
ment of proper measures in order to cancel social (interaction and perception) factors
the negative effect of oral disease on the and traumatizing and uncomfortable experi-
quality of life [9]. ences affect an individuals well-being.
Nowadays the evaluation of the relation The report between these factors and
between the quality of life and oral health is the pathology of the dental-maxillary appa-

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 OHDMBSC - Vol. IV - No. 4 - December, 2005

ratus leads to the evaluation of the quality of main characteristics [12,13]. The first, and
life in report to oral health. most important one, is the lack of decision
In the purpose of evaluating this rela- taking capabilty when it comes to maintain-
tion, there are now internationally recog- ing ones own oral health, this decision
nized and adopted methods which material- capabilty belonging to either parents or
ize in social-dental indicators, designed for caregivers. The second main distinction
use on extensive social groups [14]. between the adult patient and child patient is
These indicators are defined as evalu- represented by the very significant differ-
ations of the level to which oral status may rences in quality when it comes to percep-
perturb the performance of social functions tion and experience. Because of these two
and lead to major modifications of behavior factors, the evaluation of a childs quality of
such as work incapacity, school absence, life in report to his/her dental health calls for
parenting and home [12]. means that are specifically adapted to the
These indicators are considered essen- various phases of development [3,15].
tial complementary indicators to clinical From the various socio-dental indices,
analysis and measurable in relation to spe- used for determining the relation between
cific evaluation indicators of oral health the quality of life and oral health, the OHIP
[14]. (Oral Health Impact Profile) and OIDP
Based on numerous and specific ques- (Oral Impact on Daily Performances) are
tions, organized into questionnaires, socio- some of those adapted for use on children.
dental indices measure the relation between The Child-OIDP (the Child Oral
the quality of life and oral health. Impacts on Daily Performance Index) is
This approach attempts to describe spe- used for planning community supported oral
cific experiences and to summarize the health programs for children [7,8].
entire definition of the relation between the This indicator uses two steps:
quality of life and oral health. - the first consists in determining self
The First International Conference on perceived oral health issues by the assisted
Measuring Oral Health and Quality of Life filling of a list of questions containing most
took place in 1997, at North Carolina of the oral pathological conditions which are
University (U.S.A.). Ten questionnaires present during childhood.
were presented and validated as indicators - step two consists in evaluating the
for the measurement of the relationship impact of oral conditions on the quality of
between quality of life and oral health. life of children through the assisted filling
Most of these questionnaires (single interview) of the Child-OIDP indica-
(Sociodental Scale, RAND Dental Health tor questionnaire that focuses on eight
Index, General Oral Health Assessment fields/performances: chewing, speech, oral
Index, Dental Impact Profile, Oral Health hygiene, relaxation (including sleep), smil-
Impact Profile, Oral Health Quality of Life ing, emotional state, study (including class
Inventory, Oral Impacts on Daily attendance and home study), contact with
Performances, Geriatric Oral Health other people. Answering is assisted by
Assessment Index, a.s.o.) were created and images representing either the negative or
used on middle aged and third age popula- the positive side of each performance.
tion [4,5]. The answers to the questionnaire focus
Evaluating the impact of oral health on both on the frequency and the severity of the
the quality of life of children requires spe- oral health issues affecting the quality of the
cific determination methods because they subjects lives, as well as on the perceived
differ from adult patients by at least two intrusion, the reason which, from the sub-

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 OHDMBSC - Vol. IV - No. 4 - December, 2005

jects point of view, caused a certain impact. The evaluation of the real status of the
The aim of this study is to determine subjects oral health, based on the clinical
the relation between the quality of life in 12- oral health indicators, included:
years old children from Harsova, based on - recording of the dental status,
the Child-OIDP index, and the real oral- expressed by the DMFT index; the examina-
health status of the subjects. tion was realized exclusively by clinical
means, respecting the WHO protocol and
Materials and Method criteria (one single examiner, in natural
light, after drying and isolating the teeth,
The study was realized in the town of using the dental probe and the flat mirror);
Harsova, between March and June 2004, on because of this, the DMFT index does not
twelve-year-old subjects. The total number include the initial enamel lesions;
of students of this age at the time was 143. - OHI-S Green oral hygiene index;
The subjects and their legal guardians - registration of dento-maxillary anom-
(parents or caregivers) were informed about alies in accordance with the Angle classifi-
their participation in this study during class- cation;
es. - measurement of dental fluorosis with
The study includes an examination of the Dean indicator.
the oral health state (at the dental office),
filling in a questionnaire and an assisted The evaluation of the relation between
interview, with one interviewer. the quality of life and the oral health by the
The subjects were organized into week- Child-OIDP index (Child-Oral Impact on
ly groups. They made two appointments Daily Performances), following the
each one for the dental exam and for fill- Georgios Tsakos protocol.
ing in the initial questionnaire and the sec-
ond for the interview based on the original First Step First list of questions
Child-OIDP (Child-Oral Impact on Daily
Performances) questionnaire introduced by - filling the first questionnaire (Figure
Georgios Tsakos, professor with the 1). This happened both individually and
Department of Epidemiology and Public assisted (G. Tsakos recommends
Health, University College in London, groups/classes).
England.
Figure 1. First set of questions

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 OHDMBSC - Vol. IV - No. 4 - December, 2005

The goal of this first set of questions is by multiplying the frequency and severity
to get the subjects accustomed to oral condi- scores.
tions which may represent reasons for The final score for one activity
impacts, with repercussions on their quality (impact intensity) may, in this way, have
of life. values ranging from 0 to 9
The impact intensity is calculated as
II nd Step the Interview follows:
- very severe: value 9 (severity 3 x fre-
The following interview ignores the quency 3)
answers given to the first set of questions. - severe: value 6 (either severity 3 x
It focuses on evaluating the impact of frequency 2 or severity 2 x frequency 3)
oral disease on the following eight activi- - moderate: values 3-4 (severity 2 x
ties: frequency 2; severity 3 x frequency 1;
1. Eating; severity 1 x frequency 3)
2. Speech; - small: value 2 (severity 2 x frequency
3. Oral Hygiene; 1; severity 1 x frequency 2)
4. Sleep and resting; - very small: value 1 (severity 1 X
5. Smiling, the ability to show ones frequency 1)
teeth without embarrassment; - zero: (severity 0 x frequency 0)
6. Maintaining the emotional status; The general average (the prevalence)
7. Study, lessons, learning, going to of the impacts of oral health issues on daily
school; activities of the subjects is calculated as a
8. Socializing. percentage of the maximum obtainable
The reminding time for the Child-OIDP score (9 x 8 = 72), so the sum of the eight
index is 3 months. activities (which may be anywhere between
0 and 72) is divided by 72 and multiplied by
The questionnaire was filled with an 100.
assistant (as indicated in the original ques- Another way to appreciate the impact of
tionnaire by G. Tsakos [7,8]), each question oral health on the quality of the life of sub-
coming with supportive explanations, in jects is to verify the number of activities
order to clarify both the content as well as affected by oral health issues.
the way to answer about frequency, severity
and intrusion perceived of a specific issue. Results
The frequency and the severity of the
impact of oral health issues of the subjects The present study includes calculations of:
on daily activities were estimated by sum- 1. oral health clinical indicators;
ming the answers to the questions with the 2. the frequency of oral pathological
scores for frequency and severity. conditions (specified in the first set of
To evaluate the perceived intrusion, as questions) which have been perceived
the cause which, in the subjects view, deter- as causing impacts on the daily activi-
mined a specific result, each one of the ties of the subjects;
questions is accompanied by a symptom 3. main oral conditions that cause
from the Ist Step list. impacts on each of the eight activities
(perceived intrusion);
The score for the impact of oral health 4. the intensity of the impacts of oral
issues on each of the activities is obtained health issues on the daily activities of
the subjects;

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 OHDMBSC - Vol. IV - No. 4 - December, 2005

Figure 2. Child-OIDP Registration Form

PERCEIVED
DAILY PERFORMANCES SEVERITY FREQUENCY
INTRUSION
1. Are you having difficulties eating (biting, None at all - 0 None at all - 0
What do you think
chewing)? How often, during the past 3 Very little - 1 Very little - 1
is causing these
months, have you encountered these diffi- Pretty much - 2 Pretty much - 2
difficulties?
culties? Quite a lot - 3 Quite a lot - 3
2. Are you having difficulties with speech None at all - 0 None at all - 0
What do you think
or word pronunciation? How often, during Very little - 1 Very little - 1
is causing these
the past 3 months, have you encountered Pretty much - 2 Pretty much - 2
difficulties?
these difficulties? Quite a lot - 3 Quite a lot - 3
3. Are you having problems washing your None at all - 0 None at all - 0
What do you think
mouth due to mouth related issues? How Very little - 1 Very little - 1
is causing these
often, during the past 3 months, have you Pretty much - 2 Pretty much - 2
difficulties?
encountered these difficulties? Quite a lot - 3 Quite a lot - 3

4. Have you had sleepless nights due to None at all - 0 None at all - 0
What do you think
toothaches of other mouth related issues? Very little - 1 Very little - 1
is causing these
How often, during the past 3 months, have Pretty much - 2 Pretty much - 2
difficulties?
you encountered these difficulties? Quite a lot - 3 Quite a lot - 3

5. Did you feel ill because of problems in None at all - 0 None at all - 0
What do you think
mouth? How often, during the past 3 Very little - 1 Very little - 1
is causing these
months, have you encountered these diffi- Pretty much - 2 Pretty much - 2
difficulties?
culties? Quite a lot - 3 Quite a lot - 3
6. Do you avoid smiling or showing your None at all - 0 None at all - 0
What do you think
teeth because of problems inside your Very little - 1 Very little - 1
is causing these
mouth? How often, during the past 3 months, Pretty much - 2 Pretty much - 2
difficulties?
have you encountered these difficulties? Quite a lot - 3 Quite a lot - 3
7. Have toothaches or other mouth related
None at all - 0 None at all - 0
problems ever prevented you from attend- What do you think
Very little - 1 Very little - 1
ing classes or going to school? How often, is causing these
Pretty much - 2 Pretty much - 2
during the past 3 months, have you encoun- difficulties?
Quite a lot - 3 Quite a lot - 3
tered these difficulties?
8. Have your problems with your teeth pre-
None at all - 0 None at all - 0
vented you from meeting with your friends What do you think
Very little - 1 Very little - 1
or from other social activities? How often, is causing these
Pretty much - 2 Pretty much - 2
during the past 3 months, have you encoun- difficulties?
Quite a lot - 3 Quite a lot - 3
tered these difficulties?

5. the general score and the prevalence out of the latter 60 are female and 57 male.
for the impacts of the oral health issues
on the eight daily activities included in 1. Estimating the Oral Health State on the
the Child-OIDP indicator. Basis of Clinical Indicators
It is important to specify that, out of the
initial number of 143 children, 117 have 1. the average value of the DMFT indi-
chosen to participate in this study (which cator for the 117 subjects is 2.59;
accounts for a 81.41% response rate), and 2. 22.22% (26 children) do not have

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 OHDMBSC - Vol. IV - No. 4 - December, 2005

caries on the permanent teeth; which were perceived by the subjects and
3. the average value of the oral hygiene mentioned in the answers to the first set of
indicator OHI-S is 2.8 (values range from questions are shown in Table 1.
0.5 to 3); Self perceived oral issues which have a
4. 58.97% of the subjects (69) show major negative impact on the daily activities
dental-maxillary anomalies (Ist, IInd and of the children are:
IIIrd Angle class); - bleeding gums 62.39%
5. 17.94% of the subjects (21) show - dental sensitivity 44.44%
white spots consistent with uncertain and - toothaches 38.46%
incipient fluorosis. - badly positioned teeth 28.20%
Among those less mentioned we count:
2. The Frequency of Pathological States - bad breath and oral ulcers 5.12%
Specified in the First Set of Questions and - erupting permanent teeth 3.41%
Which of Them Were Perceived as Having - tooth shape and number 2.56%
Impact on the Daily Activities of the Fractures to permanent teeth, mouth
Subjects: and face deformities or missing permanent
teeth were not mentioned.
The frequency of the oral health issues

Table 1. The frequency of oral conditions mentioned in the first set of questions
Oral symptom Frequency (%)
Toothache 38.46
Dental sensitivity 44.44
Tooth decay 11.11
Permanently fractured tooth 0
Modified teeth color 11.96
Modified teeth shape or number 2.56
Dental position 28.20
Gum bleeding 62.39
Gum swelling 3.41
Plaque 21.36
Bad breath 5.12
Oral ulcers 5.12
Exfoliating deciduous tooth 10.25
Erupting permanent tooth 3.41
Unerupted permanent tooth; slot/space 0.85
Mouth and face deformities 0
Missing permanent tooth 0

3. Main Oral Conditions Which Cause Eating has been mostly affected by
Impacts on Each of the eight Activities toothache and teeth sensitivity and by the
(step 2 questionnaire analysis) exfoliation of deciduous teeth.
Speech suffered because of badly positioned
Oral conditions which caused impacts on teeth, toothaches and bad breath.
each of the eight activities (perceived intru- Oral hygiene was impacted by bleeding
sion) and the frequency with which certain gums and dental sensitivity.
oral pathological states caused impacts on Sleep and resting were affected by
each of the 8 activities are presented in toothaches and gingival ulcers.
Table 2.

9
 Table 2. Perceived Intrusion
# of subjects who Causes for the Impacts (percentage of subjects who reported a specific cause impacting on a specific action)
PERFORMANCE reported impacts Position of Bad Gum Gum Slot/ Shape/
on each activity Sensitivity Pain Exfoliation Ulceration Caries Eruption Color
teeth breath bleeding inflammation space no. teeth
Eating/Drinking 65 35.38% 32.33% 10.76% 7.69% 7.69% 6.15% 4.61% - - - - - -
Speech 18 - 27.77% - 55.55% - - - 16.66% - - - -
Oral hygiene 37 32.43% - 5.4% - - 5.4% 5.4% - 45.94% 5.4% - - -
Sleep/Resting 7 - 57.15% - - 42.85% - - - - - - - -
Smiling 9 - - 33.33% - 4.76% - - - - 28,57% 23,8% 9,52%
Emotional status 21 - 66.66% 11.11% - 22.2% - - - - - - - -
Study 6 - 66.66% - - 33.33% - - - - - - -
Socializing 7 - - - 42.85% - - - 28.57% - - - - -

Table 3. The Intensity of the Impacts on Daily Activities and Their Rate

10
# of sub-
# of Intensity of the impacts jects who
subjects
did not
who
Very Severe Severe Moderate Small Very Small report any
Activity reported
impact on
impacts # of subj. Percent of # of subj. Percent of # of subj. Percent of # of subj. Percent of # of subj. Percent of
their activ-
on an who report- those who who report- those who who report- those who who report- those who who report- those who
ed very reported reported reported reported ed very reported ities (out
OHDMBSC - Vol. IV - No. 4 - December, 2005

activity ed severe ed moder- ed small

severe impacts on impacts on impacts on impacts on small impacts on of total #)
impacts ate impacts impacts
impacts an activity an activity an activity an activity impacts an activity
Eating 65 1 1.5% 2 3% 18 27.6% 25 38.4% 19 29.2% 52
Speech 18 - - - - 6 33.3% 4 22.2% 8 44.4% 99
Oral hygiene 37 2 5.4% 6 16.2% 10 27% 11 29.7% 8 21.6% 80
Sleep, Resting 7 - - - - - - 1 14.28% 6 85.7% 110
Smiling 21 - - - - 5 4.07% 1 28.5% 15 71.4% 96
Emotional state 9 - - - - 2 22.2% 4 44.4% 3 33.3% 108
Studying 6 - - - - - - 2 33.3% 4 66.6% 111
Socializing 7 - - - - 2 28.5% 2 28.5% 3 42.8% 110
 OHDMBSC - Vol. IV - No. 4 - December, 2005

Smiling was often affected by badly posi- 5. The General Score of the Child-OIDP
tioned teeth, empty spaces for erupting per- Indicator
manent teeth and modified tooth coloration. The general score for the Child-OIDP indi-
The emotional status suffered because of cator that was obtained in this study was cal-
toothaches, by gingival ulcers and exfoliat- culated as an average of the scores obtained
ing deciduous teeth. for each of the subjects.
Learning (studying) was affected by The final scores for the subjects includ-
toothaches and gingival ulcers. ed in the study ranged between 0 and 63,
and the average is of 46.764 points.
4. The Intensity of Oral Impacts on Daily
Activities Discussions

The intensity of oral health issues impact on Because of the fact that the studies concern-
daily activities of the subjects is showed in ing the relation between oral health and the
Table 3. quality of life of children aged 12 are not so
A small number of subjects suffered numerous even internationally and the
very severe (3 subjects) and severe (8 sub- analysis criteria and categories vary, com-
jects) impacts of the oral issues on daily parative studies are quite limited.
activities, and the most affected activities In adolescents of Brazil [11], the fre-
were feeding and exercising of dental quency of impacts of oral health on their
hygiene. quality of life is 32%, and in Uganda 62%.
The prevalence of the impacts of oral The frequency of toothache in South
health on daily activities increases propor- Africa schoolchildren is 88% and in those of
tionate with the reduction in intensity: 43 New Zealand 73% [6].
subjects suffered from moderate impacts, 50 The prevalence of oral impacts, meas-
small impacts and 67 very small. ured using the Child-OIDP indicator, for the
At the same time, as the intensity of twelve-year-olds in the present study was
impacts decreases, the number of affected 64.95%
activities increases. If severe and very Even though this value is not propor-
severe impacts affect a reduced number of tionate to the relatively small DMFT index
activities (feeding and oral hygiene), moder- value, it may be correlated with unsatisfying
ate impacts refer to 6 (feeding, speech, oral dental hygiene (OHI-S = 2.8) and with the
hygiene, smiling, the emotional state and large frequency of dental-maxillary anom-
social relations), while the small and very alies.
small ones affect all eight. It is important for this study that, even
So, a subject who suffers from numer- though the impacts of oral health on the
ous impacts, but of reduced intensity, with quality of the subjects life are frequent,
implications on all daily activities is actual- their intensity is mainly moderate-small.
ly much more affected by oral health issues Very severe and severe impacts occur
than another one suffering from very severe only in a reduced number of activities: feed-
impacts, which only affect a reduced num- ing and oral hygiene performance.
ber of his actions. From the point of view of the activities
The actions most affected by oral health most often affected by oral health issues, the
issues are feeding and oral hygiene, fol- present study is in accordance with all other
lowed by smiling and speech capacity. studies of this type performed on subjects of
The least affected are studying, sleep- the same age [1,2].
ing and socializing. Feeding and oral hygiene performance

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 OHDMBSC - Vol. IV - No. 4 - December, 2005

are also the daily activities that suffered 3. The oral health issues most frequent-
most frequently because of oral health ly perceived to have a negative impact on
issues. the daily activities of children are bleeding
The reasons of these impacts are physi- gums (62.39%), dental sensitivity (44.44%),
cal agents, toothaches, exfoliating decidu- toothaches (38.46%) and misplaced teeth
ous teeth, badly positioned teeth, oral ulcers (28.20%)
and carious cavities, which limit the con- 4. Oral conditions perceived by the sub-
sumption of certain food-types and which jects to have a small impact on the quality of
will eventually cause improper feeding from life are bad breath and oral ulcers (5.12%)
a quality point of view for the twelve-year- erupting permanent teeth (3.41%) and the
olds, involved in full process of growth and shape and the modified number of teeth
development. (2.56%)
Another extremely important activity 5. Feeding and oral hygiene, followed
for each individuals oral health is the per- by smiling and speech are the most affected
formance of oral hygiene. It is badly affect- activities by oral health issues.
ed by oral disease and particularly by bleed- 6. The least affected are studying, rest-
ing gums, as deducted from the present ing and socializing.
study. The absence of proper oral hygiene, 7. The number of subjects that have suf-
overlapped with already existing issues, will fered very severe and severe impacts is
most certainly lead to increasing oral dis- small (9.4%), and the respective affected
ease in these subjects. activities are feeding and dental hygiene.
Smiling and social relations are most 8. The prevalence of the impacts of oral
often affected by misplaced teeth and color health on daily activities increases propor-
changes. tionate to the decrease in intensity.
The least affected by oral health issues 9. With the decrease of impact intensity,
are studying and socializing. the number of affected activities increases
(severe and very severe impacts affect a
Conclusions reduced number of activities while the less-
er ones affect all of the eight activities
1. The general score for the Child-OIDP included in the questionnaire).
indicator obtained in this study, making the 10. The present study may constitute
average of each subjects score, is of one of the pilot studies for validating the
64.95% Child-OIDP in Romania.
2. The elevated score for the Child- 11. Further extensive studies, per-
OIDP obtained in this study is in accordance formed both on the adult and juvenile popu-
with the reduced oral health status of the lation will be required to accurately appreci-
subjects, and especially that of (unsatisfy- ate the way in which the oral health status
ing) dental hygiene and increased frequency affects the quality of life for the population
of dental-maxillary anomalies. of our country.

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Correspondence to: Dr. Cristina Nuc, DMD, PhD, Lecturer, Faculty of Dental Medicine and
Pharmacy, Department of Preventive Dentistry, 7, Ilarie Voronca str., 900684 Constana,
Romania.

13