Chapter 1

INTRODUCTION

The word health was derived from Old English hǣlþ. 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 insight
on 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

1
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
Outcome of Oral Health on
Oral health status Daily Living

(DMFT) (OHIP)

Demographic Variable

(age, gender & education)

Figure 1.1 Conceptual Framework

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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.

3
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.

4
Handicap- It is one of the disadvantages due disease either as loss of opportunities,
actual material and social deprivation and dissatisfaction.

5
 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

Locker from one proposed by the World Health Organization for general health. The

model proposes that a hierarchy of impacts can arise from oral disease.

DISEASE

IMPAIRMENT

FUNCTIONAL PAIN &

LIMITATION DISCOMFORT

DISABILITY
PHYSICAL, PSYCHOLOGICAL, SOCIAL

HANDICAP
Figure 2.1 Locker’s Conceptual Model of Oral Health

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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 Thurstone’s 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

Have you had any difficulty pronouncing any words
Functional limitations
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?
Have you had painful aching in your mouth?
Have you found it uncomfortable to eat any food because
Physical pain
of problems with your teeth, mouth or dentures?

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 Have you been self conscious because of your teeth,
mouth or dentures?
Psychological discomfort
Have you felt tense because of problems with your teeth,
mouth or dentures?
Has your diet been unsatisfactory because of problems
with your teeth, mouth or dentures?
Physical disability
Have you had to interrupt meals because of problems
with your teeth, mouth or dentures?
Have you found it difficult to relax because of your teeth,
mouth or dentures?
Psychological Disability
Have you been embarrassed because of problems with
your teeth, mouth or dentures?
Have you been irritable with other people because of
problems with your teeth, mouth or dentures?
Social Disability
Have you had difficulty doing your usual job because of
problems with your teeth mouth or dentures?
Have felt that life was less satisfying because of problems
Handicap
with your teeth, mouth or dentures?
Have you totally unable to function because of problems
with 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 “don’t 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

9
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 α). 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, Jyväskylä 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<0.000). There were no

sex differences in the severity of impact but on following items women reported

having problems more often than men: feeling embarrassed (17% vs. 7%, p<0.05)

and life being in general less satisfying (13% vs. 6%, p<0.05). The internal reliability

of the scale evaluated by using Crohnbach’s coefficient alpha was 0.93. This proves

that Finnish translation of OHIP-14 provides a reliable instrument for assessing oral

health impact among Finnish adults.

Sinhalese Version

To test the psychometric properties of a Sinhalese translation of the OHIP-14

scale for use among older adults in Sri Lanka. The English version of the OHIP-14

was translated in to Sinhalese, pre-tested and subsequently administered to the

13
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 test–retest 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,

14
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 worker’s 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 patient’s 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 patient’s socio-demographic profile, dental health seeking behavior,

16
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. Don’t know was

17
 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 patient’s 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 21.1
38-48 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 7.8
High 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

Standard.
N Mean Deviation
Number 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

22
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 40 44.4
(fairly often and always)
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 4
Irritable 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

24
 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 1.11
Difficulty 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

Std.
Mean 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 0.81
Total 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

25
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

Standard.
Gender N Mean Deviation
Female 55 0.80 0.85
Functional
Male 35 0.50 0.73
Female 55 1.11 0.85
Physical Pain
Male 35 1.15 0.78
Psychological Female 55 1.54 1.09
Discomfort Male 35 1.19 1.09
Female 55 1.01 1.03
Physical Disability
Male 35 0.83 0.82
Female 55 1.10 1.02

26
 Psychological Male
35
Disability 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

Standard
N Mean Deviation
Functional Grade school 7 1.07 0.98
High School 35 0.70 0.89
College
31
Undergraduate 0.60 0.74
Vocational
5
Graduate 0.70 0.76
College
12
Graduate 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

27
 College
31
Undergraduate 1.14 0.88
Vocational
5
Graduate 0.86 0.55
College
12
Graduate 1.19 0.56
Total 90 1.12 0.82
Psychology Grade school 7 1.11 0.91
Discomfort High School 35 1.22 1.13
College
31
Undergraduate 1.63 1.13
Vocational
5
Graduate 0.69 0.73
College
12
Graduate 1.78 1.01
Total 90 1.40 1.10
Physical Grade school 7 1.07 0.93
Disability High School 35 0.89 1.00
College
31
Undergraduate 0.92 1.01
Vocational
5
Graduate 1.30 0.84
College
12
Graduate 0.92 0.80
Total 90 0.94 0.95
Psychological Grade school 7 1.69 0.96
Disability High School 35 1.06 0.94
College
31
Undergraduate 1.00 0.99
Vocational
5
Graduate 0.80 1.02
College
12
Graduate 1.10 0.89
Total 90 1.08 0.96
Social Grade school 7 1.64 1.08
Disability High School 35 1.01 0.98
College
31
Undergraduate 1.16 1.06
Vocational
5
Graduate 0.48 0.53
College
12
Graduate 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

28
 College
31
Undergraduate 1.12 1.09
Vocational
5
Graduate 1.44 1.09
College
12
Graduate 0.90 0.81
Total 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

Mean Sum of
Gender N Rank Ranks
DMFT Female 55 48.42 2663.00
Male 35 40.91 1432.00
Total 90
No. of Female 55 45.67 2512.00
Decayed Male 35 45.23 1583.00
Teeth Total
90

No. of Female 55 48.72 2679.50

Missing Male 35 40.44 1415.50
Teeth Total
90

No. of Filled Female 55 44.61 2453.50

Teeth 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.

29
OHIP and Dental Conditions

Table 4.11 Correlation Coefficients of DMFT and OHIP

Number of Number of
Decayed Missing Number of
Teeth Teeth 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.

30
 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

31
 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

32
 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.

33
 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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