Resumen de Association of Gingivitis With Child Oral Health–Related Quality of Life

Fernanda Tomazoni, Fabrício B. Zanatta, Simone Tuchtenhagen, Guilherme N. da Rosa, Joana P. Del Fabro, Thiago M. Ardenghi

• Background: Child oral health–related quality of life (COHRQoL) has been increasingly assessed. However, the full relationship between gingivitis and COHRQoL has been assessed by only a small number of studies. This study aims to assess the association between gingival bleeding and how a child perceives its OHRQoL.

  Methods: This cross-sectional study used multistage random sampling to enroll 1,134 12-year-old schoolchildren from Santa Maria, a southern city in Brazil. Participants were examined for gingival bleeding according to the community periodontal index criteria, a full-mouth clinical examination of six sites per tooth. COHRQoL was assessed by the Brazilian version of the Child Perceptions Questionnaire for 11- to 14-Year-Old Children (CPQ11–14), and data on socioeconomic status were collected. Multilevel Poisson regression models fitted the association of gingivitis with overall and domain-specific CPQ11–14 scores.

  Results: In general, children with bleeding in ≥15% of sites had higher total CPQ11–14 scores and domain-specific scores than their counterparts. This association persisted after adjustment for other potential confounders. The presence and extent of gingival bleeding was associated mainly with emotional limitation domains of the CPQ11–14; those with extended levels of gingivitis had a 1.20 times higher mean score than those with low-level/no gingival bleeding (rate ratio = 1.20; 95% confidence interval = 1.10 to 1.31).

  Conclusion: The present results indicate that the presence of extensive levels of gingivitis might be negatively associated with how children perceive their oral health and their daily life.

  Gingivitis associated with dental plaque affects the protective tissue of the teeth and can contribute to the development of a wide range of clinical signs and symptoms, such as bleeding, edema, redness, bad breath, and gingival enlargement.1 Most children and adolescents are estimated to have some signs of adverse oral conditions, such as bleeding, calculus, or dental plaque.2 Moreover, gingival disease is ranked as the most common disease in children and adolescents.3 Prevalence data from Brazil indicate at least 27.1% of 12-year-olds have gingival bleeding, and 24% of this population have dental calculus.4 Nevertheless, a social gradient seems to exist in the occurrence of gingivitis, namely the most disadvantaged areas present with high levels of disease.5-8 In addition, individuals from low socioeconomic backgrounds are more likely to be exposed to various risk factors affecting oral health, and oral health contributes substantially to one’s quality of life not only functionally but also psychologically and socially.9 Traditionally, gingival outcomes were measured by normative clinical measures that consider only the physical status of the individual. These measures only assess patients’ health conditions according to professional judgment, ignoring any social or psychologic influences on oral health,10 and a relatively low importance is placed on the patient’s self-perceived oral health and needs.11 Therefore, previous efforts advocated for the assessment of child oral health–related quality of life (COHRQoL) to be an adjunct of normative measurements that document the full impact of oral disease according to the child’s daily life.12 COHRQoL is frequently measured by means of self-applied questionnaires referred to as sociodental indicators.13 Several questionnaires were developed to measure oral health and its impact on the quality of life of children and adolescents. The self-perception measures comprise the Child-Oral Impacts on Daily Performances,14 the Early Childhood Oral Health Impact Scale,15 the Child Oral Health Quality of Life,16 the Child Perceptions Questionnaire (CPQ),16 and the Child Oral Health Impact Profile.17 The CPQ for 11- to 14-Year-Old Children (CPQ11–14) is one of these instruments.16 The instrument was originally developed in Canada, but additional studies confirmed its acceptable psychometric proprieties for Brazilian schoolchildren.18,19 The CPQ11–14 assesses the COHRQoL encompassing four subscales: 1) oral symptoms; 2) functional limitations; 3) emotional well-being; and 4) social well-being.18 Several studies reported negative impacts of poor dental status on quality of life.16,18 The relation between gingival conditions and OHRQoL was investigated with divergent findings. Previous studies suggest that destructive periodontal disease has a negative impact on adolescent quality of life,20 yet gingivitis has a modest or insignificant effect.21-24 However, a national study conducted on Thai children found gingivitis to have a moderate-to-high level of impact on quality of life, mainly in the psychologic construct.25,26 Gingival bleeding attributable to gingivitis could affect the psychologic health of children through negative social interactions or low self-image satisfaction.26 The full association between gingivitis and COHRQoL was not comprehensively assessed, and results may vary according to the sample age, diagnostic threshold, or extent of the disease. In an epidemiologic context, understanding the relation of gingival bleeding occurrence and COHRQoL may contribute to the evaluation of treatment options and aid in the definition of high-risk groups, which can be used to develop public health programs. This study assesses the association of gingival bleeding with how children perceive their OHRQoL. It was hypothesized that children with a high level of gingival bleeding would report higher overall and domain-specific CPQ11–14 scores than their counterparts.