Effects of Enamel Fluorosis and Dental Caries on Quality of Life

Abstract

The objectives of this study were to determine the impact of enamel fluorosis and dental caries on oral health-related quality of life (OHRQoL) in North Carolina schoolchildren and their families. Students (n = 7,686) enrolled in 398 classrooms in grades K-12 were recruited for a onetime survey. Parents of students in grades K-3 and 4-12 completed the Early Childhood Oral Health Impact Scale (ECOHIS) and Family Impact Scale (FIS), respectively. Students in grades 4-12 completed the Child Perceptions Questionnaire (CPQ8-10 in grades 4-5; CPQ11-14 in grades 6-12). All students were examined for fluorosis (Dean's index) and caries experience (d2-3fs or D2-3MFS indices). OHRQoL scores (sum response codes) were analyzed for their association with fluorosis categories and sum of d2-3fs and D2-3MFS according to ordinary least squares regression with SAS procedures for multiple imputation and analysis of complex survey data. Differences in OHRQoL scores were evaluated against statistical and minimal important difference (MID) thresholds. Of 5,484 examined students, 71.8% had no fluorosis; 24.4%, questionable to very mild fluorosis; and 3.7%, mild, moderate, or severe fluorosis. Caries categories were as follows: none (43.1%), low (28.6%), and moderate to high (28.2%). No associations between fluorosis and any OHRQoL scales met statistical or MID thresholds. The difference (5.8 points) in unadjusted mean ECOHIS scores for the no-caries and moderate-to-high caries groups exceeded the MID estimate (2.7 points) for that scale. The difference in mean FIS scores (1.5 points) for the no-caries and moderate-to-high groups exceeded the MID value (1.2 points). The sum of d2-3fs and D2-3MFS scores was positively associated with CPQ11-14 (B = 0.240, p < .001), ECOHIS (B = 0.252, p ≤ .001), and FIS (B = 0.096, p ≤ .01) scores in ordinary least squares regression models. A child's caries experience negatively affects OHRQoL, while fluorosis has little impact.

Clarifying the Impact of Untreated and Treated Dental Caries on Oral Health-Related Quality of Life among Adolescents

“…Children with untreated caries seem to be more likely to experience pain and difficulty chewing foods and also report embarrassment when anterior teeth are affect- ed by caries [Ramos-Jorge et al, 2014Schuch et al, 2015]. Similar results have also been demonstrated in other populations from different socioeconomic strata Li et al, 2014;Onoriobe et al, 2014;Pulache et al, 2016]. The results from the few studies that investigated the impact of treated dental caries in adolescents are contradictory.…”

“…Dental caries is reported to be the main oral health outcome associated with a poorer quality of life among adolescents [Li et al, 2014;Onoriobe et al, 2014;Carvalho et al, 2015;Pulache et al, 2016]. Different methods have been proposed for the measurement of dental caries in epidemiological studies, and the association with OHRQoL is suggested when results are described for individuals with untreated caries (D component of the DMFT index) [Peres et al, 2009;Piovesan et al, 2010;Krisdapong et al, 2013].…”

<b><i>MMP13</i></b> Contributes to Dental Caries Associated with Developmental Defects of Enamel

“…Dental fluorosis was assessed using Dean's modified index [Onoriobe et al, 2014]. Children were included in the DDE group if they presented at least one tooth with a DDE phenotype.…”

Critique of the review of 'Water fluoridation for the prevention of dental caries' published by the Cochrane Collaboration in 2015

“…Research shows that communities rate questionable and very mild fluorosis as of better appearance and higher self-rated oral health than no fluorosis, with some reports stating that moderate fluorosis is judged as no different to teeth without any fluorosis. [36][37][38] This indicates that if a threshold exists for fluorosis of aesthetic concern, it may be higher than that proposed in the 1990s, which was equivalent to mild fluorosis. The possible explanation for this shift is that enamel opacities classed as mild fluorosis are a whitening of teeth, a characteristic that has become socially desirable, as evidenced by the demand for tooth whitening products and procedures.…”