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Year : 2018  |  Volume : 16  |  Issue : 3  |  Page : 198-202

The prevalence and impact of teeth wear on oral health related quality of life among rural adult population of Sullia taluk, D.K

Department of Public Health Dentistry, KVG Dental College and Hospital, Dakshina Kannada, Karnataka, India

Date of Submission02-Jan-2018
Date of Acceptance07-May-2018
Date of Web Publication6-Aug-2018

Correspondence Address:
Dr. Jaseela Praveena
Department of Public Health Dentistry, KVG Dental College and Hospital, Sullia, Dakshina Kannada, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_4_18

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Introduction: Teeth wear (TW) an otherwise physiological process if present above acceptable level might cause a debilitating effect on the quality of life (QoL). With increasing life expectancy and people retaining their natural teeth into old age, the problem of wearing off of teeth over time poses a major public health concern. Aim: The aim of this study is to identify the prevalence of TW and its effects on individual QoL and satisfaction with their dentition. Methodology: A cross-sectional descriptive study was conducted among 650 individuals selected from Sullia Taluk, Dakshina Kannada district, Karnataka, India, to assess the prevalence of TW as determined by teeth wear index (Smith and Knight, 1984) and impact of the same on oral health-related QoL on 240 individuals with TW (39.15 ± 3.05 years) measured using a translated version of Oral Health Impact Profile (OHIP)-14 questionnaire. Results: Analysis revealed that 39.97% of the study individuals had a TW severity of score 2 and TW severity of score 3 were observed among 20% of the study participants. The overall mean OHIP-14 score of the study population was 16.91 ± 8.07 with 36.7% moderately and 0.8% severely affected impact on OHRQoL. Physical pain, psychological discomfort, physical disability, and psychological disability with respective mean values of 1.47 ± 1.3, 1.18 ± 1.07, 1.85 ± 1.5, and 1.53 ± 1.3 were the main affected domains in oral health QoL. Conclusion: The severity of TW in the study population was score 2 having moderate impact on the QoL with physical disability, physical pain, psychological discomfort, and disability as the contributing factors.

Keywords: Oral Health Impact Profile, oral health-related quality of life, prevalence, teeth wear

How to cite this article:
Praveena J, Battur H, Fareed N, Khanagar S. The prevalence and impact of teeth wear on oral health related quality of life among rural adult population of Sullia taluk, D.K. J Indian Assoc Public Health Dent 2018;16:198-202

How to cite this URL:
Praveena J, Battur H, Fareed N, Khanagar S. The prevalence and impact of teeth wear on oral health related quality of life among rural adult population of Sullia taluk, D.K. J Indian Assoc Public Health Dent [serial online] 2018 [cited 2022 Jun 30];16:198-202. Available from: https://www.jiaphd.org/text.asp?2018/16/3/198/238586

  Introduction Top

Adults and geriatric population constitute of about 47.11% and 6% of the Indian population today, respectively.[1] The geriatric population is bound to increase to about 27% by 2050. The Oral health of adults today will be the expected oral health of elderly tomorrow. Despite the fact that dental disease is rarely life-threatening, it can still affect the quality of one's life. Pain, fear, and difficulties with speech, esthetics, chewing, and eating can impact the quality of life (QoL). Different levels of oral status can have varying impacts on daily living. Teeth wear (TW) an otherwise physiological process if present above the acceptable level might have a debilitating effect on the QoL. With increased life expectancy[2] and people retaining, their natural teeth into old age, the problem of wearing off of teeth over time is a major public health concern.

Tooth wear is a serious multifactorial irreversible debilitating condition leading to non-carious, physiologic, pathologic, or functional loss of dental hard tissues.[3] Patients with a worn dentition often complain of tooth sensitivity (dentine exposure), dental pain (involvement of the pulp), poor esthetics (shortened clinical crown, loss of vertical dimension), and functional impairment (difficulties with chewing due to occlusal alterations and dental tissue loss) which majorly affect their QoL to the extent that they live in constant fear of pain and sensitivity.[4] Studies show that tooth wear has a measurable impact on patients' satisfaction with their appearance, pain levels, oral comfort, general performance, chewing, and eating capacity and have a psychological impact on their QoL which might be comparable to edentulousness.[5],[6],[7] However, there are no available literature on the impact of TW on oral health-related QoL (OHRQoL) among Indian population. Hence, this study purports to identify the prevalence of TW and its effects on individual QoL and satisfaction with their dentition among adult population of Sullia taluk, Dakshina Kannada District, Karnataka.

  Methodology Top

This population-based cross-sectional study was conducted among 35–44-year-old adult population of Sullia Taluk, Dakshina Kannada District, Karnataka. Ethical clearance was obtained from the Institutional Ethics Committee (Ref No.: SS35/2016-17). Necessary permission was obtained from the concerned village panchayat authorities. Signed informed consent was obtained from all participants. Data were collected from December 2016 to May 2017. Sample size for this study was estimated based on the prevalence (functional domain of Oral Health Impact Profile [OHIP]) calculated by conducting a pilot study. The calculated sample size was 226. Five percent of the calculated sample size was added to compensate for sampling loss if any. Thus, the final sample size accounted to 240. A total of 632 individuals were examined from four randomly chosen villages and 240 willing participants in the age group of 35–44 years with above acceptable level of TW were included in this study. Participants with any reported or apparent medical/oral conditions (excluding TW) that were assumed to have had an impact on QoL were excluded. Sample methodology adopted in this study was a multistage probability strategy. In the first stage, primary sampling units (PSUs) villages were randomly selected from a list of villages obtained from the office of the Gram Panchayat. The second stage consisted of random selection of households (HH) in each PSU proportional to the size of the unit. The third stage consisted of selecting members satisfying the inclusion/exclusion criteria from the included HH [Figure 1].

Data collection

The chief investigator along with an assistant visited each included village for data collection. Interviews and clinical examinations were performed on eligible members of the selected HH and data were obtained from the participants on a specially designed proforma containing three parts. Part A contained the basic demographic details, Part B contained Smith and Knight TW index.[8] Additional data on the impact of TW on QoL were collected in Part C of the proforma (translated OHIP short version questionnaire containing 14 questions[9]) from participants with above acceptable TW. Reliability of the questionnaire was assessed by conducting the test–retest approach on 30 participants, Cronbach's alpha coefficient which showed a high reliability of 0.96.
Figure 1: Sampling methodology

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Descriptive statistics, Chi-square test, ANOVA and post hoc Tukey test was performed to evaluate the data. Data analysis was carried out using IBM SPSS (Statistical Package for Social Sciences) Version 21.0, Chicago, IL, USA with P value statistically significant at ≤0.05.

  Results Top

Eighteen individuals refused to participate in the study, out of the 650 individuals approached, citing refusal for a clinical examination as the main reason for non participation thus yielding a response rate of 99.9%. Two hundred and forty dentate adults with a mean age of 39.19 ± 3 from among the 632 dentate adults thus examined had above acceptable level of TW and were included as the study sample, representing 37.97% prevalence of TW with 27.2% having mild TW, 45.5% having moderate, and 20.6% having severe TW. Analysis of basic demographic data revealed the gender distribution of 1:0.76 among the study participants. Majority belonged to lower middle class (53.3%) with slightly predominant consumption of mixed diet (51.2%). About 31% of the individuals with TW were arecanut/betel nut chewers with 32.9% of the population being frequent consumers of carbonated/alcoholic beverages while 37% were consumers of non-alcoholic/non-carbonated/citric or fruit drinks [Table 1].
Table 1: Basic demographical characteristics of the study population

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About 32.1% of the study participants reported dentinal hypersensitivity. Analysis of impact of TW among the study participants revealed 50% did not have any impact on oral health QoL while about 36.7% were affected moderately and 0.8% was severely affected by TW [Table 2]. Comparison of mean impact on oral health QoL among different domains revealed that there was a significant difference in physical pain (P < 0.001), psychological discomfort (P < 0.001), psychological disability (P < 0.001), and physical disability (P < 0.001) as shown in [Table 3]. Between-group comparisons of impact of TW on QoL among varying TW groups showed a significant difference in physical pain and physical disability with respect to group 1 versus Group 3 and Group 2 versus Group 3. Psychological discomfort and overall OHIP scores showed a significant difference among all the groups (P < 0.001) while psychological disability showed significant result among mild and moderate TW (P < 0.001) [Table 4].
Table 2: Prevalence of reported hypersensitivity and teeth wear in relation to OHRQoL among the study population

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Table 3: Mean Oral Health Impact Profile-14 domain scores and its impact in relation to severity of teeth wear among the studied population

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Table 4: Intergroup comparison of mean domain scores using post hoc Tukey test

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  Discussion Top

The concept of OHRQoL regards how oral outcomes impacts an individual's well-being and QoL.[10] Over the past few decades, dental research has given increasing attention to the assessment of impact on patients' QoL and many studies regarding this issue have been published in the dental literature providing a helpful source of information to researchers, oral health decision-makers, and clinicians. However, the main foci of attention have been edentulousness, dental caries, and periodontal diseases. With an alarming increase in the prevalence of TW and its possible impact on OHRQoL along with a very limited published literature internationally and none from the Indian subcontinent, the need for research on this particular subject has become an absolute necessity. To the best of our knowledge, this study is the first of its kind in India, conducted to assess the prevalence and impact of TW on OHRQoL. Participants were selected through a multistage sampling strategy, and then those with pathological TW were accessed for impact on OHRQoL using OHIP-14 Kannada version. The instrument was tested for both validity and reliability.

The prevalence of TW in his study was 37.97%, much higher to the prevalence reported by Hegde et al. in 2016[11] among South Canara population which can be attributed to the fact that the majority of the population in our study are arecanut cultivators and habitual consumers as opposed to the coastal population in the later. A much higher prevalence of 54.7% TW was reported by Li and Bernabé 2016[7] from the UK. The main reason attributed being high consumption of carbonated beverages in the Western population. Our findings are however similar to the ones reported by Deshpande[12] from Nagpur on a population with similar betel/arecanut habits. The main reason for these wide variations in the prevalence of TW that is reported could also be due to the reporting of different types of TW that is collectively measured in the index used.

It is difficult to isolate the cause of tooth wear, as there are so many factors involved in the process. The factors assessed in this study are mainly the habit history, brushing technique used, type of diet, and consumption of carbonated and noncarbonated beverages. The frequency of consumption of noncarbonated citric or fruit juices were 37% among the study participants. The studied population had equal prevalence for horizontal and combination techniques of brushing and an almost equal number of vegetarian and mixed diet consumers; these factors are associated with increased prevalence in TW similar to the results of several previously reported studies.[13],[14],[15],[16]

Impact of TW on QoL has not been reported from India; this study reports an overall OHIP score of 16.2 ± 9.1 similar to the 14.02 ± 8.09 reported by Li and Bernabé.[7] National and regional studies have reported the impact of various oral diseases/conditions such as dental caries, edentulousness, and periodontal diseases on OHRQoL ranging from 10.12 ± 1.4 to 25.46 ± 8.4 affecting 36.5%–56% of participants[17],[18],[19],[20] suggesting that TW is also a condition with considerable impact such as other oral diseases/conditions in affecting the QoL. The main domains that contributed to the impact on OHRQoL in our study were physical pain, physical disability, psychological discomfort, and psychological disability in accordance with Li and Bernabé, who reported an impact on psychological discomfort (1.15 ± 0.9) and psychological disability (1.18 ± 0.8) and Al-Omiri et al., who reported a negative impact on physical pain, psychological discomfort, and disabilty.[5],[7] However, the relative contribution of each domains varied in each study.

The possible limitations of this study could be the study setting being an exclusive rural population with socioeconomic status being a confounding factor for the QoL. In addition, OHRQoL was not assessed among those with physiological TW; hence, the general OHRQoL among the population is unknown.

Pathological TW being a debilitating disease, dental clinicians need to have an accurate perception of how patients feel about TW and what impact it has on their QoL as it may influence an individual's capacity to live comfortably, be successful in employment, enjoy life, experience relationships, and possess a positive self-image. National data on prevalence of TW and more elaborate study of its impact on related QoL are needed for understanding the etiology of TW and preventive measures to be implemented.

  Conclusion Top

Impact of TW assessed among the study participants revealed 50% had impact on oral health QoL with about 36.7% moderately affected and 0.8% severely affected with physical disability, physical pain, psychological discomfort, and disability as the contributing factors.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

World Population Prospects: The 2017 Revision. ESA.UN.org (custom data acquired via website). United Nations Department of Economic and Social Affairs, Population Division. Available from: https://esa.un.org/unpd/wpp/. [Last accessed on 2017 Oct 10].  Back to cited text no. 1
United Nations Statistics Division – Demographic and Social Statistics. Available from: https://www.unstats.un.org/unsd/demographic/products/dyb/dyb2016.html. [Last accessed on 2016 Dec 05].  Back to cited text no. 2
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Li MH, Bernabé E. Tooth wear and quality of life among adults in the United Kingdom. J Dent 2016;55:48-53.  Back to cited text no. 7
Smith BG, Knight JK. An index for measuring the wear of teeth. Br Dent J 1984;156:435-8.  Back to cited text no. 8
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Slade GD, editor. Measuring Oral Health and Quality of Life. Chapel Hill: University of North Carolina: Dental Ecology, School of Dentistry, University of North Carolina; 1997.  Back to cited text no. 10
Hegde MN, Hegde P, D'souza SP, Attavar A. Prevalence of tooth wear in south west coastal population of India. Int J Prim Health Care 2016;6:47-56.  Back to cited text no. 11
Deshpande S. Investigation of tooth wear and its associated etiologies in adult patients visiting dental institute in India. Dentistry 2015;5:271.  Back to cited text no. 12
Hegde MN. Prevalence of tooth wear due to dietary factors in South Canara population. Br J Med Med Res 2015;9:1-6.  Back to cited text no. 13
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Bartlett DW, Fares J, Shirodaria S, Chiu K, Ahmad N, Sherriff M, et al. The association of tooth wear, diet and dietary habits in adults aged 18-30 years old. J Dent 2011;39:811-6.  Back to cited text no. 16
Fotedar S, Sharma KR, Fotedar V, Bhardwaj V, Chauhan A, Manchanda K, et al. Relationship between oral health status and oral health related quality of life in adults attending H.P Government Dental College, Shimla, Himachal Pradesh – india. Oral Health Dent Manag 2014;13:661-5.  Back to cited text no. 17
Sanadhya S, Aapaliya P, Jain S, Sharma N, Choudhary G, Dobaria N, et al. Assessment and comparison of clinical dental status and its impact on oral health-related quality of life among rural and urban adults of Udaipur, India: A cross-sectional study. J Basic Clin Pharm 2015;6:50-8.  Back to cited text no. 18
Kumar S, Kumar A, Badiyani B, Kumar A, Basak D, Ismail MB, et al. Oral health impact, dental caries experience, and associated factors in 12-15-year-old school children in India. Int J Adolesc Med Health 2017;29. pii:/j/ijamh. 2017.29.issue-2/ijamh-2015-0041/ijamh-2015-0041.xml.  Back to cited text no. 19
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  [Figure 1]

  [Table 1], [Table 2], [Table 3], [Table 4]


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