|BRIEF RESEARCH ARTICLE
|Year : 2016 | Volume
| Issue : 2 | Page : 150-153
Association between oral health status and oral health-related quality of life among the prison inmate population of kanda model jail, Shimla, Himachal Pradesh, India
Shailee Fotedar1, Atul Chauhan2, Vinay Bhardwaj1, Kavita Manchanda1, Vikas Fotedar3
1 Assistant Professor, Department of Public Health Dentistry, HP Government Dental College, Shimla, Himachal Pradesh, India
2 Lecturer, Department of Oral Medicine and Radiology, HP Government Dental College, Shimla, Himachal Pradesh, India
3 Assistant Professor, Department of Radiotherapy and Oncology, RCC, Indira Gandhi Medical, College, Shimla, Himachal Pradesh, India
|Date of Web Publication||23-Jun-2016|
Department of Public Health Dentistry, HP Government Dental College, Shimla, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The prison population is a challenging one with many health problems including oral health. In a country such as India, the information regarding the oral health status in prisoners is scant. So, a cross-sectional study was carried out among a 311 prison inmate population of Kanda model jail, Shimla, Himachal Pradesh, India, to assess the dental caries levels, periodontal health status, and oral health-related quality of life (OHRQoL). Dental caries was present among 71.8% of the population and the mean decayed missing and filled teeth index (DMFT) of the population was 5.1 ± 2.1. Calculus was seen among 54.9% of the population. The mean severity score, summed for the 14 items in the scale was 14.57. Dental caries, periodontal disease, the number of missing teeth were significantly associated with OHRQoL. The population had a higher level of oral diseases and one half of the population reported that their oral condition had negatively impacted them in some way, thereby affecting their quality of life.
Keywords: Oral health, oral health-related quality of life (OHRQoL), prison inmates
|How to cite this article:|
Fotedar S, Chauhan A, Bhardwaj V, Manchanda K, Fotedar V. Association between oral health status and oral health-related quality of life among the prison inmate population of kanda model jail, Shimla, Himachal Pradesh, India. Indian J Public Health 2016;60:150-3
|How to cite this URL:|
Fotedar S, Chauhan A, Bhardwaj V, Manchanda K, Fotedar V. Association between oral health status and oral health-related quality of life among the prison inmate population of kanda model jail, Shimla, Himachal Pradesh, India. Indian J Public Health [serial online] 2016 [cited 2020 Feb 18];60:150-3. Available from: http://www.ijph.in/text.asp?2016/60/2/150/184573
Each population group needs a different approach for health care. One of the strategies in public health is to identify unique population groups, study their health problems, and explore methods for health care. Prisoners make a special group of population as they are different from other people in context of their "freedom of movement." The majority of prisoners are those who come from a context already shaped by social exclusion. 
They are at a higher risk of violence among themselves, which results in high chronic stress levels that may deteriorate physical and mental health.  Added to this, the facilities available are not up to the satisfactory level and, therefore, the oral health status of prisoners is affected to a marked extent. 
Oral health-related quality of life (OHRQoL) is defined as an individual's assessment of how the following affect his or her well-being: Functional factors, psychological factors, social factors, and experience of pain/discomfort in relation to orofacial concerns. 
The most widely used instrument is the Oral Health Impact Profile (OHIP), and its shortened version OHIP-14.  The questionnaire measures the impact of oral problems and covers physical, psychological, and social dimensions of daily living. It is divided into seven dimensions, each with two items. The domain "Functional limitation" concerns the loss of function of parts of the body such as difficulty with chewing. The domains "Physical discomfort" and "Psychological discomfort" deal with experiences of pain and discomfort such as pain and feeling miserable. The domains "Physical disability," "Psychological disability," and "Social disability" refer to limitations in performing daily life activities such as avoiding certain foods, lack of concentration, and feeling irritable with others, respectively. Finally, the domain "Handicap" concerns a sense of disadvantage in functioning such as suffering financial loss due to temporomandibular joint (TMJ) problems. The responses are scored on a five-point Likert scale, from never to very often. 
When OHRQoL measures are used alongside traditional clinical methods of measuring oral health status, a more comprehensive assessment of the impact of oral diseases on the several dimensions of subjective well-being becomes possible. So, the present study was sought to evaluate the dental caries status, periodontal status, and the OHRQoL in the prison inmate population of Kanda model jail, Shimla, Himachal Pradesh, India. In addition, it is an attempt to find the effect of dental caries and periodontal disease on OHRQoL.
A descriptive cross-sectional study was conducted among the inmates of Model Kanda Jail, Shimla, Himachal Pradesh, India. Permission to conduct the study was taken from the Head of the Department, Public Health Dentistry, H.P. Govt. Dental College, Shimla, Himachal Pradesh, India. Prior permission was taken from the jail authorities to conduct the study. Only those individuals who were willing to participate in the study were questioned and examined.
The study was conducted in the month of September, 2013. There were 547 prisoners at that time in the jail. Purposive sampling was done as the inmates who gave verbal consent were included in the study. So, the study was conducted on a total of 311 inmates out of 547 residing in the Kanda Model Jail. The study was performed in the hospital of the jail. Clinical examination for dental caries and periodontal status was done by decayed missing and filled teeth index (DMFT)  and community periodontal index(CPI).  In this study, subjects with a score of 3 (having periodontal pockets of 4-5 mm) and 4 (having periodontal pockets of 6 mm or more) were defined as a case of periodontal disease. An estimate of accumulated tooth loss was obtained by counting the number of missing teeth.
OHRQoL was assessed using the OHIP-14 questionnaire. Answers to the 14 questions are scored on five-point ordinal scales, ranging from never (0), hardly ever (1), occasionally (2), fairly often (3), and very often (4).
OHIP-14 scores were computed in two ways: First, a total OHIP-14 score was calculated by summing responses to all 14 items, with possible scores ranging 0-56 and second, OHIP-14 subscale scores were calculated for each of the dimensions by summing the ordinal response scores for the two items comprising each subscale. The total OHIP-14 score and the subscale scores constitute measures of "severity" of adverse impacts by oral diseases, whereby, the higher the OHIP-14 score, the poorer the OHRQoL. The total number of people reporting one or more items "fairly often" or "very often" was calculated as percentages, and the extent (number of items reported "fairly often" or "very often") were calculated as well.
General information about the age, gender, educational background, and oral hygiene practices was recorded as well.
The Kappa statistic for this study was 0.71, indicating good inter-examiner reliability. Statistical analysis was made using the statistical software package Statistical Package for the Social Sciences (SPSS 16, Inc., Chicago, IL). Descriptive statistics such as mean and proportions were calculated. Bivariate relationships between each independent variable and the prevalence of impacts reported "fairly often or very often" were evaluated using the Pearson's chi-squared test.
A total of 547 inmates were present in the Model Kanda jail but only 311 inmates agreed to participate, thus accounting to the response rate of 56.8%. Out of the 311 inmates, there were 286 males (91.9%) and 25 females (8.1%). Mean age of the population was 40.8 ± 6.3. The majority of the study population, i.e., 176 (56.5%) inmates belonged to the age group 36-50 years. About one-third (31.8%) of the subjects were illiterate.
Around three-fourths (71.8%) of the subjects were affected by dental caries. The mean DMFT of the population was 5.1 ± 2.1. It was found that 171 (54.9%) had calculus, 41 (13.2%) had shallow pockets, and 13 (4%) had deep pockets.
[Table 1] summarizes the data on percentage of subjects affected, extent and severity of impacts by OHIP-14 dimension, and total scale score. The mean severity score, summed for the 14 items in the scale was 14.57. The physical pain, physical disability, and functional limitation dimensions accounted for highest prevalence, extent, and severity of impacts.
|Table 1: Prevalence, extent, and severity of impacts by OHIP-14 subscale and total score|
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[Table 2] shows the bivariate associations between the percentage of subjects with impacts (fairly/very often) and gender and the clinical measures.
|Table 2: Occurrence of impacts (fairly/very often) by gender and oral disease prevalence|
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In the present study, 71.8% of participants were affected by dental caries and had a mean DMFT of 4.47 that is higher than 44.5% for the general population as per the National Oral Health Survey and Fluoride Mapping.  The high proportion of dental caries may be due to the fact that untreated dental decay is greater in prison population as compared to the general population, which was additionally reported by Lars Moller et al.  But the prevalence is less as compared to 78.7% with the mean DMFT of 4.79 as reported by Dhanker K and Ingle et al.  Coming to the CPI scores, 4.5% of the subjects had healthy periodontium and 54.2 had a score of 2. A percentage of 13.2 and 4 had a CPI score of 3 and 4 that is almost same as reported by McGrath  but is lesser than as reported by Dhanker K and Ingle et al.  The high prevalence of dental caries and periodontal diseases among the prison inmates may be attributed to the low utilization of preventive and therapeutic dental services and no dental services for the prison inmates in the prison hospital. This indicates that these inmates need thorough oral health care by the dental professionals along with proper dental health education to improve the existing condition.
In the current study, around 50.1% of the subjects reported that their oral condition had negatively impacted upon them in some way "fairly often" or "very often" over the preceding 6 months, thereby affecting their quality of life. The percentage of subjects affected by negative impacts in this study is higher than that of 15.9% in the U.K., 18.2% in Australia.  The mean OHIP score (severity score) was higher in the present study (14.97) as compared to the general population in Gujarat (8.8) and Rajasthan (11.2), India,  Australia (7.5).  The difference in the occurrence of negative impacts can be explained by the fact that the negative impacts are less frequent in general populations as the oral health services available to the population comprise both preventive and curative services, while, among prison inmates oral health services are mostly relief-oriented.
In the physical pain category, response categories fairly often or very often were reported by 21.8%. It was reported mostly by those having one or more decayed teeth and this finding is consistent with the findings of Shashidhar Acharya.  In physical disability and functional limitation (response categories fairly often or very often) was 18.0% and 4.5% and was mostly reported by those having missing teeth and these findings are consistent with the findings of Slade GD  and Naveen Ingle et al. 
Bivariate analysis shows that presence of negative impacts was significantly higher among females. Dental caries, periodontal status, and the number of missing teeth are significantly related to OHRQoL.
The limitation of the present study was the sampling method, as only those who agreed to participate participated. However, the study has certain strengths, such as both the clinical indicators of oral health status and the multi-item OHQRoL was used.
The presence of oral diseases was higher in the prison population than in the general population, indicating less treatment experience. About one half of the population reported that their oral condition had negatively impacted them in some way, thereby affecting their quality of life. Females experienced more severe impacts of oral disorders than males. OHRQoL was significantly related to dental caries, periodontal disease, and the number of missing teeth. It creates an alarming need to focus on these risk groups with special emphasis on the factors that are contributing to the poor oral health status and to provide service to improve their oral health.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Heidari E, Dickinson C, Wilson R, Fiske J. Verifiable CPD paper: Oral health of remand prisoners in HMP Brixton, London. Br Dent J 2007;202:E1.
Prison Heath. Available from:
. [Last accessed on 2013 Jul 18].
Inglehart MR, Bagramian RA. Oral health-related quality of life: An introduction. In: Inglehart MR, Bagramian RA, editors. Oral Health-Related Quality of Life. Chicago: Quintessence Publishing; 2002. p. 1-6.
Locker D. Measuring oral health: A conceptual framework. Community Dent Health 1988;5:3-18.
Klein H, Palmer CE, Knutson JW. Studies on dental caries index. Dental status and dental needs of elementary school children. Public Health Report (Wash) 1938;53:751-65.
World Health Organization. Oral Health Surveys. Basic Methods. 4 th
ed. Geneva: World Health Organisation; 1997. p. 26-9.
National Oral Health Survey and Fluoride Mapping. India: DCI Publication; 2002-2003. p. 89-92.
Moller L, Stover H, Jürgens R, Gatherer A, Nikogosian H. Health in Prison: A WHO Guide to the Essentials in Prison Health. Europe: WHO; 2007. p. 147-55.
Dhanker K, Ingle NA, Kaur N, Gupta R. Oral health status and treatment needs of inmates in district jail of Mathura city - A cross sectional study. J Oral Health Comm Dent 2013;7: 24-32.
McGrath C. Oral health behind bars: A study of oral disease and its impact on the life quality of an older prison population. Gerodontology 2002;19:109-14.
Slade GD, Nuttall N, Sanders AE, Steele JG, Allen PF, Lahti S. Impacts of oral disorders in the United Kingdom and Australia. Br Dent J 2005;198:489-93, discussion 483.
Jain M, Kaira LS, Sikka G, Singh S, Gupta A, Sharma R, et al
. How do age and tooth loss affect oral health impacts and quality of life? A study comparing two state samples of Gujarat and Rajasthan. J Dent (Tehran) 2012;9:135-44.
Acharya S. Oral health-related quality of life and its associated factors in an Indian adult population. Oral Health Prev Dent 2008;6:175-84.
[Table 1], [Table 2]