Indian Journal of Public Health

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 62  |  Issue : 4  |  Page : 271--276

Oral health-related quality of life among male subjects with oral submucous fibrosis in a tertiary care hospital


Ashok Kumar Jena1, Subhalaxmi Rautray2, Mounabati Mohapatra3, Sombir Singh4,  
1 Associate Professor, Department of Dental Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Assistant Professor, Department of ENT and Head and Neck Surgery, SCB Medical College, Cuttack, Odisha, India
3 Professor and Head, Department of Dental Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
4 Senior Resident, Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, Union Territory, India

Correspondence Address:
Dr. Ashok Kumar Jena
Department of Dental Surgery, All India Institute of Medical Sciences, Sijua, Dumduma, Bhubaneswar, Odisha
India

Abstract

Background: Oral submucous fibrosis is very common in Asia. It has many deleterious effects on individual's oral functions. Thus, there is a need to assess the effect of oral submucous fibrosis on quality of life. Objective: To assess the oral health-related quality of life (OHRQoL) in male subjects with oral submucous fibrosis. Methods: Two hundred and thirty male subjects in the age range of 20–40 years were recruited in the cross-sectional, two-group comparative study. Of 230 male subjects, 115 were oral submucous fibrosis subjects who were included in the study group and 115 healthy subjects formed the control group. English version of the oral health impact profile-14 (OHIP-14) was used to assess the OHRQoL. Wilcoxon signed-rank, Kruskal–Wallis, and Bonferroni tests were applied, and the P = 0.05 was considered as level of significance. Results: The mean and median OHIP-14 scores were 19.10 ± 0.66 and 18.00 in the study group and 3.98 ± 3.80 and 3.00 in the control group subjects, respectively (P < 0.001). Mean score of all the seven domains of OHIP-14 was significantly more in oral submucous fibrosis subjects (P < 0.001). All the oral submucous fibrosis subjects had one or more negative effects on OHRQoL compared to 64.34% of healthy subjects. Stage-4 of the oral submucous fibrosis had maximum effect on quality of life compared to other stages (P < 0.001). Conclusions: The quality of life among males is severely affected by oral submucous fibrosis, and Stage-4 of oral submucous fibrosis has maximum effect on the quality of life.



How to cite this article:
Jena AK, Rautray S, Mohapatra M, Singh S. Oral health-related quality of life among male subjects with oral submucous fibrosis in a tertiary care hospital.Indian J Public Health 2018;62:271-276


How to cite this URL:
Jena AK, Rautray S, Mohapatra M, Singh S. Oral health-related quality of life among male subjects with oral submucous fibrosis in a tertiary care hospital. Indian J Public Health [serial online] 2018 [cited 2020 Oct 27 ];62:271-276
Available from: https://www.ijph.in/text.asp?2018/62/4/271/247220


Full Text



 Introduction



Oral submucous fibrosis is a common disease of oral cavity among Asians, having a prevalence rate of 0.4% among rural Indians.[1] This disease is more common among 20–40 years of age group individuals.[2] It is multifactorial in origin but has high frequency with consumption of areca nut.[3],[4] The alkaloid components of areca nut stimulate fibroblastic proliferation and collagen synthesis in the submucosal layer.[4] The most common initial symptom of oral submucous fibrosis is burning sensation either on eating spicy, hot food or on intake of hot beverages. Early symptoms are blisters, ulcerations, and recurrent stomatitis. Restricted mouth opening and tongue movements are seen when the disease progresses. Malignant transformation can occur in 4.5%–30% of cases.[5],[6],[7] As oral submucous fibrosis has many deleterious effects on individual's oral functions, it is essential to understand the consequences of this disease on quality of life. To the best of our knowledge, there is no study in the literature evaluating the oral health-related quality of life (OHRQoL) among oral submucous fibrosis subjects. Thus, the present cross-sectional, two-group comparison study was designed to assess the OHRQoL among male subjects with oral submucous fibrosis.

 Materials and Methods



Study design

This cross-sectional, two-group comparison study was carried out between August 2015 and December 2016. All the consecutive oral submucous fibrosis subjects who were directly reported or referred from other departments to the Outpatient Department of Dental Surgery were screened for the study. Subjects in the age range of 20–40 years who can read and understand English and having only oral submucous fibrosis were considered as inclusion criteria. The exclusion criteria included subjects with oral submucous fibrosis along with any acute local problems such as pericoronitis, pulpitis, or acute gingivitis, aphthous stomatitis, already seeking treatment for oral submucous fibrosis, or any other dental disease and any known systemic disease. A total of 148 oral submucous fibrosis subjects were examined during the study period. All the subjects were informed about the etiology, clinical features, management, and prognosis of oral submucous fibrosis. Of total 148 subjects examined, 121 subjects fulfilled the inclusion and exclusion criteria. Of 121 subjects, 115 were males and six were females. As there were only six females, they were excluded from the study. Thus, a total of 115 male subjects formed the study group. In all the study group subjects, oral submucous fibrosis was diagnosed clinically. Based on the extent of fibrosis, the oral submucous fibrosis was divided into four stages[8] [Table 1]. The control group comprised 115 healthy male subjects in the same age range and having similar sociocultural characteristics. One of the authors (AKJ) explained about the study to each subject; all the subjects read, understood, and signed informed consent form; and the study was performed as per the Declaration of Helsinki 1975, as revised in 2000.{Table 1}

Data collection

A questionnaire of general conditions was filled out by patients to determine their demographic data such as age, sex, habits, and sociocultural characteristics. The quality of life was assessed by oral health impact profile-14 (OHIP-14).[9] The OHIP-14 questionnaire consists of 14 items covering seven domains: functional limitations, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and any handicaps. Each item was scored on a 5-point scale (0 for never to 4 for very often) to rate the effect of overall oral health status. Each patient was first explained about all 14 questions, and then, the questionnaire was given to fill it up within a time period of 10 min.

Statistics

A master file was made in Microsoft Excel software, and the data were statistically analyzed on a computer using SPSS software version 17 (Statistical Packages for the Social Sciences, Chicago, IL, USA). Descriptive statistics were used. The Kolmogorov–Smirnov normality test was applied and data were not normally distributed. The nonparametric tests, i.e., Wilcoxon signed-rank test and Kruskal–Wallis tests, were applied for comparison between the study and control groups. Bonferroni test was used for multiple comparisons. The P = 0.05 was considered as level of significance.

 Results



Post hoc power calculation was done. Importing the mean OHIP-14 scores, i.e., 19.1 for the study group and 3.98 for control group, and two-sided confidence interval as 95% into OpenEpi, Version 3 software,[10] the power of the study was found as 95.32 which validates the adequacy of sample size and the study findings.

The mean age of the subjects in the study and control group was 28.74 ± 5.60 and 28.59 ± 6.03 years, respectively. The mean mouth opening among the subjects of study group was 25.45 ± 8.27 mm and among control subjects was 47.80 ± 4.10 mm. The descriptive data showing percentage of subjects having different habits and the average duration and frequency of habit among study and control group subjects are described in [Table 2]. The OHIP scores among the oral submucous fibrosis and healthy control subjects are described in [Table 3]. The mean scores of all the seven domains of OHIP-14 were significantly more among oral submucous fibrosis subjects (P < 0.001). Physical pain and psychological discomforts were most severely affected in oral submucous fibrosis subjects compared to healthy subjects (P < 0.001). The item No. 14, i.e., totally unable to function, was comparable among the two groups (P = 0.084). The effect of severity of oral submucous fibrosis on quality of life is described in [Table 4] and [Table 5]. The functional limitation was significantly more in Stage-4 compared to Stage-1, Stage-2, and Stage-3 of disease (P < 0.001). The severity of disease had similar effect on the physical pain, psychological discomfort, and physical disability. The psychological disability, social disability, and handicap were more in Stage-4 of disease. The total OHIP-14 score was significantly more in Stage-1, Stage-2, and Stage-4 compared to Stage-3 of oral submucous fibrosis (P < 0.001).{Table 2}{Table 3}{Table 4}{Table 5}

 Discussion



Oral submucous fibrosis is one of the high-risk premalignant diseases that progress into cancer. The rate of oral submucous fibrosis converting into malignancy is in the range of 4.5%–30%.[5],[6],[7] Various other premalignant lesions such as leukoplakia and erythroplakia are also frequently present with oral submucous fibrosis, leading to its poor prognosis. The homogenous and nodular leukoplakias are usually associated with oral submucous fibrosis.[11] The presence of other premalignant lesions and oral ulcers on oral submucous fibrosis can further deteriorate the OHRQoL.

In modern public health research and practice, quality of life is considered as a valid, appropriate, and significant tool of service need and intervention outcomes. The assessment of OHRQoL is a complex and subjective issue which involves the overall and specific evaluation of few life dimensions, such as pain, speech, chewing, and social and psychological aspects.[12] The effect of oral submucous fibrosis on OHRQoL can be related to the impairment, disability, and handicap.[13] The OHIP-14 questionnaire which was used in the present study is designed to measure self-reported dysfunction, discomfort, and disability attributed to oral submucous fibrosis. The OHIP questionnaire is very reliable and sensitive to changes and also to exhibit suitable cross-cultural consistency. However, in the present study, all the patients were from the Odia community. As there is no Odia version of OHIP-14 questionnaire, the English version was used in this study. In OHIP-14 questionnaire, identification of score 0 and 4 is usually very easy by the patients, but choosing the intermediate answers such as 1, 2, and 3 have some difficulties.[14] As a result, the OHIP has limitations in showing evidence of subtle variations in the effect of OHRQoL. Thus, addition of global ratings of OHRQoL is always better in understanding the negative effect of oral submucous fibrosis.[15]

In the present study, we observed that overall 64.34% of healthy subjects had one or more effects on OHRQoL whereas all (100%) oral submucous fibrosis subjects had one or more effects on OHRQoL. The mean OHIP-14 score was 3.98 ± 3.80 in healthy group subjects. Similar to our observation, Liu et al.[16] also reported 6.55 ± 6.73 as the mean OHIP-14 score among healthy subjects. The majority of score in each OHRQoL item was either 0 or 1 in normal subjects, whereas in oral submucous fibrosis subjects, the scores were higher in each item. The mean OHIP score was 19.10 ± 7.66 among oral submucous fibrosis patients which was much more compared to healthy subjects. We observed that the maximum effect of oral submucous fibrosis on quality of life was because of physical pain and psychological discomfort. The more physical pain among oral submucous fibrosis patients was mainly due to pain or burning sensation to spicy food and hot beverages, discomfort, and limited mouth opening, which resulted problems in eating. Stomatitis is a significant feature of oral submucous fibrosis, which is secondary to the epithelial atrophy of oral mucosa. Considering the characteristics and multiplicity of signs and symptoms of oral submucous fibrosis, discomfort during eating including soreness is the first function to be affected. The psychological discomfort was because of the sensation of feeling worried and tense when the patients were seeking treatment during their first visit without knowing their diagnosis and prognosis. Similarly, mouth is commonly related to appearance and social contact. Thus, oral submucous fibrosis might cause embarrassment particularly if the lesion has involved lips and tongue.[14] Similar to our observation among oral submucous fibrosis patients, deterioration of physical pain and psychological discomforts are also very common among medically compromised patients[17] and patients with temporomandibular joint disorder,[18] oral lesions associated with HIV,[19] oral cancer,[20] recurrent oral cancers,[20] precancerous lesions such as leukoplakia, erythroplakia, and oral lichen planus,[20] and oral mucosal diseases such as recurrent aphthous ulcer,[16] burning mouth syndrome,[16] and candidiasis.[16] However, the deterioration of OHRQoL in oral submucous fibrosis patients was more compared to patients with other oral diseases.[16],[17],[18],[19],[20]

We observed that the functional limitation and physical pain were more in the Stage-4 of the oral submucous fibrosis. This could be because of more extent of the fibrosis in the oral cavity and more restricted mouth opening as the disease progressed. However, we observed that the psychological discomfort, physical disability, and psychological disability were similar in all stages of oral submucous fibrosis. The social disability was more in Stage-1 and Stage-4 of the disease compared to the Stage-2 and Stage-3 of the oral submucous fibrosis.

From the present study, we observed that oral submucous fibrosis significantly compromises the daily life activities. Physical pain and psychological discomfort badly affect day-to-day quality of life in oral submucous fibrosis patients.

 Conclusions



From the present study, it was concluded that the OHRQoL in oral submucous fibrosis patients was very poor compared to normal healthy subjects. The physical pain and psychological discomforts were affected maximum in oral submucous fibrosis patients. The Stage-4 of the oral submucous fibrosis had maximum effect on the OHRQoL.

In the present study, the original English version of OHIP-14 questionnaire was used to assess the effects of oral submucous fibrosis on OHRQoL among male patients. An Odia version of same questionnaire may also be prepared and validated to test the effects of oral submucous fibrosis on OHRQoL. In addition, further study may be conducted to assess the effect of various treatments for oral submucous fibrosis on OHRQoL.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Murti PR, Bhonsle RB, Gupta PC, Daftary DK, Pindborg JJ, Mehta FS, et al. Etiology of oral submucous fibrosis with special reference to the role of areca nut chewing. J Oral Pathol Med 1995;24:145-52.
2Pindborg JJ. Oral precancerous conditions in South East Asia. Int Dent J 1965;15:190-9.
3Borle RM, Borle SR. Management of oral submucous fibrosis: A conservative approach. J Oral Maxillofac Surg 1991;49:788-91.
4Pillai R, Balaram P, Kannan SR. Pathogenesis of oral submucous fibrosis. Cancer 1992;59:2011-20.
5Aziz SR. Oral submucous fibrosis: Case report and review of diagnosis and treatment. J Oral Maxillofac Surg 2008;66:2386-9.
6Pundir S, Saxena S, Aggarwal P. Oral submucous fibrosis a disease with malignant potential- report of two cases. J Clin Exp Dent 2010;2:215-8.
7Chattopadhyay A, Ray JG. Molecular pathology of malignant transformation of oral submucous fibrosis. J Environ Pathol Toxicol Oncol 2016;35:193-205.
8More CB, Das S, Patel H, Adalja C, Kamatchi V, Venkatesh R, et al. Proposed clinical classification for oral submucous fibrosis. Oral Oncol 2012;48:200-2.
9Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25:284-90.
10Sullivan KM, Dean A, Soe MM. OpenEpi - a web based epidemiologie and statistical calculator for public health. Public Health Rep 2009;124:471-4.
11More C, Thakkar K. Oral submucous fibrosis-an insight. J Pearldent 2010;1(3).
12Kieffer JM, Hoogstraten J. Linking oral health, general health, and quality of life. Eur J Oral Sci 2008;116:445-50.
13Scott DL, Garrood T. Quality of life measures: Use and abuse. Baillieres Best Pract Res Clin Rheumatol 2000;14:663-87.
14Silva CA, Grando LJ, Fabro SM, de Mello AL. Oral health related to quality of life in patients with stomatological diseases. Stomatologija 2015;17:48-53.
15Ni Riordain R, McCreary C. The use of quality of life measures in oral medicine: A review of the literature. Oral Dis 2010;16:419-30.
16Liu LJ, Xiao W, He QB, Jiang WW. Generic and oral quality of life is affected by oral mucosal diseases. BMC Oral Health 2012;12:2.
17Locker D, Matear D, Stephens M, Jokovic A. Oral health-related quality of life of a population of medically compromised elderly people. Community Dent Health 2002;19:90-7.
18Barros Vde M, Seraidarian PI, Côrtes MI, de Paula LV. The impact of orofacial pain on the quality of life of patients with temporomandibular disorder. J Orofac Pain 2009;23:28-37.
19Yengopal V, Naidoo S. Do oral lesions associated with HIV affect quality of life? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:66-73.
20Rana M, Gellrich NC, Rana M. Comparison of health-related quality of life of patients with different precancer and oral cancer stages. Clin Oral Investig 2015;19:481-8.