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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 7  |  Issue : 1  |  Page : 41-45

A cross-sectional comparative analysis of smoking and oral health-related quality of life


Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia

Date of Submission26-Mar-2022
Date of Decision19-Apr-2022
Date of Acceptance11-May-2022
Date of Web Publication27-Jul-2022

Correspondence Address:
Dr. Nabeeh A AlQahtani
Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/KKUJHS.KKUJHS_18_22

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  Abstract 

Introduction: Tobacco use is a major public health concern globally, and its usage has various harmful effects on both general and oral health. Thus, assessment of the oral health-related quality of life (QOL) is necessary among smokers to improve their oral health. The aim of this study was to assess the oral health-related QOL among smokers and nonsmokers. Methodology: A cross-sectional comparative research was conducted. A total of 520 participants, of which 260 were smokers and 260 were nonsmokers, were included in the study. To acquire data related to sociodemographic parameters and smoking status, the World Health Organization QOL-Brief version assessment tool was used, and to review the association between oral health-related QOL, the Oral Health Impact Profile-14 (OHIP-14) was used. Results: When comparing smokers and nonsmokers' OHIP, the mean rank of every OHIP-14 question was higher in smokers with a significant P = 0.001, except for “satisfaction of life,” where the P value was not significant (P = 0.347). The distribution of total OHIP-14 scores as per sociodemographic variable showed that a higher mean rank of OHIP-14 was found in unmarried, nonearning, and noneducated participants as compared to married, employed, and literate participants. However, the difference was not statistically significant. Conclusion: Oral health-related QOL among smokers is poor as compared to nonsmokers.

Keywords: Dental problems, nonsmokers, oral health, quality of life, smokers


How to cite this article:
AlQahtani NA. A cross-sectional comparative analysis of smoking and oral health-related quality of life. King Khalid Univ J Health Sci 2022;7:41-5

How to cite this URL:
AlQahtani NA. A cross-sectional comparative analysis of smoking and oral health-related quality of life. King Khalid Univ J Health Sci [serial online] 2022 [cited 2022 Nov 28];7:41-5. Available from: https://www.kkujhs.org/text.asp?2022/7/1/41/352520


  Introduction Top


Quality of life (QOL) is a broad term but a concept that is innate for all people. Broadly, a poor QOL upsets global life fulfillment, personal and family security, good health and well-being, interrelationships, and leisure time recreation.[1] A multidimensional model by which we can assess the quality of oral health profile is oral health-related QOL (OHRQoL). The domains included in this model are endurance, absence of any type of impairment; lack of pain; appropriate functioning in terms of the physical, psychological, and social aspects; the self-approach of an individual toward their oral health; and nonexistence of any social handicap related to dental functioning.[2]

The OHRQoL assesses the various oral conditions and effects of dental actions on the patient's psychological utterance.[3] As dental and facial esthetics can affect the self-confidence of a person, they are also linked with the psychological behavior of an individual, and therefore, it has been considered as an integral part of the OHRQoL.[4],[5] There are several pieces of evidence-based studies have termed, that increased rate of occurrences of oral diseases and disorders are directly associated with social inequity, which can further affect oral health.[6],[7],[8],[9]

Tobacco use is a major public health concern globally because approximately a quarter third of the adult population worldwide consume tobacco by either chewing it or by smoking it. According to a survey, roughly 7 million people die annually from the use of tobacco and its products; in addition, it is implicated that this figure will increase to approximately 10 million with 70% demission and middle-income nation states.[10] Tobacco use has various negative effects on both oral and overall health. Apart from diverse systemic unfavourable effects including cancer and cardiovascular diseases, consumption of tobacco affects oral health too. It ranges from staining of teeth and on effects on dental restorations, alteration in taste, color change of gingival, periodontal disease, development of smokers' palate, various premalignant and malignant lesions and conditions, and oral candidiasis.[11],[12],[13],[14]

Tobacco consumption is a worldwide crisis among adults not only in developing but also in developed countries. Only a few studies have been conducted on the relationship between OHRQoL and smoking. We, therefore, wanted to highlight this link. The research was performed at the College of Dentistry, King Khalid University, Abha, Saudi Arabia, to assess Oral health-related QOL among smokers.


  Methodology Top


Study design and study settings

A cross-sectional comparative research was conducted to review the oral health-related QOL among smokers and nonsmokers in Saudi Arabia. The participants were among patients who visited the College of Dentistry, King Khalid University, Abha, Saudi Arabia, from January 2022 to February 2022.

Ethical aspects

All study protocols were submitted to the institutional ethical board, and ethical approval was obtained. Informed assent was obtained from all the study participants before initiating the study.

Sampling and sample size

The sample size was calculated using a two-proportion formula, with nonsmokers' (P1) and smokers' (P2), and their poor oral health-related QOL was 0.14 and 0.24, respectively.[15] To estimate the desired sample size, α was taken as 0.05 and β was taken as 0.2 with 80% of power, r = 1; therefore, according to this formula, the total sample size estimated was 520. Thus, 260 participants were examined in the smoker group and 260 in the nonsmoker group.

Inclusion and exclusion criteria

Patients visited the College of Dentistry, King Khalid University, Abha, Saudi Arabia, for dental treatment and patients who were willing to give consent were included in the study, whereas patients who presented with severe pain, who were not able to respond to the questionnaire, and who were not willing to participate were excluded from the study.

Data collection

The operational definition that considered for smokers is as follows: participants who presently smoke cigarettes and also whoever had smoked approximately 100 cigarettes in his/her lifetime. All the study participants were divided into two groups based on this criterion: group 1 were smokers and Group 2 were nonsmokers or who had smoked <100 cigarettes in their lifetime.[16] To attain data related to sociodemographic parameters and smoking status, the World Health Organization QOL-Brief version (WHOQOL-Brief)[17] was used; a higher score in demographic details in WHOQOL-Brief indicates better general health-related QOL (HRQOL).

For the consideration of OHRQoL, the Oral Health Impact Profile (OHIP) questionnaire is most extensively used.[3] The main questionnaire consists of 49-item forms, but in the present study, a modified version of the main OHIP was used, that is, OHIP-14. OHIP-14 has 7 domains that provide a comprehensive measurement of serviceable restraint, physical tenderness, psychological discomfort, physical, psychological, and social disability, and handicap situations on the grounds of Locker's conceptual model of oral health. The reactions of OHIP-14 are calculated through a five-point Likert scale: 0 = never; 1 = hardly ever; 2 = occasionally; 3 = fairly often; and 4 = very often/every day. The high OHIP-14 scores point out poor health, while low scores indicate a better oral health-related QOL.[18] The data collection was done in the College of Dentistry, King Khalid University, Abha, Saudi Arabia, by a single investigator to minimize the bias.

Study variables and statistical analysis

The primary variables in this study were age, literacy status, marital status, financial position, and smoking status, while OHRQOL is a dependent variable. The response of participants regarding every article of OHIP-14 was presented as frequencies and proportions, and the descriptive analysis was to evaluate the total OHIP and subscale scores. Data distribution was checked by Kolmogorov–Smirnov tests. As the data were not normally distributed, nonparametric tests such as the Mann–Whitney U-test and Kruskal–Wallis test were conducted to test the relation between study variables. The level of significance was set at 5%.


  Results Top


This cross-sectional research was carried out to review how oral health related to the QOL in smokers and nonsmokers. A total of 520 study participants were included in this study, in which 260 were examined in the smoker group and 260 were in the nonsmoker group. The mean age of study participants was 38.31 ± 13.041, with the lowest age of 18 and the highest of 68 years. Among 520 study participants, 344 (66.2%) were married, 176 (33.8%) were unmarried, and 320 (61.5%) were earning, whereas 200 (38.5%) were not earning. In the present study, 360 (69.2%) study participants were educated ≥ high school, 120 (23.1%) were less than high school, and 40 (7.7%) were illiterate. The demographic details of study participants are shown in [Table 1].
Table 1: Demographic details of study participants

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The allocation of responses of OHIP-14 showed that the majority 176 (33.8%) and 132 (25.4%) participants hardly ever felt difficulty in pronouncing words, but their taste had worsened. The physical pain domain showed that 116 (22.3%) participants fairly often showed pain in the mouth and 96 (18.5%) were fairly often uncomfortable in eating food. The psychological discomfort domain showed that 164 (31.5%) were occasionally self-consciousness, while 136 (26.2%) felt tense feeling fairly often. The domain of physical disability showed that 148 (28.5%) participants were unsatisfied with their diet fairly often and 140 (26.9%) hardly ever missed a meal. As per the domain of psychological disability, 144 (27.7%) and 136 (26.2%) hardly ever felt hard to relax and felt uncomfortable. The social disability domain showed that 124 (23.8%) and 144 (27.7%) were hardly ever short-tempered with others and find difficulty doing their jobs, respectively. The domain of handicap showed that 200 (38.5%) and 156 (30%) hardly ever thought of the lifeless satisfying and unable to function. The distributions of responses of various OHIP-14 questions are shown in [Table 2].
Table 2: Frequency in the distribution of responses of oral health impact profile-14 scores among study participants (n=520)

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When we compared OHIP among smokers and nonsmokers, the mean rank of every OHIP-14 question was higher in smokers as compared to nonsmokers with a significant P = 0.001, except in satisfaction of life where the P value was not significant (P = 0.347). The distributions of responses of OHIP-14 and their comparison between smokers and nonsmokers are shown in [Table 3] and [Graph 1].
Table 3: Oral Health Impact Profile scores among smoker and nonsmoker groups

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The distribution of total OHIP-14 scores as per sociodemographic variable showed that a higher mean rank of OHIP-14 was found in unmarried than married participants, but the difference was not statistically significant. Similarly, a high mean rank value of total OHIP-14 was found in participants who were unemployed with a nonsignificant P = 0.735. As per the education status of the study participants, total mean rank of OHIP-14 was higher in illiterate participants as compared to others with a P = 0.39. The distributions of responses of total OHIP-14, with the sociodemographic parameters, are shown in [Table 4].
Table 4: Oral Health Impact Profile score distribution in sociodemographic variables

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  Discussion Top


In the modern research era, the eminence of life is considered a vital and applicable tool for any services provided and their outcomes. Oral health is a fundamental part of our general health excellence; therefore, assessment of OHRQoL is a multifaceted tool. It includes evaluation of several dimensions such as discomfort or any pain, verbal communication, chewing, and social and psychological aspects of every individual.[19]

In the present study, the OHIP-14 questionnaire was used to assess OHRQoL among smokers and nonsmokers. A total of 520 participants were included in the study of which 260 were examined in the smoker group and 260 in the nonsmoker group. The mean age of study participants was 38.31 ± 13.041, with the lowest age of 18 and the highest of 68 years. A similar study was conducted by Sagtani et al., with 125 current smokers and 125 nonsmokers, and an age range from 15 to more than 60 years.[17] A study by Ahsan et al. examined a total of 620 participants with the mean age of study participants 41.38 ± 13.77 and 43 ± 13.3 years, in the smoker and nonsmoker group, respectively.[20]

In the present study, among 520 study participants, 344 (66.2%) were married, 176 (33.8%) were unmarried, and 320 (61.5%) were earning, whereas 200 (38.5%) were not earning. The education status of the study participants showed that 360 (69.2%) study participants were educated ≥ high school, 120 (23.1%) were less than high school, and 40 (7.7%) were illiterate, whereas a study by Sagtani et al. included 222 married and 28 unmarried participants, 96 earning, and 154 not earning participants. Furthermore, 110 participants were illiterate, 50 were educated less than in high school, and only 90 were educated more than in high school.[17]

The present study showed that the OHIP among smokers is worst as compared with nonsmokers; the mean rank of every OHIP-14 question was drastically high in smokers as compared to nonsmokers. It showed smokers have a poor oral health-related QOL as compared with nonsmokers. Similar results were found by Ahsan et al. and Bakri et al., who found that tobacco users had poor OHRQoL as compared with nontobacco users.[20],[21] In the present study, OHIP was better among educated participants, almost comparable findings were seen in the study by Batra et al. In Batra et al.'s study, direct association was found between education and OHIP of study participants.[22] It established that sociostructural surroundings can persuade the social network of any individual, which further affects the thinking mechanism and people's preference in lifestyles, such as an adaptation of deleterious habits: smoking and alcohol intake. Gabardo et al. found that low social hold and smoking habits enhance the probability of bad oral health self-perception and adaptation of harmful habits associated with worse OHRQoL.[15],[23]

OHRQoL is a multidimensional concept, which can be relevantly assessed by the OHIP-14 questionnaire. OHIP-14 is a self-reported, subjective instrument that can influence diverse variables favorably or unfavorably. Therefore, we observed that smoking habit significantly reduces the oral health profile. Serviceable restraint, physical tenderness, psychological discomfort, physical, psychological, and social disability extensively influence and affect day-to-day QOL in smokers.


  Conclusion Top


From the findings of the present study, we concluded that oral health-related QOL among smokers is poor as compared to nonsmokers. There are several factors which can influence oral health profile in favorable or unfavorable manner. OHRQoL also linked with sociodemographics of the population, including their education level, marital status, capacity of earning, and other factors. OHRQoL is a broad term, and thus to improve it, a multipronged approach is required in which both oral health professionals and public health proficient can play crucial roles.

Acknowledgment

We express our gratitude to all of our study contestants for their precious time and valuable information for this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

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



 

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