Impact of sense of coherence on oral health-related quality of life among Brazilian adults

Abstract It has been postulated that oral health-related quality of life (OHRQoL) may be affected by the sense of coherence (SOC), but there are no epidemiological studies investigating this association in Brazilian adults. The present study was conducted among adults of a mid-sized Brazilian city, with the aim of looking into this association. The probability sampling consisted of 342 adults aged 35-44 years old, from a mid-sized Brazilian city, who were examined at their homes for caries (Decayed, Missing and Filled Teeth [DMFT] Index) and periodontal disease (Community Periodontal Index - CPI), according to WHO criteria. The questionnaire applied included demographic factors, socioeconomic information, use of dental services, behavior, SOC and the Oral Health Impact Profile (OHIP). The OHIP outcome, measured by prevalence of the impact, was analyzed by binary logistic regression using a hierarchical approach, a conceptual model, and a 5% significance level. A total of 67.9% of the respondents had one or more impacts on OHRQoL, and 54.4% showed a high SOC. The impact on OHRQoL was more prevalent in adults who had a manual occupation (PR = 2.47, 95%CI 1.24–4.93), those who perceived the need for dental treatment (PR = 2.93, 95%CI 1.67–5.14), and those who had untreated caries (PR = 1.93, 95%CI 1.07–3.47). Those with a low SOC had a twofold higher prevalence of impact on OHRQoL (PR = 2.19, 95%CI 1.29–3.71). This impact on OHRQoL was associated with a low SOC, even after adjusted by socioeconomic, behavioral and clinical factors. Future studies should consider the SOC in determining the oral health impact on quality of life.

摘要 已有假说提出，口腔健康相关生活质量（oral health-related quality of life, OHRQoL）可能会受到心理一致感（sense of coherence, SOC）的影响，但目前尚无针对巴西成年人群开展的、探究二者关联的流行病学研究。本研究以巴西一座中等规模城市的成年群体为研究对象，旨在明确这一关联。本研究采用概率抽样方法，纳入342名年龄介于35~44岁的成年受试者，由研究人员前往受试者家中开展口腔检查，依据世界卫生组织（World Health Organization, WHO）的标准评估龋病情况（龋失补（Decayed, Missing and Filled Teeth, DMFT）指数）与牙周疾病状况（社区牙周指数（Community Periodontal Index, CPI））。研究所用问卷涵盖人口学特征、社会经济信息、牙科服务利用情况、行为习惯、心理一致感以及口腔健康影响量表（Oral Health Impact Profile, OHIP）相关内容。本研究以口腔健康影响的患病率作为OHRQoL的结局指标，通过二元logistic回归开展分析，分析过程采用分层分析策略、结合概念模型，并设定5%的显著性水平。最终共有67.9%的受访者存在至少1项口腔健康相关生活质量受损情况，54.4%的受试者表现出较高水平的心理一致感。口腔健康相关生活质量受损在体力劳动者（患病率比PR=2.47，95%置信区间CI：1.24~4.93）、自认存在牙科治疗需求的人群（PR=2.93，95%CI：1.67~5.14）以及存在未治疗龋病的人群中更为普遍（PR=1.93，95%CI：1.07~3.47）。心理一致感水平较低的人群，其口腔健康相关生活质量受损的患病率为其他人群的2倍（PR=2.19，95%CI：1.29~3.71）。即使在校正社会经济、行为与临床相关因素后，口腔健康相关生活质量受损仍与较低水平的心理一致感存在显著关联。未来相关研究在探究口腔健康对生活质量的影响时，应将心理一致感纳入考量范畴。