Caries and Fluorosis Impacts on Oral Health-Related Quality of Life

Objective: To determine the impacts of dental caries and enamel fluorosis on oral health-related quality of life (OHRQoL) in North Carolina Schoolchildren and their families.

Method: All students (n=7,686) enrolled in a probability sample of 398 classrooms in grades K-12 in North Carolina public schools and their parents were recruited for a one-time survey in 2003-04.  Parents of children in grades K-3 and 4-12 completed the Early Childhood Oral Health Impact Scale (ECOHIS) and the Family Impact Scale (FIS), respectively.  Students in grades 4-5 (CPQ_8-10) and 6-12 (CPQ_11-14) completed a Child Perception Questionnaire.  All students received a clinical examination for enamel fluorosis in anterior teeth (Dean’s Index) and caries experience (d_2-3fs, D_2-3MFS) by one of 6 trained dentists.  OHRQoL (sum of impact frequency Likert scores) were analyzed by fluorosis categories (unaffected; questionable-very mild; mild-moderate-severe) and caries scores (sum of d_2-3fs, D_2-3MFS) descriptively and using OLS regression, while controlling for covariates (child ever had dental injury, treatment needed, unmet demand, dental home, age, race-ethnicity, percent poverty level, county urbanicity and parental education).

Result: Clinical or OHRQoL information was available for 6,088 children (Response Rate=79.2%).  72.4% of children were unaffected by fluorosis, 24.0% had questionable or very mild fluorosis, and 3.4% had mild, moderate or severe fluorosis.  Mean d_2-3fs and D_2-3MFS scores per child were 2.1 and 1.7, respectively.  CPQ_8-10, CPQ_11-14, ECOHIS and FIS mean scores were 13.3, 21.4, 4.9 and 2.4, respectively.  No associations were found between fluorosis categories and any OHRQoL scales in the multivariate analysis (all P-values > 0.1).  The sum of d_2-3fs and D_2-3MFS scores was positively and strongly associated with ECOHIS (B=0.220; P=<.001), FIS (B=0.063; P=.001), and CPQ_11-14 (B=0.239; P<.001) scores.

Conclusion: The child’s caries experience had a negative impact on OHRQoL of the child and parent, while fluorosis prevalence or severity had no impact.