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Table of Contents   
ORIGINAL RESEARCH  
Year : 2022  |  Volume : 33  |  Issue : 2  |  Page : 141-145
Relationship between sense of coherence, OHRQoL, and dental caries among nursing students in South India


1 Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montréal, Canada
2 Department of Dentistry, Health Sciences, City University College of Ajman, Ajman, UAE
3 Department of Clinical Science, College of Dentistry, Ajman University, Ajman, UAE

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Date of Submission12-Apr-2022
Date of Decision31-May-2022
Date of Acceptance24-Jun-2022
Date of Web Publication13-Oct-2022
 

   Abstract 


Background: Dental caries is one of the most common dental diseases that affect all population and is associated with the avoidance of care. Research has reported that sense of coherence (SOC) is related to many aspects of health including oral health. SOC determines the quality of health and might have a direct association with the development of subjective assessments of oral health. Objectives: To find the association between SOC, Oral Health-Related Quality of Life (OHRQoL) and caries status among nursing college students in southern state of India. Design: Cross-sectional design using questionnaire and assessment of caries status. Participants: Nursing students from south India. Methods: Convenience sampling method was followed and students who were present on the day of the study and consented to participate were included in the study. The total study sample consisted of 494 nursing students. SOC and OHRQoL were measured by a self-administered questionnaire; caries status was assessed using Decayed, Missing and Filled Tooth (DMFT) index. Results: Association between SOC and Oral Health Impact Profile (OHIP) and caries status and OHIP was found to be statistically significant. Correlation between dental caries and OHIP was found to be statistically significant, with R-value –0.251 shows that OHIP is negatively correlated with caries status. Conclusion: SOC as a psychosocial resource is capable of facilitating the motivation for positive oral health behaviours. These resources along with socio-economic and demographic factors can create an environment that is partially responsible for the individuals' cognitive and physical functions that can express themselves as the individuals' well-being and positive health behaviours.

Keywords: Dental caries, oral health impact profile, oral health related quality of life, salutogenesis, sense of coherence

How to cite this article:
Haricharan PB, Almudarris B, Azim SA, Albanna FS, Elkareimi Y, Kuduruthullah S. Relationship between sense of coherence, OHRQoL, and dental caries among nursing students in South India. Indian J Dent Res 2022;33:141-5

How to cite this URL:
Haricharan PB, Almudarris B, Azim SA, Albanna FS, Elkareimi Y, Kuduruthullah S. Relationship between sense of coherence, OHRQoL, and dental caries among nursing students in South India. Indian J Dent Res [serial online] 2022 [cited 2022 Nov 29];33:141-5. Available from: https://www.ijdr.in/text.asp?2022/33/2/141/358448



   Introduction Top


Oral health is a state of the mouth and associated structures where disease is contained and/or future disease is inhibited. It is important for general health and essential for overall well-being of an individual. Although several holistic approaches at community and individual levels have been tried to maintain oral health, these measures are inadequate in resolving the issues of oral diseases.

Psychosocial concepts are said to be associated with general health and oral health. One such concept recently reviewed in many studies is Antonovsky's general theory of salutogenesis, which is the key determinant of achieving and maintaining good somatic health.[1] The theory seeks to explain health-promoting factors as distinct from the factors that increase the risk of specific diseases. An individual with a strong sense of coherence (SOC) has the ability to define life events as less stressful (comprehensibility), can mobilize resources to deal with encountered stressors (manageability), and possesses the motivation, desire, and commitment to cope (meaningfulness).

Previous studies have shown the association of SOC with experience of health, health-oriented behaviours, and socio-economic status. A strong SOC has been reported to associate positively with self-reported good health[2] and negatively with experiences of stress, somatic symptoms, and health complaints.[3] A weak SOC has been found to promote the psycho-social effects of health problems.[4] The SOC has also been associated with several general and oral health behaviours, such as dietary habits, alcohol consumption,[5] drug recovery,[6] and physical activity.[7] It has been found that the dental attendance pattern and caries experience in anterior teeth are related to the SOC of adolescents[8] and to that of their mothers.

Antonovsky (1987) points out that youth and student year are a significant period to the development of SOC. It has been reported that weak life control is associated with unhealthy living habits among young people. Also, problems with mental health, poor performance, failure in academics, and marginalization are associated with weak life control.[9]

Previous studies have shown SOC is a determinant of quality of life. The World Health Organization defines quality of life as the perception of individuals regarding life and the cultural and values context in which they live and in relation to their objectives and expectancies.[10] Quality of life in relation to oral health is based on three main dimensions – physical symptoms, perceptions of welfare, and physical and social functional capacity.[11]

Oral health-related quality of life (OHRQoL) are measured using various measures in descriptive population-based research, especially to measure nonclinical aspects of oral health that any individual deem most relevant to their overall well-being.[12] The oral health impact profile (OHIP) gives a comprehensive measure of self-reported discomfort, dysfunction, and disability attributed to oral conditions. The items of the OHIP consist of seven subscales that measure only negative aspects of oral health. The subscales are functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. It has also been suggested that in future research, there is a need to identify additional determinants of OHRQoL, including psychological and social variables.[13],[14] The SOC, as a psycho-social resource, could include features that have modifying effects on the OHIP via oral health and oral health behaviour. In addition, the SOC might have a direct association with the development of subjective assessments of oral health.

Hence, this study aims to investigate the association between SOC, OHRQoL, and caries status among nursing college students in the southern state of India. The objectives of the study are to find the association between SOC and caries status; to find the association between caries status and OHRQoL.


   Materials and Methods Top


This is a cross-sectional study designed to investigate the association between dental caries, SOC, and OHRQoL among 500 nursing students in South India. Permission was obtained from the Institutional Ethical Committee before the start of the study (Ref.IEC1311-02). Convenience sampling method was followed and students who were present on the day of the study and consented to participate were recruited. Further, the students were also informed that the findings might be communicated in a peer reviewed journal.

Sense of Coherence

SOC scale having 12 5-point Likert-type items with descriptive end points derived from the short version of the SOC-13 scale proposed by Antonovsky was used in this study. All three components of the SOC, including comprehensibility, manageability, and meaningfulness were measured by four items each to give equal importance to all components. The missing item of the SOC scale was 'Does it happen that you have feelings inside you would rather not feel?' Mean SOC scores were calculated for each individual; higher scores indicate stronger SOCs.

Oral Health Related Quality of Life

OHRQoL was measured with a self-administered version of the OHIP scale, with 14 5-point Likert-type items (1-very often, 2-fairly often, 3-Sometimes, 4-very seldom, 5-not at all, and 6-do not know). To enable comparisons with data from similar studies, two summary measures were computed: (i) the prevalence (percentage) of people reporting one or more items 'fairly often' or 'very often', and (ii) the extent (i.e., the number of items reported 'fairly often' or 'very often').

Dental caries

Dental examinations for caries and missing teeth were conducted by calibrated dental examiners using the decayed, missing, and filled tooth (DMFT) index. Type 3 examination using mouth mirror and probe was done in the classrooms.

Method of data collection

Self-reporting questionnaires containing SOC-13 items and OHIP-14 items were administered in English language. After the completion of the questionnaire, oral examination was conducted in the classrooms using Type 3 examination technique using a mouth mirror and probe.

Statistical analysis

Data were analysed using SPSS Version-17 (Chicago, IL) and responses to the questions were analysed by calculating percentages based on the number of students who answered the questions. Chi-square test was used to test the association between SOC and dental caries, SOC and OHIP, and dental caries and OHIP-14. Pearson's correlation coefficient was calculated to test the strength of association between the OHIP-14 and Dental caries.


   Results Top


Out of the 500 questionnaires, only 494 were included in the final analysis. Among the total population (n = 494), 82.4% were female students and the mean age was 20.84 (±1.79).

Dental caries

Mean DMFT of the study group was 2.22. Decayed component was higher (μ = 1.53) followed by filled (μ = 0.54) and missing (μ = 0.15) [Table 1]. The subjects were distributed according to the DMFT component in [Table 2]. For decayed component, majority (N = 260; 52.6%) had 1–3 decayed teeth. For missing component, majority (89.8%) had no missing teeth. For filled component, around 374 (75.7%) had no filled teeth.
Table 1: Distribution of subject according to mean age and DMFT

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Table 2: Distribution of subject according to components of DMFT

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SOC

The distribution of the subjects according to SOC scores is given in [Table 3]. The SOC scores ranged from 21 to 54, with a mean of 37.8 (SD = 5.01). The minimum SOC score was 12 and maximum 60. The mean SOC score among males was 37.97 (SD = 5.03) and 37.20 (SD = 4.89) among females.
Table 3: Distribution of subjects according to dental caries and SOC categories

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The study group was divided into weak (12–28), moderate (29–44), and strong (45–60) SOC. A majority of the subjects 87.1% fell in the moderate SOC and 10.3% were in the strong SOC group; and only 2.6% in the weak SOC category. About 61.5% in the weak SOC category had dental caries, 24.7% in the moderate SOC had dental caries, and 29.4% in the strong SOC had dental caries. The association between dental caries and SOC was found to be statistically significant [Table 3].

OHIP-14

The oral health impact consists of seven domains. In [Table 4], distribution of subjects according to the domains is presented in detail. In the functional limitation domain, a majority of the subjects (64.2%) have never or hardly ever had trouble in pronouncing any words and around 68.1% subjects have never or hardly ever felt that their sense of taste was worsened.
Table 4: Distribution of subjects according to the seven domains of oral health impact profile

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In the second domain – Physical pain, a total of 289 (58.4%) had never or hardly ever experienced pain in their mouth followed by 105 (21.3%) subjects who had occasionally experienced pain in their mouth. A total of 294 subjects (59.4%) have never or hardly ever felt uncomfortable to eat foods; next, a majority of 106 subjects (21.4%) have very or fairly often felt uncomfortable to eat foods.

In the third domain – psychological discomfort, a total of 316 (63.8%) never or had hardly ever been self-conscious while eating followed by 111 subjects (22.4%) who had very or fairly often self-conscious while eating. A total of 287 subjects (58%) have never or fairly often tensed because of dental problems followed by 108 subjects (21.8%) have very or fairly often felt tensed because of dental problems.

In the physical disability domain, a majority of 341 (68.9%) subjects reported they never or hardly ever felt their diet has been unsatisfactory and also a majority of 333 subjects (67.3%) have never or fairly often have to interrupt meals unsatisfactorily because of dental problems.

In the psychological disability domain, a majority of 316 (63.8%) subjects reported no or hardly ever difficulty to relax because of dental problems. Also 294 (59.4%) reported they were embarrassed because of dental problems.

In the social disability domain, most of the subjects (66.5%) reported they never or hardly ever were irritable because of dental problems. Among the subjects, 376 (76%) reported never or hardly ever had difficulty doing usual jobs because of dental problems.

In the handicap domain, a total of 365 (73.9%) subjects reported they never or hardly ever felt life less satisfying because of dental problems and 372 subjects (75.2%) reported they never or hardly ever were unable to function because of dental problems.

Test of association

Association between SOC-13 and OHIP-14 was done using Chi-square test and it was found to be statistically significant with Chi-square value 177.3 and P value < 0.001. Association between caries status and OHIP was also found to be statistically significant using Chi-square test, with P value < 0.001. Pearson's correlation coefficient was used to test correlation between dental caries and OHIP, and it was found to be statistically significant, with R-value –0.251 and P value < 0.001. It shows that OHIP is negatively correlated with caries status [Figure 1].
Figure 1: Correlation between caries status (Decayed, Missing, and Filled Teeth) and oral health impact profile

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   Discussion Top


This study was carried out to find the association of SOC, dental caries, and OHRQoL among nursing students of South India. In this study, majority (82.4%) were females, and the mean age was 20.84; this is in line with the age at which students normally take up graduate courses after their pre-university/secondary school qualification.

The caries status was assessed using DMFT index and mean DMFT was found to be 2.2. This was found to be similar to the study conducted by Dagli et al.[15] The mean decayed teeth of the subjects were 1.53 and filled teeth were 1.21. This was found in contrast to the study by Dagli et al. Being in health care, they might have more awareness towards dental problems and have thus availed treatment.

The SOC was measured by means of 12 items derived from the Antonovsky[1] short SOC scale (SOC-13). For this study, the short SOC scale was chosen and one item was dropped from the scale to yield an even number of items for all subscales. The reliability of this study's SOC scale seems to be maintained because the distribution of the individuals' mean SOC scores was comparable to previous SOC studies.[16]

In this study, a majority of the population had a moderate SOC score. This was found to be similar to the study by Freire et al.[8] that was conducted among Brazilian adolescents. In addition, in this study, statistically significant association was found between SOC and caries status, this was in line with studies conducted by Savolainen et al.[13] and Freire et al.[8] Although previous studies have shown strong association between SOC and dental health, a strong explanation why people with strong SOC have better dental health is lacking. An indirect pathway between SOC and caries is explained in a study by Savolainen et al.,[13] subjects with stronger SOC adhere to proper brushing technique and behaviours; another possible explanation is through dental attendance. SOC influences dental attendance that in turn influences caries levels through overtreatment.

It can be suggested that health-related quality of life, as a phenomenon, has much broader scope than has been shown in various studies and that the introduction of psycho-social factors into this context is useful. The OHIP is also known to be relevant to oral health.[17] The comprehensive association of SOC and OHIP emphasizes that SOC could be a determinant of oral health.

This study also examined the association of caries status and OHIP, which was found to be statistically significant. Similar results are shown by various studies Do et al.,[18] John et al., Steele et al.,[19],[20] The correlation of the caries status and OHIP was done in this study, which showed negative correlation between caries status and OHIP scores. The correlation was statistically significant. This negative correlation is interpreted as higher the number of caries or missing teeth, lower is the OHIP scores, thus implying higher negative impacts. This explains the fact that subjects with high dental caries had higher impacts on OHRQoL. SOC is found to be a health-promoting factor, common to several health behaviours and to attempt to support the development of this factor during adolescence by creating, for example, an adequate social environment; this could lead to a wide-ranging improvement of health behaviours.


   Conclusion Top


SOC as a psychosocial resource is capable of facilitating the motivation for positive health behaviours and the understanding of its health benefits. These resources along with socio-economic and demographic factors can create an environment that is partially responsible for the individuals' cognitive and physical functions. These functions express themselves as the individuals' well-being and positive health behaviours. Thus, SOC could provide help in planning health promotion strategies.

Financial support and sponsorship

Nil.

Statement of consent

The nursing graduates provided their consent for participation in this study and for the publication of the results of the study.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Antonovsky A. Unraveling the Mystery of Health – How People Manage Stress and Stay Well. London: Jossey-Bass Publishers; 1987. p. 15–32.  Back to cited text no. 1
    
2.
Antonosky A, Sagy S, Adler I, Visel R. Attitudes toward retirement in an Israeli cohort. Int J Aging Hum Dev 1990;31:57–77.  Back to cited text no. 2
    
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4.
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Nyamathi AM. Relationship of resources to emotional distress, somatic complaints, and high-risk behaviors in drug recovery and homeless minority women. Res Nurs Health 1991;14:269–77.  Back to cited text no. 6
    
7.
Hassmen P, Koivula N, Uutela A. Physical exercise and psychological well-being: A population study in Finland. Prev Med 2000;30:17–25.  Back to cited text no. 7
    
8.
Freire MC, Sheiham A, Hardy R. Adolescents' sense of coherence, oral health status, and oral health-related behaviours. Community Dent Oral Epidemiol 2001;29:204–12.  Back to cited text no. 8
    
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Pietilä AM. Factors associated with life control in young men. J Adv Nurs1994;20:491-9.  Back to cited text no. 9
    
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WHO. Programme on mental health WHOQOL. Measures of Quality of life.WHO/MAS/MNH/PSF97.4.1997.  Back to cited text no. 10
    
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Chen MS, Hunter P. Oral health and quality of life in New Zealand: A social perspective. Soc Sci Med 1998;41:1213-22.  Back to cited text no. 11
    
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Slade GD. Assessment of oral health-related quality of life. In: Inglehart MR, Bagramian RA, editors. Oral Health-Related Quality ofLife. Carol Stream, IL: Quintessence Publishing Co, Inc; 2002. p. 29–45.  Back to cited text no. 12
    
13.
Savolainen J, Suominen-Taipale A-L, Hausen H, Harju P, Uutela A, Martelin T, et al. Sense of coherence as a determinant of the oral health-related quality of life: A national study in Finnish adults. Eur J Oral Sci 2005;113:121–7.  Back to cited text no. 13
    
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Dorri M, Sheiham A, Hardy R, Watt R. The relationship between sense of coherence and toothbrushing behaviours in Iranian adolescents in Mashhad. J Clin Periodontol 2010;37:46–52.  Back to cited text no. 14
    
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Dagli JR, Kumar S, Dhanni C, Duraiswamy P, Kulkarni S. Dental health among green mine labourers, India. J Oral Health Comm Dent 2008;2:1-7.  Back to cited text no. 15
    
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SavolainenJ. A salutogenic perspective to oral health sense of coherence as a determinant of oral and general health behaviours, and oral health-related quality of life. Available from: http://herkules.oulu.fi/isbn951427881X/isbn951427881X.pdf.  Back to cited text no. 16
    
17.
Bagramian RA, Taichman RS, McCauley L, Green TG, Inglehart MR. Mentoring of dental and dental hygiene faculty: A case study. J Dent Educ 2011;75:291-9.  Back to cited text no. 17
    
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Do LG, Spencer A. Oral health-related quality of life of children by dental caries and fluorosis experience. J Public Health Dent2007;67:132-9.  Back to cited text no. 18
    
19.
Steele JG, Sanders AE, Slade GD, Allen PF, Lahti S, Nuttal N, et al. How do age and tooth loss affect oral impacts and quality of life? A study comparing two national samples. Community Dent Oral Epidemiol 2004;32:107–14.  Back to cited text no. 19
    
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Tsakos G, Marcenes W, Sheiham A. The relationship between clinical dental status and oral impacts in an elderly population. Oral Health Prev Dent 2004;2:211–20.  Back to cited text no. 20
    

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Correspondence Address:
Dr. Syed Kuduruthullah
Lecturer, Health Science, Department of Dentistry City University College of Ajman, Ajman
UAE
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.ijdr_331_22

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