Volume 9, Issue 2 (5-2021)
Jorjani Biomed J 2021, 9(2): 5-16 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
davari A, daneshkazemi A, Dastjerdi G, borhan Z, abbasi S. Evaluation of DMFT Index Based on Mental and Psychological Profile in Shahedieh, Yazd Province. Jorjani Biomed J 2021; 9 (2) :5-16
URL: http://goums.ac.ir/jorjanijournal/article-1-789-en.html
URL: http://goums.ac.ir/jorjanijournal/article-1-789-en.html
1- Department of Operative Dentistry, School of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; Member of Social Determinant of Oral Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2- Medical school Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
4- Department of operative and aesthetic dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran , s.abbasi@stu.ssu.ac.ir
2- Medical school Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
4- Department of operative and aesthetic dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran , s.abbasi@stu.ssu.ac.ir
Full-Text [PDF 555 kb]
(874 Downloads)
| Abstract (HTML) (3146 Views)
Table 1. Mean and standard deviation of DMFT index based on age
Table 2. Mean and standard deviation of the number of missing and filled (M, F) in eight groups assessed based on the level of education
Table 3. Mean and standard deviation of decayed teeth and DMFT index in eight groups based on the level of education
Table 4. Comparison of indexes and having depression at the present time
Table 5. Comparison of indexes and depression treatment
Table 8. Regression
Table 9. Regression
Discussion
Oral and dental diseases (e.g., tooth decay and periodontal diseases) are very common and are associated with economic, social and psychological complications in addition to physical problems. This disease seriously affects the quality of life in several people and various aspects of their lives, such as mouth function, facial appearance, and social relations. In other words, personal self-assessment of the effect of functional, psychological, social factors and experience of pain and discomfort due to oral problems is defined as " oral health-related quality of life (OHRQoL)” (11). In fact, OHRQoL is a personal assessment of how functions and psychological and social states of a person are affected by clinical indexes of oral health. While there are common clinical indexes in dentistry such as DMFT and CPITN to evaluate prevalent oral and dental diseases, they fail to meet the needs in the field of OHRQoL assessment.
In the current research, there was no difference between the four age groups in terms of the number of filled teeth and DMFT index, which showed a lack of association between age and filled teeth and DMFT index, which is inconsistent with the results of current studies. However, this lack of consistency might be due to our larger sample size and difference in research settings. Nonetheless, aging can increase dental caries due to changes in dietary habits, an increase in unhealthy habits, as well as changes in the composition and function of salivary glands. The WHO has measured the DMFT index for Iran in its surveys, reporting a low level for the age range of 8-12 years (1.2-2.6). The same index is in the average range (9- 13.9) for the age range 35-44 years, which shows the increase of the index by aging, which is incongruent with our findings (12). This may be due to the disparity of different age groups concerning other variables affecting the DMFT index, which results in bias.
In the present study, the mean DMFT index was slightly higher in women (19.94), compared to men (19.60). However, no significant difference was observed between the groups. Therefore, it could be concluded that gender does not correlate with the DMFT index. However, Nourollahian reported a lower mean DMFT index in women, compared to men (13). In another research by Torabi et al., the mean DMFT was lower in women, compared to men (14). Notably, the mentioned results are not consistent with our findings, which might be due to the larger sample size in the current research and difference in the research setting.
On the other hand, Ajami found no significant difference between male and female participants in terms of DMFT (15). Deyhimi et al. reported a mean DMFT index of 5.43 for evaluated dental students. In the aforementioned study, the mean DMFT index was insignificantly higher in women, compared to men (16). In this respect, our findings are in line with the mentioned study. Nevertheless, the results cannot be compared due to the lack of significance. Some of the causes of this slight difference are various geographical locations and cultural differences. On the other hand, none of the aforementioned studies are comparable to the present research in terms of sample size. In addition, the current research has a good internal power and citing strength owing to its larger sample size.
Nonetheless, Splieth et al. conducted research on 4022 subjects in Germany and reported a higher DMFT in women, compared to men, which is congruent with our findings (17). In the current research, the mean number of missing teeth was lower in PhD holders (10.63), compared to other groups. Moreover, the mean number of filled teeth was lower in subjects with MScs, compared to the other groups. In the present study, no association was found between the level of education and missing and filled teeth. According to the results, there was just a slight difference between seven groups of elementary education, junior high school, diploma, associate degree, BSc, MSc, and illiterate regarding the mean DMFT index. However, the mean DMFT index decreased in PhD holders (16.68). Furthermore, the groups of elementary education, junior high school, associate degree, BSc, MSc, and illiterate were almost similar in terms of decayed teeth.
In addition, our findings were indicative of no relationship between the level of education and the number of decayed teeth and DMFT index. In a research by Khalilnejhad et al., subjects with higher levels of education had lower DMFT indexes, which is in line with our findings (18). On the other hand, Torabi et al. found no association between literacy and DMFT index (14). Moreover, Rigi Lodz et al. identified no relationship between the level of education and DMFT (10). In this respect, the results of the mentioned study are in accordance with the results obtained by Siukosaari et al (19). The level of knowledge, attitude and health performance were higher in women, compared to men, and in graduated individuals and lower ages, compared to poorly educated people and higher ages, reported by Taheri et al . The obvious cultural differences and the traditional structure of the geographical areas studied in the researches cited by the present study might be the cause of different results.
On the other hand, lack of significance of the difference between the DMFT indexes in the different groups regarding level of education might be related to lack of examination of dental caries by a dentist and with the use of radiology images. It is expected that oral health indexes and oral care improve by increasing the level of education and knowledge about this area.
In the current research, there was no relationship between marital status and the number of missing and filled teeth. In studies by Fox, Locker et al., and Beck, it was shown that the relative importance of education will decrease in case of considering other socioeconomic factors, such as level of income, last dental visit, and age (20-22). Evidently, this difference makes no change in the nature of the results obtained in the current research. This is mainly due to the fact that PhD holders will have a higher level of income, compared to other educational groups, owing to their level of education. On the other hand, an increased level of education is associated with higher knowledge and a better attitude toward adhering to health recommendations, which will ultimately lead to better health status. In a study by Taheri et al., knowledge, attitude, and practice of health were higher in women, compared to men and, in educated individuals and low ages, compared to poorly educated subjects and high ages (23), which confirmed our findings. In the present study, no correlation was observed between marital status and missing and filled teeth. However, a significant association was detected between marital status and the number of decayed teeth.
Given the higher mean of decayed teeth in the group of single participants, it can be hypothesized that two possible causes have led to this conclusion. Firstly, single people are usually younger, which might be associated with bad eating habits and eating more harmful foods. On the other hand, given the cultural and traditional structure of Yazd province, it can be inferred that single people who are not young are usually unable to marry because of economic conditions. This factor is directly related to dental health and oral hygiene and the prevention of diseases (24).
SteveKiesly et al. reported that individuals with depression and anxiety have a possible potential risk of dental diseases and missing teeth (1). According to the results of Katarzyna et al., depression was associated with a higher number of missing teeth, decayed teeth, and dry mouth in individuals aged 65 years and higher. Therefore, some of the parameters of oral health can affect patients’ overall health. In addition, depression can impair oral and dental health (25). In 2017, Kim et al. evaluated the relationship between stress, depression and suicidal thoughts with oral health status and oral function in a large sample of Korean adults aged 35 years and higher. According to the results, there was a correlation between oral functional problems (e.g., chewing and talking) and mental health (26). Meanwhile, we found no significant relationship between depression and tooth decay.
In another study by Zengin et al. (2015), oral hygiene of patients with psychological disorders was insufficient, and most patients had missing teeth and required prosthesis repair. Nevertheless, dental treatment was rejected. Some patients are reluctant to have appropriate dental treatment (e.g., prosthesis, restorative therapy, and surgical treatment (27). Nevertheless, our findings are incongruent with the results of the mentioned studies. There are several limitations to the results of this study. An important issue when comparing the results of various studies regarding DMFT variables is the geographical, cultural and sample size differences that cause data dispersion. On the other hand, an examination by a dentist with the help of a mirror to detect distal and buccal caries, dental floss for interproximal caries, and radiographic images were not performed to confirm these issues. Therefore, this can be attributed to the weakness of the results and the cause of their difference with the smaller sample size studies, where precise examinations were performed by a dentist. In addition, there was no significant relationship between DMFT index and psychological diseases (depression and other psychiatric diseases) and between the treatment of psychological diseases (treatment of depression and treatment of other psychiatric diseases) and the DMFT index alone. As such, it is recommended that more studies be performed to evaluate oral health indexes and life quality indexes and the psychological state of people. This is mainly due to the fact that the current studies have shown a strong correlation between life quality and clinical state and dental diseases of individuals (5). The limitation in analyzing the results is the inconsistency of the subjects with incomplete completion of information for each variable. The subjects had a difference in terms of missed and null codes for each variable. As a result, the number and percentages in the two variables analysis were different from the analysis of each variable alone.
Conclusion
According to the results of the study, no significant association was observed between the DMFT index and the psychological profiles of the participants.
There is an association between poor oral health and mental health. Dental anxiety has negative impact on oral health. A higher level of anxiety is associated with fewer filled teeth and higher calculus index. Therefore, in this prospective research, we use DMFT index to evaluate oral health status based on mental and psychological profile of 9967 subjects in Shahedieh, Yazd province.
Full-Text: (799 Views)
Highlights
There is an association between poor oral health and mental health. Dental anxiety has negative impact on oral health. A higher level of anxiety is associated with fewer filled teeth and higher calculus index. Therefore, in this prospective research, we use DMFT index to evaluate oral health status based on mental and psychological profile of 9967 subjects in Shahedieh, Yazd province.
Introduction
Oral health affects physical and mental health, growth, enjoyment, looking, talking, chewing, food tastes and community. However, oral and dental health might have less priority in terms of diagnosis of psychological diseases (1). The goal of the World Health Organization (WHO) is achieving the highest level of health for all people. In its statute, the WHO defines health as: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”(2).
Attention deficit hyperactivity disorder (ADHD) can cause poor oral and dental health, thereby having adverse effects on the periodontal health of people with this condition. Dental anxiety (dental anxiety is a term used to describe fear, anxiety or stress in a dental setting. Being scared to visit the dentist can result in delaying or avoiding dental treatment) has a negative impact on oral health (3). A higher level of dental anxiety is associated with fewer filled teeth and a higher calculus index. Studies show that those who experience mental illness also suffer from poor oral health and do not adhere to oral health instructions (4).
In 2015, Roohafza et al. found a relationship between psychological factors (e.g., stress, anxiety and depression) and tooth decay. Broken and missing teeth might affect depression mostly through the psychological constructs of OHRQoL (oral health-related quality of life), which confirms the link between psychological factors and missing teeth (5).
Decayed, missing, and filled teeth (DMFT): suggested by the WHO, DMFT is used to evaluate oral health. In fact, this is an index for evaluation of dental health and can be measured by clinical examination with the use of a mirror and an explorer.
The index’s parameters are, as follows:
Decay (D): this term refers to opaque enamels, clinging explorer, a cavity, recurrent caries, and temporary filling.
Missing (M): untreated decayed teeth or teeth that cannot be kept due to decay.
Filling (F): All teeth that have a filling or are covered due to caries.
Tooth (T)
After the evaluation of each of the three parameters, the number of teeth that had any of these features was summed up to determine the DMFT index. Unfortunately, the DMFT index is extremely higher among Iranian children, compared to the global mean. In other words, Iranian children have many more decayed, filled and missing teeth, compared to the global average (6). In addition to tooth decay, lack of oral hygiene has consequences such as gingivitis, endocarditis, cardiovascular disease, memory impairment, diabetes, cancers, halitosis, dental irregularities, as well as reduced self-esteem and quality of life (7).
Reduced energy and depression-related motivation can affect oral health and prevent measures related to oral hygiene, which results in an increased risk of tooth decay and periodontal diseases, cryogenics nutrition (leading to decay), avoiding dental cares and xerostomia caused by antidepressants (8). While there is an association between poor oral health and mental health, psychological conditions are assessed using comprehensive psychometric tools applied to determine HRQoL, which also includes mental health in most cases. This research showed the association between missing teeth and dental pain with HRQoL (9). According to studies, there are behavioral and psychological mechanisms explaining the relationship between depression and oral health. Increased depression intensity is associated with poor oral hygiene caused by decreased saliva secretion and increased Lactobacillus count (10).
Despite many efforts in interventions and use of all abilities, many students and other target groups of oral health programs have difficulties adhering to recommended programs or changing behavior. It is recommended that more studies be conducted on dental anxiety in the Iranian population. On the other hand, despite the existing findings on the relationship between psychological diseases and tooth decay in adults, few clinical studies have been performed on this issue. Moreover, literature review revealed a lack of study on the assessment of the relationship between psychological diseases and oral health. With this background in mind, this study aimed to evaluate the DMFT-affecting psychological diseases in adults in Shahedieh in a cohort study in 2016.
Materials and Methods
In this prospective research, we used the Shahedieh cohort study in 2016, to collect data. Total, 9967 subjects were enrolled in the study, 5028 of whom were men (50.4) and 4939 were women (49.6). Psychological variables such as the history of depression and other psychological disorders, the treatment and no treatment in patients, and the current incidence of mental illness were extracted from the especial Yazd Shahedieh cohort questionnaire after receiving the necessary permissions. Oral health status in the participants was estimated based on the DMF index for permanent teeth in the participants. In this context, the total number of decayed teeth (D=decayed), the number of missing teeth (M=missing) and filled teeth (F=filled) were assessed as the DMF indexes. A total score of zero to 28 or 32 could be obtained by the participants. The uncounted teeth in the study included: impacted teeth, congenitally missing teeth, supernumerary teeth, and teeth extracted for reasons other than decay.
Inclusion and Exclusion Criteria
Inclusion criteria: age of ≥30 years
Exclusion criteria: incomplete questionnaires.
Type & Methods of Study
This is a prospective cohort research.
Sampling Procedure
All subjects were residing in Shahedieh and aged above or equal to 30 years.
Data Analysis Method
Data analysis was performed in SPSS version 22 using frequency distribution, mean, percentage, and standard deviation to describe the descriptive data, as well as Chi-square, t-test, and ANOVA to analyze the data. In addition, a P-value of less than 0.05 was considered statistically significant.
Result
According to Table 1, the lowest (zero) and highest (32) DMFT rates were observed in 130 and 2001 individuals, respectively.
The mean age of the participants was 48.84 years, and all of the subjects were aged above 30. The highest mean DMFT index (19.77) was observed in the age group of 50-59 years. Based on ANOVA results, there was no significant relationship between age and DMFT indexes, and this difference between age group was not statistically significant (p=0.747).
The mean number of decayed teeth was 2.34, and the highest number of this type of teeth was detected in subjects in the age range of 50-59 years. Therefore, there was no significant relationship between age and tooth decay (p=0.35).
The highest mean number of missing teeth (13.58) was observed in the age group of above 60 years. Therefore, there was no correlation between age and missing teeth (p=0.61).
The highest mean number of filled teeth (4.37) was observed in the age group of 30-39 years. Therefore, there was no correlation between age and filled teeth (p=0.08).
No significant difference was observed between the male and female participants regarding the number of decayed (p=0.14) and missing teeth (p=0.24) and DMFT index (p=0.69). However, a higher number of filled teeth were found in male subjects, compared to female participants, showing a significant difference in this regard (p=0.02).
It was observed that a high number of participants (31.2%) had an elementary level of education. Meanwhile, only 0.2% of the subjects had a PhD.
As observed in Table 2, the mean number of missing teeth was lower in PhD holders (10.63), compared to other participants. However, these statistics were not significant (p=0.26). The mean number of filled teeth in subjects with MScs was lower, compared to the other groups. The eight groups were compared in terms of the difference in the number of filled teeth using ANOVA, showing no significant difference between the groups (P=0.66).
There is an association between poor oral health and mental health. Dental anxiety has negative impact on oral health. A higher level of anxiety is associated with fewer filled teeth and higher calculus index. Therefore, in this prospective research, we use DMFT index to evaluate oral health status based on mental and psychological profile of 9967 subjects in Shahedieh, Yazd province.
Introduction
Oral health affects physical and mental health, growth, enjoyment, looking, talking, chewing, food tastes and community. However, oral and dental health might have less priority in terms of diagnosis of psychological diseases (1). The goal of the World Health Organization (WHO) is achieving the highest level of health for all people. In its statute, the WHO defines health as: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”(2).
Attention deficit hyperactivity disorder (ADHD) can cause poor oral and dental health, thereby having adverse effects on the periodontal health of people with this condition. Dental anxiety (dental anxiety is a term used to describe fear, anxiety or stress in a dental setting. Being scared to visit the dentist can result in delaying or avoiding dental treatment) has a negative impact on oral health (3). A higher level of dental anxiety is associated with fewer filled teeth and a higher calculus index. Studies show that those who experience mental illness also suffer from poor oral health and do not adhere to oral health instructions (4).
In 2015, Roohafza et al. found a relationship between psychological factors (e.g., stress, anxiety and depression) and tooth decay. Broken and missing teeth might affect depression mostly through the psychological constructs of OHRQoL (oral health-related quality of life), which confirms the link between psychological factors and missing teeth (5).
Decayed, missing, and filled teeth (DMFT): suggested by the WHO, DMFT is used to evaluate oral health. In fact, this is an index for evaluation of dental health and can be measured by clinical examination with the use of a mirror and an explorer.
The index’s parameters are, as follows:
Decay (D): this term refers to opaque enamels, clinging explorer, a cavity, recurrent caries, and temporary filling.
Missing (M): untreated decayed teeth or teeth that cannot be kept due to decay.
Filling (F): All teeth that have a filling or are covered due to caries.
Tooth (T)
After the evaluation of each of the three parameters, the number of teeth that had any of these features was summed up to determine the DMFT index. Unfortunately, the DMFT index is extremely higher among Iranian children, compared to the global mean. In other words, Iranian children have many more decayed, filled and missing teeth, compared to the global average (6). In addition to tooth decay, lack of oral hygiene has consequences such as gingivitis, endocarditis, cardiovascular disease, memory impairment, diabetes, cancers, halitosis, dental irregularities, as well as reduced self-esteem and quality of life (7).
Reduced energy and depression-related motivation can affect oral health and prevent measures related to oral hygiene, which results in an increased risk of tooth decay and periodontal diseases, cryogenics nutrition (leading to decay), avoiding dental cares and xerostomia caused by antidepressants (8). While there is an association between poor oral health and mental health, psychological conditions are assessed using comprehensive psychometric tools applied to determine HRQoL, which also includes mental health in most cases. This research showed the association between missing teeth and dental pain with HRQoL (9). According to studies, there are behavioral and psychological mechanisms explaining the relationship between depression and oral health. Increased depression intensity is associated with poor oral hygiene caused by decreased saliva secretion and increased Lactobacillus count (10).
Despite many efforts in interventions and use of all abilities, many students and other target groups of oral health programs have difficulties adhering to recommended programs or changing behavior. It is recommended that more studies be conducted on dental anxiety in the Iranian population. On the other hand, despite the existing findings on the relationship between psychological diseases and tooth decay in adults, few clinical studies have been performed on this issue. Moreover, literature review revealed a lack of study on the assessment of the relationship between psychological diseases and oral health. With this background in mind, this study aimed to evaluate the DMFT-affecting psychological diseases in adults in Shahedieh in a cohort study in 2016.
Materials and Methods
In this prospective research, we used the Shahedieh cohort study in 2016, to collect data. Total, 9967 subjects were enrolled in the study, 5028 of whom were men (50.4) and 4939 were women (49.6). Psychological variables such as the history of depression and other psychological disorders, the treatment and no treatment in patients, and the current incidence of mental illness were extracted from the especial Yazd Shahedieh cohort questionnaire after receiving the necessary permissions. Oral health status in the participants was estimated based on the DMF index for permanent teeth in the participants. In this context, the total number of decayed teeth (D=decayed), the number of missing teeth (M=missing) and filled teeth (F=filled) were assessed as the DMF indexes. A total score of zero to 28 or 32 could be obtained by the participants. The uncounted teeth in the study included: impacted teeth, congenitally missing teeth, supernumerary teeth, and teeth extracted for reasons other than decay.
Inclusion and Exclusion Criteria
Inclusion criteria: age of ≥30 years
Exclusion criteria: incomplete questionnaires.
Type & Methods of Study
This is a prospective cohort research.
Sampling Procedure
All subjects were residing in Shahedieh and aged above or equal to 30 years.
Data Analysis Method
Data analysis was performed in SPSS version 22 using frequency distribution, mean, percentage, and standard deviation to describe the descriptive data, as well as Chi-square, t-test, and ANOVA to analyze the data. In addition, a P-value of less than 0.05 was considered statistically significant.
Result
According to Table 1, the lowest (zero) and highest (32) DMFT rates were observed in 130 and 2001 individuals, respectively.
The mean age of the participants was 48.84 years, and all of the subjects were aged above 30. The highest mean DMFT index (19.77) was observed in the age group of 50-59 years. Based on ANOVA results, there was no significant relationship between age and DMFT indexes, and this difference between age group was not statistically significant (p=0.747).
The mean number of decayed teeth was 2.34, and the highest number of this type of teeth was detected in subjects in the age range of 50-59 years. Therefore, there was no significant relationship between age and tooth decay (p=0.35).
The highest mean number of missing teeth (13.58) was observed in the age group of above 60 years. Therefore, there was no correlation between age and missing teeth (p=0.61).
The highest mean number of filled teeth (4.37) was observed in the age group of 30-39 years. Therefore, there was no correlation between age and filled teeth (p=0.08).
No significant difference was observed between the male and female participants regarding the number of decayed (p=0.14) and missing teeth (p=0.24) and DMFT index (p=0.69). However, a higher number of filled teeth were found in male subjects, compared to female participants, showing a significant difference in this regard (p=0.02).
It was observed that a high number of participants (31.2%) had an elementary level of education. Meanwhile, only 0.2% of the subjects had a PhD.
As observed in Table 2, the mean number of missing teeth was lower in PhD holders (10.63), compared to other participants. However, these statistics were not significant (p=0.26). The mean number of filled teeth in subjects with MScs was lower, compared to the other groups. The eight groups were compared in terms of the difference in the number of filled teeth using ANOVA, showing no significant difference between the groups (P=0.66).
Table 1. Mean and standard deviation of DMFT index based on age
| Age | N | Mean | Standard deviation | Confidence interval | Mini mum |
Maxi mum |
ANOVA results P-value |
||
| Lower limit | Higher limit | ||||||||
| DMFT |
30-39 | 1825 | 19.66 | 8.94 | 19.25 | 20.07 | 0 | 32 | 0.74 |
| 40-49 | 2924 | 19.71 | 8.98 | 19.38 | 20.3 | 0 | 32 | ||
| 50-59 | 2254 | 19.92 | 8.83 | 19.55 | 20.28 | 0 | 32 | ||
| +60 | 1470 | 19.88 | 8.94 | 19.43 | 20.34 | 0 | 32 | ||
| Total | 8473 | 19.78 | 8.92 | 19.59 | 19.97 | 0 | 32 | ||
Table 2. Mean and standard deviation of the number of missing and filled (M, F) in eight groups assessed based on the level of education
| Level of education | Number of subjects | Mean | Standard deviation | Confidence interval | Minimum | Maximum | ANOVA results P-value |
||
| Lower limit | Higher limit | ||||||||
| Missing teeth | Elementary | 2899 | 13.50 | 10.94 | 13.10 | 13.90 | 0 | 32 | 0.260 |
| Junior high school | 1535 | 13.01 | 10.71 | 12.47 | 13.55 | 0 | 32 | ||
| Diploma | 1908 | 13.07 | 10.70 | 12.59 | 13.56 | 0 | 32 | ||
| Associate degree | 367 | 13.71 | 11.04 | 12.57 | 14.84 | 0 | 32 | ||
| BSc | 922 | 14.02 | 11.10 | 13.30 | 14.74 | 0 | 32 | ||
| MSc | 177 | 13.47 | 11.20 | 11.81 | 15.14 | 0 | 32 | ||
| PhD | 16 | 10.63 | 9.57 | 5.53 | 15.72 | 0 | 32 | ||
| Illiterate | 1505 | 13.63 | 11.05 | 13.07 | 14.19 | 0 | 32 | ||
| Total | 9329 | 13.41 | 10.90 | 13.19 | 13.63 | 0 | 32 | ||
| Filled teeth | Elementary | 2894 | 4.06 | 4.70 | 3.89 | 4.23 | 0 | 24 | 0.664 |
| Junior high school | 1536 | 4.15 | 4.71 | 3.92 | 4.39 | 0 | 21 | ||
| Diploma | 1907 | 4.24 | 4.65 | 4.03 | 4.44 | 0 | 22 | ||
| Associate degree | 367 | 4.28 | 4.63 | 3.80 | 4.75 | 0 | 20 | ||
| BSc | 922 | 4.19 | 4.72 | 3.88 | 4.49 | 0 | 21 | ||
| MSc | 176 | 3.55 | 4.43 | 2.89 | 4.21 | 0 | 19 | ||
| PhD | 16 | 4.50 | 5.16 | 1.75 | 7.25 | 0 | 17 | ||
| Illiterate | 1503 | 4.09 | 4.72 | 3.85 | 4.33 | 0 | 24 | ||
| Total | 9321 | 4.13 | 4.69 | 4.03 | 4.22 | 0 | 24 | ||
We estimated the DMFT index and the mean number of decayed teeth in eight educational groups of elementary, junior high school, diploma, associate degree, BSc, MSc, and PhD (Table 3). The mean DMFT decreased in PhD holders (16.68). In addition, the highest mean DMFT index was observed in the MSc group (20.36). The eight groups were compared using ANOVA, and the results showed no significant difference (P=0.14). The mean number of decayed teeth decreased in PhD holders (1.56). Furthermore, the highest mean number of decayed teeth was observed in subjects with an elementary level of education. The eight groups were compared in terms of decayed teeth using ANOVA, the results of which indicated no significant difference between the groups (P=0.82). As such, no correlation was observed between the level of education and decayed teeth (p=0.82) and DMFT index (p=0.147) (Table 3).
ANOVA results showed, there was a significant association between decayed teeth index and marital status (p=0.035). On the other hand, no significant relationship was found between filled and missing teeth and DMFT with marital status (p>0.05).
No significant relationship was observed between DMFT index and depression. (p=0.19) (Table 4).No significant relationship was observed between DMFT indexes and depression treatment. (p=0.45) (Table 5).
No significant relationship was detected between psychological disorders and the DMFT index. (P=0.82) (Table 6).
ANOVA results showed, there was a significant association between decayed teeth index and marital status (p=0.035). On the other hand, no significant relationship was found between filled and missing teeth and DMFT with marital status (p>0.05).
No significant relationship was observed between DMFT index and depression. (p=0.19) (Table 4).No significant relationship was observed between DMFT indexes and depression treatment. (p=0.45) (Table 5).
No significant relationship was detected between psychological disorders and the DMFT index. (P=0.82) (Table 6).
Table 3. Mean and standard deviation of decayed teeth and DMFT index in eight groups based on the level of education
| Level of education | N | Mean | Standard deviation | Confidence interval | Mini mum |
Maxi mum |
ANOVA results | ||
| Lower limit | Upper limit | ||||||||
| DMFT | Elementary | 2894 | 19.79 | 9.04 | 19.46 | 20.12 | 0 | 32 | P-Value |
| Junior high school | 1534 | 19.47 | 8.84 | 19.03 | 19.92 | 0 | 32 | 0.147 | |
| Diploma | 1907 | 19.53 | 8.77 | 19.13 | 19.92 | 0 | 32 | ||
| Associate degree | 367 | 20.26 | 9.14 | 19.32 | 21.20 | 0 | 32 | ||
| BSc | 922 | 20.36 | 8.88 | 19.78 | 20.93 | 0 | 32 | ||
| MSc | 176 | 19.44 | 9.36 | 18.04 | 20.83 | 0 | 32 | ||
| PhD | 16 | 16.68 | 7.91 | 12.47 | 20.90 | 0 | 32 | ||
| Illiterate | 1503 | 19.92 | 8.96 | 19.47 | 20.37 | 0 | 32 | ||
| Total | 9319 | 19.77 | 8.93 | 19.59 | 19.95 | 0 | 32 | ||
| Decayed teeth | Elementary | 2894 | 2.23 | 3.41 | 2.11 | 2.35 | 0 | 26 | |
| Junior high school | 1535 | 2.32 | 3.31 | 2.15 | 2.48 | 0 | 22 | 0.829 | |
| Diploma | 1907 | 2.21 | 3.31 | 2.07 | 2.36 | 0 | 21 | ||
| Associate degree | 367 | 2.28 | 3.63 | 1.91 | 2.66 | 0 | 19 | ||
| BSc | 922 | 2.16 | 3.29 | 1.94 | 2.37 | 0 | 24 | ||
| MSc | 176 | 2.52 | 3.65 | 1.98 | 3.07 | 0 | 17 | ||
| PhD | 16 | 1.56 | 2.50 | 0.23 | 2.90 | 0 | 8 | ||
| Illiterate | 1503 | 2.21 | 3.37 | 2.04 | 2.38 | 0 | 22 | ||
| Total | 9320 | 2.24 | 3.37 | 2.17 | 2.31 | 0 | 26 | ||
Table 4. Comparison of indexes and having depression at the present time
| Parameter | Decayed teeth | Filled teeth | Missing teeth | DMFT | ||||
| Mean | Standard deviation | Mean | Standard deviation | Mean | Standard deviation | Mean | Standard deviation | |
| Had depression | 2.08 | 3.19 | 4.15 | 4.73 | 13.83 | 10.92 | 20.06 | 8.94 |
| Had no depression | 2.26 | 3.39 | 4.13 | 4.68 | 13.34 | 10.89 | 19.72 | 8.93 |
| P-value | 0.06 | 0.86 | 0.12 | 0.19 | ||||
Table 5. Comparison of indexes and depression treatment
| Parameter |
Decayed teeth | Filled teeth | Missing teeth | DMFT | ||||
| Mean | Standard deviation | Mean | Standard deviation | Mean | Standard deviation | Mean | Standard deviation | |
| Under treatment | 2.22 | 3.47 | 4.29 | 4.73 | 13.49 | 10.45 | 20.01 | 8.64 |
| No treatment | 2.24 | 3.36 | 4.12 | 4.68 | 13.40 | 10.93 | 19.75 | 8.96 |
| P-value | 0.88 | 0.34 | 0.84 | 0.45 | ||||
| Parameter |
Decayed teeth | Filled teeth | Missing teeth | DMFT | ||||
| Mean | Standard deviation | Mean | Standard deviation | Mean | Standard deviation | Mean | Standard deviation | |
| Had psychiatric disorders | 2.09 | 3.11 | 3.84 | 4.47 | 13.77 | 11.05 | 19.70 | 9.16 |
| Had no psychiatric disorders | 2.25 | 3.39 | 4.16 | 4.71 | 13.37 | 10.88 | 19.77 | 8.91 |
| P-value | 0.20 | 0.06 | 0.32 | 0.82 | ||||
Based on Table 7, no significant relationship was observed between the DMFT indexes and the treatment of psychological disorders (P=0.97).
The results of regression analysis showed that the level of DMFT in those who have depression is 0.34 higher than those who do not have depression, (Table 8) and the level of DMFT in those who have psychological disorders is 0.34 higher than those who do not have other psychological disorders, but this difference was not significant (Table 9).
This analysis also showed that the amount of DMFT in other variables (sex, age, level of education) were not significantly different from each other. (P>0.05) (Table 8, 9).
The results of regression analysis showed that the level of DMFT in those who have depression is 0.34 higher than those who do not have depression, (Table 8) and the level of DMFT in those who have psychological disorders is 0.34 higher than those who do not have other psychological disorders, but this difference was not significant (Table 9).
This analysis also showed that the amount of DMFT in other variables (sex, age, level of education) were not significantly different from each other. (P>0.05) (Table 8, 9).
Table 7. Comparison of indexes and treatment of other psychological disorders
| Parameter | Decayed teeth | Filled teeth | Missing teeth | DMFT | ||||
| Mean | Standard deviation | Mean | Standard deviation | Mean | Standard deviation | Mean | Standard deviation | |
| Under treatment | 2.28 | 3.36 | 3.80 | 4.43 | 13.61 | 10.79 | 19.69 | 8.89 |
| No treatment | 1.98 | 2.95 | 3.87 | 4.49 | 13.90 | 11.24 | 19.70 | 9.32 |
| P-value | 0.18 | 0.84 | 0.71 | 0.97 | ||||
Table 8. Regression
| Model | Unstandardized Coefficients | Standardized coefficients | |||
| B | Std.Error | Beta | t | Sig. | |
| Constant | 19.472 | .484 | 40.208 | .000 | |
| Depression | .346 | .264 | .014 | 1.314 | .189 |
| Age | .007 | .010 | .007 | .649 | .516 |
| Education | .031 | .040 | .009 | .785 | .433 |
| Sex | -.340 | .186 | -.019 | -1.829 | .067 |
- Dependent Variable: DMFT
- Predictors: (Constant), Depression, Education, Sex, Age
Table 9. Regression
| Model | Unstandardized Coefficients | Standardized coefficients | |||
| B | Std. Error | Beta | t | Sig. | |
| Constant | 19.536 | .483 | 40.414 | .000 | |
| Age | .006 | .010 | .007 | .636 | .525 |
| Education | .031 | .040 | .008 | .774 | .439 |
| Sex | -.341 | .186 | -.019 | -1.831 | .067 |
| Psychological disorders | -.079 | .328 | -.002 | -.240 | .811 |
- Dependent Variable: DMFT
- Predictors: (Constant), Psychiatric disorders, Education, Sex, Age
Discussion
Oral and dental diseases (e.g., tooth decay and periodontal diseases) are very common and are associated with economic, social and psychological complications in addition to physical problems. This disease seriously affects the quality of life in several people and various aspects of their lives, such as mouth function, facial appearance, and social relations. In other words, personal self-assessment of the effect of functional, psychological, social factors and experience of pain and discomfort due to oral problems is defined as " oral health-related quality of life (OHRQoL)” (11). In fact, OHRQoL is a personal assessment of how functions and psychological and social states of a person are affected by clinical indexes of oral health. While there are common clinical indexes in dentistry such as DMFT and CPITN to evaluate prevalent oral and dental diseases, they fail to meet the needs in the field of OHRQoL assessment.
In the current research, there was no difference between the four age groups in terms of the number of filled teeth and DMFT index, which showed a lack of association between age and filled teeth and DMFT index, which is inconsistent with the results of current studies. However, this lack of consistency might be due to our larger sample size and difference in research settings. Nonetheless, aging can increase dental caries due to changes in dietary habits, an increase in unhealthy habits, as well as changes in the composition and function of salivary glands. The WHO has measured the DMFT index for Iran in its surveys, reporting a low level for the age range of 8-12 years (1.2-2.6). The same index is in the average range (9- 13.9) for the age range 35-44 years, which shows the increase of the index by aging, which is incongruent with our findings (12). This may be due to the disparity of different age groups concerning other variables affecting the DMFT index, which results in bias.
In the present study, the mean DMFT index was slightly higher in women (19.94), compared to men (19.60). However, no significant difference was observed between the groups. Therefore, it could be concluded that gender does not correlate with the DMFT index. However, Nourollahian reported a lower mean DMFT index in women, compared to men (13). In another research by Torabi et al., the mean DMFT was lower in women, compared to men (14). Notably, the mentioned results are not consistent with our findings, which might be due to the larger sample size in the current research and difference in the research setting.
On the other hand, Ajami found no significant difference between male and female participants in terms of DMFT (15). Deyhimi et al. reported a mean DMFT index of 5.43 for evaluated dental students. In the aforementioned study, the mean DMFT index was insignificantly higher in women, compared to men (16). In this respect, our findings are in line with the mentioned study. Nevertheless, the results cannot be compared due to the lack of significance. Some of the causes of this slight difference are various geographical locations and cultural differences. On the other hand, none of the aforementioned studies are comparable to the present research in terms of sample size. In addition, the current research has a good internal power and citing strength owing to its larger sample size.
Nonetheless, Splieth et al. conducted research on 4022 subjects in Germany and reported a higher DMFT in women, compared to men, which is congruent with our findings (17). In the current research, the mean number of missing teeth was lower in PhD holders (10.63), compared to other groups. Moreover, the mean number of filled teeth was lower in subjects with MScs, compared to the other groups. In the present study, no association was found between the level of education and missing and filled teeth. According to the results, there was just a slight difference between seven groups of elementary education, junior high school, diploma, associate degree, BSc, MSc, and illiterate regarding the mean DMFT index. However, the mean DMFT index decreased in PhD holders (16.68). Furthermore, the groups of elementary education, junior high school, associate degree, BSc, MSc, and illiterate were almost similar in terms of decayed teeth.
In addition, our findings were indicative of no relationship between the level of education and the number of decayed teeth and DMFT index. In a research by Khalilnejhad et al., subjects with higher levels of education had lower DMFT indexes, which is in line with our findings (18). On the other hand, Torabi et al. found no association between literacy and DMFT index (14). Moreover, Rigi Lodz et al. identified no relationship between the level of education and DMFT (10). In this respect, the results of the mentioned study are in accordance with the results obtained by Siukosaari et al (19). The level of knowledge, attitude and health performance were higher in women, compared to men, and in graduated individuals and lower ages, compared to poorly educated people and higher ages, reported by Taheri et al . The obvious cultural differences and the traditional structure of the geographical areas studied in the researches cited by the present study might be the cause of different results.
On the other hand, lack of significance of the difference between the DMFT indexes in the different groups regarding level of education might be related to lack of examination of dental caries by a dentist and with the use of radiology images. It is expected that oral health indexes and oral care improve by increasing the level of education and knowledge about this area.
In the current research, there was no relationship between marital status and the number of missing and filled teeth. In studies by Fox, Locker et al., and Beck, it was shown that the relative importance of education will decrease in case of considering other socioeconomic factors, such as level of income, last dental visit, and age (20-22). Evidently, this difference makes no change in the nature of the results obtained in the current research. This is mainly due to the fact that PhD holders will have a higher level of income, compared to other educational groups, owing to their level of education. On the other hand, an increased level of education is associated with higher knowledge and a better attitude toward adhering to health recommendations, which will ultimately lead to better health status. In a study by Taheri et al., knowledge, attitude, and practice of health were higher in women, compared to men and, in educated individuals and low ages, compared to poorly educated subjects and high ages (23), which confirmed our findings. In the present study, no correlation was observed between marital status and missing and filled teeth. However, a significant association was detected between marital status and the number of decayed teeth.
Given the higher mean of decayed teeth in the group of single participants, it can be hypothesized that two possible causes have led to this conclusion. Firstly, single people are usually younger, which might be associated with bad eating habits and eating more harmful foods. On the other hand, given the cultural and traditional structure of Yazd province, it can be inferred that single people who are not young are usually unable to marry because of economic conditions. This factor is directly related to dental health and oral hygiene and the prevention of diseases (24).
SteveKiesly et al. reported that individuals with depression and anxiety have a possible potential risk of dental diseases and missing teeth (1). According to the results of Katarzyna et al., depression was associated with a higher number of missing teeth, decayed teeth, and dry mouth in individuals aged 65 years and higher. Therefore, some of the parameters of oral health can affect patients’ overall health. In addition, depression can impair oral and dental health (25). In 2017, Kim et al. evaluated the relationship between stress, depression and suicidal thoughts with oral health status and oral function in a large sample of Korean adults aged 35 years and higher. According to the results, there was a correlation between oral functional problems (e.g., chewing and talking) and mental health (26). Meanwhile, we found no significant relationship between depression and tooth decay.
In another study by Zengin et al. (2015), oral hygiene of patients with psychological disorders was insufficient, and most patients had missing teeth and required prosthesis repair. Nevertheless, dental treatment was rejected. Some patients are reluctant to have appropriate dental treatment (e.g., prosthesis, restorative therapy, and surgical treatment (27). Nevertheless, our findings are incongruent with the results of the mentioned studies. There are several limitations to the results of this study. An important issue when comparing the results of various studies regarding DMFT variables is the geographical, cultural and sample size differences that cause data dispersion. On the other hand, an examination by a dentist with the help of a mirror to detect distal and buccal caries, dental floss for interproximal caries, and radiographic images were not performed to confirm these issues. Therefore, this can be attributed to the weakness of the results and the cause of their difference with the smaller sample size studies, where precise examinations were performed by a dentist. In addition, there was no significant relationship between DMFT index and psychological diseases (depression and other psychiatric diseases) and between the treatment of psychological diseases (treatment of depression and treatment of other psychiatric diseases) and the DMFT index alone. As such, it is recommended that more studies be performed to evaluate oral health indexes and life quality indexes and the psychological state of people. This is mainly due to the fact that the current studies have shown a strong correlation between life quality and clinical state and dental diseases of individuals (5). The limitation in analyzing the results is the inconsistency of the subjects with incomplete completion of information for each variable. The subjects had a difference in terms of missed and null codes for each variable. As a result, the number and percentages in the two variables analysis were different from the analysis of each variable alone.
Conclusion
According to the results of the study, no significant association was observed between the DMFT index and the psychological profiles of the participants.
Type of Article: Original article |
Subject:
Basic Medical Sciences
Received: 2021/01/20 | Accepted: 2021/04/28 | Published: 2021/06/20
Received: 2021/01/20 | Accepted: 2021/04/28 | Published: 2021/06/20
References
1. Kisely S, Sawyer E, Siskind D, Lalloo R. The oral health of people with anxiety and depressive disorders - a systematic review and meta-analysis. Journal of affective disorders. 2016;200:119-32. [view at publisher] [DOI] [Google Scholar]
2. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British journal of sports medicine. 2020;54(24):1451-62. [view at publisher] [DOI] [Google Scholar]
3. Coles E, Chan K, Collins J, Humphris GM, Richards D, Williams B, et al. Decayed and missing teeth and oral-health-related factors: predicting depression in homeless people. Journal of psychosomatic research. 2011;71(2):108-12. [view at publisher] [DOI] [Google Scholar]
4. Taylor AM, Holscher HD. A review of dietary and microbial connections to depression, anxiety, and stress. Nutritional neuroscience. 2020;23(3):237-50. [view at publisher] [DOI] [Google Scholar]
5. Roohafza H, Afghari P, Keshteli AH, Vali A, Shirani M, Adibi P, et al. The relationship between tooth loss and psychological factors. Community dental health. 2015;32(1):16-9. [view at publisher] [Google Scholar]
6. Larmas M. Has dental caries prevalence some connection with caries index values in adults? Caries research. 2010;44(1):81-4. [view at publisher] [DOI] [Google Scholar]
7. Hatami H RS, EFTEKHAR AH. Ministry SMJ of Health and Medical Education (IR-Iran). Text book of public health 1st ed TEHRAN: Derakhshan Publication. 2004:483. [Google Scholar]
8. Nyvad B, Tencate JM , Robinson C. Cariology in the 21st century, . State of the art and future perspectives,. 2004;38(3):170. [view at publisher] [DOI] [Google Scholar]
9. Kazemnejad A, Zayeri F, Rokn AR, Kharazifard MJ. Prevalence and risk indicators of periodontal disease among high-school students in Tehran. Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit. 2008;14(1):119-25. [view at publisher] [Google Scholar]
10. Rigi L, Ghanbariha M, Badiee M, Abdolazimi Z. The Relationship between Dental Caries and Some Socio-economic Factors. Journal of Shahid Sadoughi University of Medical Sciences. 2012;20(4). [Google Scholar]
11. Walter MH, Woronuk JI, Tan HK, Lenz U, Koch R, Boening KW, et al. Oral health related quality of life and its association with sociodemographic and clinical findings in 3 northern outreach clinics. Journal (Canadian Dental Association). 2007;73(2):153. [Google Scholar]
12. Naito M, Yuasa H, Nomura Y, Nakayama T, Hamajima N, Hanada N. Oral health status and health-related quality of life: a systematic review. Journal of oral science. 2006;48(1):1-7. [view at publisher] [DOI] [Google Scholar]
13. Nourollahian H, Afshari H. Evaluation of second molars DMFT in 12 years old students in Zahedan. Zahedan Faculty of Dentistry. 2000:88-22. [Google Scholar]
14. Torbi M, Afshar SK, S. S, Afshar MK. assessment of oral health indices in kerman adults aged 35-44 yearsUnknown article. Journal of Isfahan Dental School. 2009;5(2):8-94. [view at publisher] [Google Scholar]
15. Ajami B. An epidemiologic Survey on the health status of 35-44 years and those above 64 years of age in Mashhad. Journal of dental school shahid beheshti university of Medical Science. 2000;18(3):-. [view at publisher] [Google Scholar]
16. Deyhimi P, Eslamipour F, Nnsari HA. DMFT and the effect of dental education on orodental health of dental students in Isfahan school of dentistry. Journal of Isfahan dental school. 2011;6(4):-. [view at publisher] [Google Scholar]
17. Splieth C, Meyer G. Factors for changes of caries prevalence among adolescents in Germany. European journal of oral sciences. 1996;104(4 ( Pt 2)):444-51. [view at publisher] [DOI] [Google Scholar]
18. Khalilinejad F, Khalilian MR, Rasaei N, Saki A. Correlation between Oral Health Status (DMFT) and BMI Index in Khuzestan Province, Iran during 2012-2013. Iranian journal of public health. 2014;43(10):1458-60. [view at publisher] [Google Scholar]
19. Siukosaari P, Ainamo A, Närhi TO. Level of education and incidence of caries in the elderly: a 5-year follow-up study. Gerodontology. 2005;22(3):130-6. [view at publisher] [DOI] [Google Scholar]
20. Beck JD, Koch GG, Rozier RG, Tudor GE. Prevalence and risk indicators for periodontal attachment loss in a population of older community-dwelling blacks and whites. Journal of periodontology. 1990;61(8):521-8. [view at publisher] [DOI] [Google Scholar]
21. Fox CH, Jette AM, McGuire SM, Feldman HA, Douglass CW. Periodontal disease among New England elders. Journal of periodontology. 1994;65(7):676-84. [view at publisher] [DOI] [Google Scholar]
22. Locker D, Leake JL. Risk indicators and risk markers for periodontal disease experience in older adults living independently in Ontario, Canada. Journal of dental research. 1993;72(1):9-17. [view at publisher] [DOI] [Google Scholar]
23. Taheri N, Kamangar S, Ghorbani S, mousavy S. Knowledge, Attitude and Practicetoward Oral Health. Jundishapur J Health Sci. 2013;5(2):107-15.
24. Alkan A, Cakmak O, Yilmaz S, Cebi T, Gurgan C. Relationship Between Psychological Factors and Oral Health Status and Behaviours. Oral health & preventive dentistry. 2015;13(4):331-9. [Google Scholar]
25. Skośkiewicz-Malinowska K, Malicka B, Ziętek M, Kaczmarek U. Oral health condition and occurrence of depression in the elderly. Medicine. 2018;97(41):e12490. [view at publisher] [DOI] [Google Scholar]
26. Kim YS, Kim HN, Lee JH, Kim SY, Jun EJ, Kim JB. Association of stress, depression, and suicidal ideation with subjective oral health status and oral functions in Korean adults aged 35 years or more. BMC oral health. 2017;17(1):101. [view at publisher] [DOI] [Google Scholar]
27. Zengin AZ, Yanik K, Celenk P, Unal-Erzurumlu Z, Yilmaz H, Bulut N. Oral hygiene and oral flora evaluation in psychiatric patients in nursing homes in Turkey. Nigerian journal of clinical practice. 2015;18(6):751-6. [view at publisher] [DOI] [Google Scholar]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
