Socio-Demographic, Behavioral, and Clinical Determinants of Children's Oral Health–Related Quality of Life

The dissertation undertakes a comprehensive study of students aged 12–14, covering their dental status, knowledge and beliefs regarding oral-health prevention and hygiene, behavioral skills, objective indicators of dentoalveolar health, and oral health-related quality of life. Its scope includes a sample epidemiological survey, sociological research, comparison with foreign data, and analysis by multiple regression.

The research examines the socio-demographic, behavioral, and clinical determinants of how children perceive their tooth health. Its aim is to identify factors that can be taken into account when developing preventive programs and evaluating the work of dental services.

Relevance of the Study. In most Western industrialized countries, the prevalence of caries among children and adolescents has decreased substantially over the past two decades (Burt, 1994; Petersen et al., 2004). The causes of this decline are diverse, but the most significant include reduced sugar consumption, improved care for the teeth and oral cavity, the use of fluoride toothpaste, improvements in the organization of dental services, and the development of school-based preventive programs (WHO, 2002; Petersen, 1992; Kallestaal et al., 1999). At the same time, there has been a positive trend in children's awareness of problems related to the health of their teeth and their attitudes toward these problems (Vigild et al., 1999).

In Russia, the trend in children's dental health is less favorable. This is primarily associated with disruptions in the functioning of the system of dental care for children and a substantial reduction in children's educational and preventive programs in this field. A detailed assessment of the situation and comprehensive epidemiological studies capable of determining the scale of the problem and identifying priority areas for action are necessary for developing a strategy for the development of curative and preventive dental care for children.

A variety of indicators have been developed to describe the prevalence of dental diseases in a population. Although these indicators are of considerable significance, they reflect only the somatic outcome of disease development. They do not, however, describe the effect of disease on functioning or psychosocial well-being. Moreover, trends in disease development are often not associated with the objective indicators as such. In studies examining the relationship between objective indicators of dental disease and patients' opinions about the state of their teeth, this relationship was often weak, and the objective indicators did not always accurately reflect patients' perceptions of their health (Gooch et al., 1989; Locker D., 1995; Locker D., Slade G. D., 1994). This supports the need to develop an approach that would encompass all dimensions of the concept of health and all possible consequences of disease. Assessing an individual's health requires analysis of the social and emotional aspects of health, in addition to establishing the presence or absence of disease. The conceptual model of quality of life recognizes the complex and multidimensional nature of health, including the influence of cultural, ecological, and psychosocial factors. Until recently, the psychosocial consequences of dental diseases received little attention because these conditions rarely threatened life. Moreover, the oral cavity has historically been considered separately from the rest of the body in studies of general health. Recent studies, however, have shown that dental pathology has emotional and psychosocial consequences as serious as those of other diseases. Thus, a patient's self-assessment of health, including dental health, is an important component of overall health assessment.

All of the foregoing confirms the high relevance of the present study. There is an urgent need for a large-scale clinical and epidemiological study of the dental health of children and an investigation of the principal social and behavioral factors associated with dental health.

The aim of the present study was to examine the effects of socio-demographic, behavioral, and clinical factors on the perceptions of children aged 12–14 of their well-being in relation to tooth health and to develop a concept for safeguarding the dental health of students.

Research Objectives:

1. Conduct a sample epidemiological survey of students in secondary general education schools aged 12–14 regarding their dental status.

2. Conduct a sociological study of children's knowledge and beliefs and of behavioral skills in the field of oral-health prevention and hygiene.

3. Analyze the principal components of quality of life related to students' dental health and identify the factors influencing students' perceptions of their dental well-being.

4. Compare indicators of dental status, the prevalence of health-promoting skills, and indicators of children's dental quality of life with findings from foreign studies.

5. Develop practical recommendations concerning priority directions for improving the dental health of students.

The scientific novelty of the study lies in the fact that, for the first time in a domestic social-hygienic study, the interrelationship of the socio-demographic, behavioral, and clinical determinants of students' dental quality of life is examined. The first use in Russia of a methodology developed by the WHO for studying the dental health of populations in various countries (ICS II) makes it possible to compare the findings with results from foreign studies and to demonstrate the influence of socio-cultural characteristics and the organizational factor on children's dental health.

The methodology, applied for the first time in Russia and incorporating multifactorial analysis to test a theoretical model linking the entire complex of socio-demographic, psychological, cognitive, behavioral, and clinical factors for the study of children's dental health, makes it possible to assess the comprehensive effects of the factors on one another.

The practical significance of the present study lies in the fact that its results may provide a basis for developing preventive programs in the field of children's dental health. Studying students' dental quality of life and its principal determinants makes it possible to account for the characteristics of various socio-demographic groups when developing such programs and to identify factors whose modification could increase children's satisfaction with their health.

Knowledge of the characteristics of children's health-promoting behavior concerning the health of their teeth, as well as the prevalence of risk factors for diseases of the oral organs, will make it possible to assess the effectiveness of preventive measures. Monitoring students' dental status with the proposed methods will make it possible to evaluate the effectiveness of dental services.

Provisions Presented for Defense:

1. Dental pathology has a substantial effect on all three components of children's quality of life: physical discomfort, poor assessment of one's well-being, and deteriorated social functioning.

2. Students' socio-demographic characteristics influence both their implementation of health-promoting behavior concerning the strengthening of tooth health and their personal assessment of dental well-being (quality of life).

3. Parents play the principal role in shaping children's health-promoting skills, whereas the efforts of dental services to prevent dental diseases in children are insufficient.

Implementation of the Study Results in Practice. The results of the present study are used in lectures and practical classes for students of the Dental Faculty at the Department of Public Health and Health Care and at the Department of Child Dentistry of the State Educational Institution of Higher Professional Education, Igor Pavlov Saint Petersburg State Medical University under Roszdrav; in the training of heads of dental and medical institutions and organizations in Saint Petersburg and the Leningrad Region; and in the work of the Committee for Health Care of the Government of Saint Petersburg, dental structures, and health care facilities in Saint Petersburg.

Presentation of the Work.

The principal findings of the study were presented and discussed at:

• A scientific-practical conference dedicated to the 100th anniversary of the birth of an Honored Science Worker of the RSFSR, Doctor of Medical Sciences, Professor S. Ya. Freydlin (Saint Petersburg, December 2003).

• The International Youth Medical Congress (Saint Petersburg, 7–9 December 2005).

• A scientific-practical conference dedicated to the 300th anniversary of Saint Petersburg, “Hygiene Education and Upbringing of the Population in Disease Prevention” (Saint Petersburg, May 2003).

• The All-Russian Scientific-Practical Conference “Humanitarian Methods of Research in Medicine: Status and Prospects” (Saratov, 1–2 March 2007).

• The First International Scientific-Practical Conference dedicated to the 70th anniversary of the Novosibirsk State Medical Academy, “Public Health: Innovations in the Economy and Management and Legal Issues in Health Care” (Novosibirsk, 10–11 November 2005).

• A joint meeting of the Department of Public Health and Health Care and the Problem Commission “Hygiene and Organization of Health Care,” with the participation of teaching staff from the Dental Faculty of Igor Pavlov Saint Petersburg State Medical University (Saint Petersburg, 9 September 2007).

• The Third International Scientific-Practical Conference “Current Issues in Dentistry for Children and the Prevention of Dental Diseases” (Saint Petersburg, 25 May 2007).

Volume and Structure of the Dissertation. The dissertation is presented in 140 pages of typewritten text and consists of an introduction, 5 chapters, conclusions and practical recommendations, a bibliography, appendices, and documents confirming the implementation of the study results in practice. The bibliography includes 215 sources, including 145 in foreign languages.