Shetty et al.

BMC Oral Health (2024) 24:432 BMC Oral Health

https://doi.org/10.1186/s12903-024-04169-x

RESEARCH Open Access

The impact of unmet treatment need on oral

health related quality of life: a questionnaire
survey
Akshata Shetty1, Rahul Bhandary1, Dhruv Ahuja2, Geetu Venugopalan1, Enzo Grossi4, Guilia Margherita Tartaglia5 and
Shahnawaz Khijmatgar3,6*

Abstract
Background Based on the present global burden of oral diseases, unmet dental needs affect a more significant
population worldwide. It is characterised by the need for dental care but receiving delayed or no care. The
contributing factors include lack of knowledge about oral health, its consequences, and the availability of dental
services. We need to find out the scale of the problem of unmet dental needs for the south Indian population.
Therefore, the objective was to determine the relationship between the presence of oral disease and the quality of
life-related to oral health using the OHIP-14 tool.
Methods The unmet dental requirements of the south Indian population were determined using a cross-sectional
questionnaire survey. Close-ended questions were used to obtain data from two investigators trained to record
the answers from the patients. The data was collected using the OHIP-14 questionnaire, which consists of 14 items
divided into seven domains with two questions each. Physical pain, psychological impairment, physical disability,
psychological disability, social disability, and disability were all considered. An additional analysis of artificial neural
network (ANN) was done.
Results The response rate was 100 per cent. N = 1029 people replied to the questionnaire about their unmet
dental needs. N = 497 (48.3%) were men, whereas N = 532 (51.7%) were women. The average age was 31.7811.72.
As their current occupation, most of the included subjects (60.1%) were students. The respondents had no known
personal habits and a mixed diet (94.93%). The average BMI was 24.022.59 (14-30.9). OHIP was present in 62.3% of the
population. The average OHIP-14 severity score was 10.97. (8.54). The severity and degree of unmet dental need were
substantial (p0.01) due to pain in the mouth/teeth/gums, malocclusion, and gum bleeding. The most common OHIP-
14 domains affected by unmet oral needs were psychological discomfort, psychological limitation, social limitation,
and feeling handicapped. The analysis of ANN revealed that high OHIP scores were primarily attributed to dental
caries, poor oral health, and dental aesthetics.

*Correspondence:
Shahnawaz Khijmatgar
[email protected]
Full list of author information is available at the end of the article

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Shetty et al. BMC Oral Health (2024) 24:432 Page 2 of 10

Conclusion The severity and degree of unmet dental needs were significant among the south Indian population.
The most common oral health status that impacted OHIP-14 domains were pain, malocclusion, and bleeding gums.
These patients were significantly impacted by psychological discomfort and social limitations and felt handicapped.
Keywords Health, Oral, Dental, Delay, Treatment, Policies, Gingivitis, Lesion, Carious, Psychology, Social, OHIP-14

Introduction that understanding the importance of the social conse-

Oral health is a good predictor of overall health. The quences of diseases and that medical interventions are
link between oral and general health has only recently intended to increase the length and quality of life are
been established. However, both healthcare experts two driving factors that change how we think about
and the general public have ignored this evidence. The health and health care. For these purposes, the quality,
issue with healthcare professionals is a lack of trust in efficacy, and healthcare performance are often judged
research and the belief that research cannot be trans- by their effect on the “quality of life” of a patient [13].
lated into clinical practice. Another issue is that health As a result, it is critical to understand that measure-
institutions have failed to address the problems of oral ments of quality of life are not a replacement for cal-
and general health. One cause could be a considerable culating illness outcomes but rather a supplement to
gap between policymakers, researchers, health profes- them. Because dentistry has stayed strictly scientific in
sionals, and the general public. Decisions are made its approach to oral health, which equates health with
without consulting with several stakeholders. Most illness, the quality of life linked with oral health is a
research funding themes and calls are advertised with relatively new but quickly rising trend [11].
one main objective, i.e. to make the world a better We hypothesize that there is a significant associa-
place to live through innovation and better healthcare tion between unmet oral healthcare needs and the oral
services. However, given the magnitude of the problem health-related quality of life (OHRQoL) among adults
(Global Burden of Disease 2017 estimated that oral dis- attending outpatient clinics. We expect that individu-
ease affects 3.5 billion people), this goal still needs to als with unmet dental treatment needs, such as dental
be met. The idea that oral disorders cause a significant caries, missing teeth, and oral pain, will report a lower
health burden and influence quality of life, finances, OHRQoL compared to those without such needs. We
discomfort, and even mortality should be accepted by also anticipate that factors like age, education level,
all stakeholders. The issue was recently well addressed and specific oral health conditions will play a crucial
by Peres MA (2019); Watt RG (2019); The LC (2019); role in determining the impact on OHRQoL.
Moynihan P (2020); Watt RG (2020) [1–6]. The rationale for this hypothesis is grounded in the
One possible solution to the abovementioned issue is existing literature, which suggests that oral health is
to conduct research and formulate a specific research intricately connected to an individual’s overall well-
topic relating to unmet requirements in oral health being. Our study highlights the prevalence of oral
care. The unmet health care needs variables that are health issues, such as dental caries, missing teeth, and
used to measure equity in access to health care ser- pain, and their potential impact on the quality of life.
vices. They refer to the proportion of people aged 15 It also identifies specific demographic factors, such
and up who thought they required health treatment as age and education level, as potential influencers of
in the previous 12 months but did not access due to OHRQoL. Given the importance of oral health and the
financial constraints, long waiting lists, or transporta- significant burden it places on individuals, it is essen-
tion issues. In 2018, 4% of the EU population lacked tial to investigate the relationship between unmet oral
access to dental care [7]. The Indian population’s healthcare needs and the quality of life experienced by
unmet dental needs are widespread, accounting for adults attending outpatient clinics. Nevertheless, in
62% of the total [8–10]. However, this must be exam- our study, we aimed to assess the oral health-related
ined concisely through well-designed studies. quality of life in adults attending the outpatient clinic
The oral health related quality of life (OHRQOL) and to determine the relationship between the pres-
is a multidimensional term capturing people’s per- ence of oral disease and the quality of life-related to
ception of significant factors in their present-day life oral health using the OHIP-14 tool.
[11]. Slade and spencer introduced the OHIP formula
in 1994, and the metric measurements were function, Research question
pain, physical disability, social disability, and disability. Is there a significant association between unmet oral
These are social metrics used to measure the impact healthcare needs, including dental caries, missing
of oral conditions at the level of society that will be teeth, and oral pain, and the oral health-related quality
relevant to policymakers [12]. Allison J et al. claimed
Shetty et al. BMC Oral Health (2024) 24:432 Page 3 of 10

of life (OHRQoL) among adults attending outpatient absent” and deemed “unmet dental treatment needs.”
clinics? The inter and intra variability was tested for two sur-
vey collecting persons using 20 patients and standard-
Materials and methods ized till the 80% score above was achieved. There was
A cross-sectional questionnaire study by a random no follow-up of the patients after collecting the survey
sampling method was conducted among the adult information from the first point of contact.
population attending the integrated clinics OPD at A.B
Shetty Dental College, Mangalore, after receiving the Data Management Total OHIP score for the respon-
institutional ethical clearance. The ethical approval dents was calculated by adding the response score for
number is ABSM/EC8/2019. A written informed con- each item to give a minimum score of 0 and a maximum
sent was obtained from all participant’s for inclusion score of 56. An impact on the quality of life was consid-
in the study. The questionnaire used in this study to ered at a response level hardly ever. The discriminant
assess oral health-related quality of life (OHRQoL) validity will be determined by comparing OHIP-14
underwent a meticulous development process to scores in those with or without treatment needed due
ensure its relevance and effectiveness. Beginning to dental caries, periodontitis, missing teeth and pain
with an extensive literature review, a pool of poten- associated with teeth.
tial questionnaire items was generated, covering key
dimensions of OHRQoL. These items were subjected Statistics
to content validity through expert review, where a Sample size calculation
panel of dental professionals (S.K; R.B; A.S) assessed Using the power and sample size estimation STATA
their alignment with the theoretical framework of software version 17.0 version, N = 1046 sample size was
OHRQoL. The questionnaire’s clinical relevance and determined as 386 based on the prevalence of dental dis-
accuracy in measuring OHRQoL were verified by two orders per cent among adults in Mangalore 0.05 (α = 0.05)
independent clinicians, Clinician S.K and Clinician precision. Therefore, a suitable sample size of n = 1000
A.S, whose inputs helped refine the instrument. The patients was needed to identify the unmet dental treat-
training of two investigators, A.S. and D.A., on collect- ment needs and their impact on oral health and quality
ing and recording the data was carried out. The com- of life with 80% power, using a two-sample t-test and
prehensive development, content validity, face validity, assuming a (two-sided) α of 0.05 and β = 0.20.
construct validity, and reliability assessments of the
questionnaire ensured its effectiveness as a tool for Data analysis
measuring OHRQoL in the study. Data collected will be processed and analyzed with
This questionnaire survey was reported according to STATA 17.0 version software. Data Analysis Strategies:
the checklist of reporting survey studies (CROSS) [14]. A association test will be done using a 95% confidence
The inclusion requirements were patients over 18 with interval, descriptive statistics and, Mann Whitney U
unmet dental treatment, with dental conditions such test, ANOVA analysis. Internal validity was deter-
as dental caries, periodontitis, teeth crowding or miss- mined using Cohen Kappa Test. The correlation coef-
ing teeth, and who could understand English or Hindi. ficient was estimated and interpreted as Schober P
The study population were patients attending the out- (2018) described [15].
patient clinic, at A.B. Shetty Dental College, Manga- An artificial adaptive system called Auto-CM was
lore, with the above inclusion criteria. The patients used to graphically show the most important connec-
with mentally incapacitated and diagnosed pregnan- tions among variables (Buscema et al., 2008). Auto-CM
cies were excluded from the study. The data collection is a special kind of ANN that develops weights that are
instrument was the OHIP-14 questionnaire, which proportional to the strength of the associations of all
consists of 14 questions in seven domains with two variables each other. The weights are then transformed
questions each. Functional disabilities, physical pain, in physical distances so that couples of variables whose
psychological impairment, physical disability, psycho- connection weights are higher become nearer and vice
logical disability, social disability, and disability were versa. After the training phase, the weights matrix of
included. The answers to the questions were based on the Auto-CM represents the warped landscape of the
a Likert scale ranging from 0-“never” to 4- “very often” dataset. Subsequently, a minimum spanning tree filter
[11]. The questionnaire also contains variables such as was applied to the weights matrix of the Auto-CM sys-
(a) demographic variables and (b) dentition status will tem to obtain a map of the main connections between
be checked and registered. C) dental treatment needs the variables of the dataset and the basic semantic of
due to the occurrence of dental caries, missing teeth, their similarities, defined connectivity map as detailed
and teeth-related pain will be reported as “present or elsewhere (Buscema et al., 2008) [16].
Shetty et al. BMC Oral Health (2024) 24:432 Page 4 of 10

Results Psychological discomfort has high OHIP-14 scores;

The response rate was 100% and inter-variability by gender, males have higher OHIP-14 scores. The
among two survey recording was more than 85%. A prevalence of oral health impact due to unmet dental
total of N = 1029 subjects responded to the question- needs was more among secondary level education and
naire regarding their unmet dental needs. N = 497 severe in PUC/Diploma level of education. The sever-
(48.3%) were males, and N = 532 (51.7%) were females. ity and extent of unmet dental needs were significant
The overall mean age was 31.78 ± 11.72. Most included due to pain in the mouth/teeth/gums, malocclusion,
subjects were students (60.1%) in their current occu- and bleeding of gums (Table 3). Psychological discom-
pation (Table 1). The distribution (%) of OHIP-14 was fort, psychological limitation, social limitation, and
illustrated in Table 2. The mean BMI was 24.02 ± 2.59 feeling handicapped were the most common OHIP-14
(14-30.9) (Fig. 1). The OHIP-14 score was illustrated domains affected due to unmet dental needs (Table 2).
in Fig. 2 for different domains. Nearly 42.6% had an The domains of OHIP-14 and personal dental unmet
absence of sound teeth, 42.6% had decayed teeth, 37.8% needs were compared to demonstrate a linear link
had missing teeth, 16.5% had pain in the oral cavity between the two variables (Tables 3 and 4). There was
due to different reasons, and 70.0% had bleeding gums. a moderately favourable relationship between dental
OHIP prevalence was present in 62.3% of individuals. caries and functional limitation and a substantial rela-
The mean OHIP-14 severity was 10.97(8.54) (Table 1). tionship between poor oral health, physical pain, and

Table 1 Distribution of study population according to sociodemographic factors and unmet dental needs
n %
Age (in years) ≤ 24 368 35.8
25–34 253 24.6
35–44 236 22.9
45–54 125 12.1
≥ 55 47 4.6
Gender Male 497 48.3
Female 532 51.7
Education Less than secondary 118 11.5
Secondary 618 60.1
PUC/Diploma 110 10.7
Graduation – Postgraduation 183 17.8
Location Karnataka 348 33.8
Kerala 641 66.2
Sound teeth Absent 976 94.8
Present 53 5.2
Decayed teeth Absent 438 42.6
Present 591 57.4
Missing teeth Absent 640 62.2
Present 389 37.8
Pain in mouth/teeth/gums Absent 859 83.5
Present 170 16.5
Malocclusion Absent 692 67.2
Present 337 32.8
Bleeding gums Absent 309 30.0
Present 720 70.0
Mobility of teeth Absent 930 90.4
Present 99 9.6
Fractured teeth Absent 1021 99.2
Present 8 0.8
Grossly decayed teeth Absent 698 67.8
Present 331 32.2
OHIP prevalence Absent 388 37.7
Present 641 62.3
OHIP-14 extent mean (SD) 1.63 (2.13)
OHIP-14 severity mean (SD) 10.97 (8.54)
Shetty et al. BMC Oral Health (2024) 24:432 Page 5 of 10

Table 2 Distribution (%) of OHIP-14

OHIP-Domain OHIP-14 Never Hardly ever Occasionally Fairly often Very often
Functional Limitation Difficulty in pronouncing words 74.8 11.1 9.2 4.1 0.8
Worsened sense of taste 74.8 11.4 8.7 3.6 1.5
Physical Pain Pain in mouth 65.5 7.0 17.2 7.9 2.4
Uncomfortable in eating any food 51.2 10.6 23.2 10.7 4.3
Psychological Discomfort Feeling self-conscious 11.6 8.3 29.6 32.8 17.8
Felt tense 35.6 13.1 26.8 16.9 7.6
Physical Limitation Unsatisfactory diet 66.6 14.5 18.6 6.2 4.2
Meals interrupted 69.0 13.6 9.6 5.2 2.6
Psychological Limitation Difficulty in relaxing 66.3 17.5 11.3 3.7 1.3
Feeling embarrassed 47.8 18.3 20.6 7.6 5.7
Social Limitation Irritation with other people 70.6 15.9 19.4 3.5 0.6
Difficulty to do usual jobs 77.1 12.1 7.7 2.9 0.3
Handicap Life was less satisfactory 72.7 9.7 9.7 5.2 2.7
Not able to function totally 91.8 4.5 2.7 0.7 0.3

psychological discomfort (Fig. 2) (Table 4). Furthermore,

there was a significant association between dental caries
and psychological restriction.
The analysis of the Artificial Neural Network (ANN)
revealed that high OHIP (Oral Health Impact Profile)
scores were primarily attributed to dental caries, poor
oral health, and dental aesthetics. In other words, these
factors emerged as common predictors for elevated
OHIP scores. This suggests that dental caries, poor oral
health, and issues related to dental aesthetics play a sig-
nificant role in influencing oral health-related quality of
life, as indicated by OHIP scores (Figs. 3 and 4).

Discussion
When OHRQoL assessments are combined with tradi-
Fig. 1 Age V BMI. The orange line representing the cut-off BMI i.e. 24.9
tional clinical procedures for assessing oral health sta-
above which a person is considered as over-weight and obese. Nearly,
50% of the included subjects are overweight and obese tus, a more comprehensive assessment of the impact
of oral problems on the various dimensions of subjec-
tive well-being is achievable [10]. OHIP-14 is a 14-item
questionnaire to assess self-reported functional limi-
tation, discomfort, and impairment caused by oral
diseases [9]. It is based on an initial extended ver-
sion of 49 items developed by the WHO and custom-
ized for oral health by Locker [11]. In this approach,
the effects of oral disease are related from a biological
level (impairment) to a behavioural level (functional
limitation, discomfort, and disability), and lastly, to a
social level (handicap). Despite being a brief question-
naire, the OHIP-14 has been shown to have acceptable
reliability and sensitivity and adequate cross-cultural
consistency. It is one of the most widely used OHRQoL
indicators worldwide and is available in various lan-
guages [12].
Fig. 2 OHIP-14 Scores for Domains Majority of the sample belonged to young age group
and were pursuing education. Most of them were
unemployed and complained to not having sound
teeth (94.8%). Our study results found that, older age
Shetty et al. BMC Oral Health (2024) 24:432 Page 6 of 10

Table 3 Distribution of study population according to sociodemographic factors and unmet dental need by prevalence, extent and
severity of OHIP-14
n Prevalence of ≥ 1 p Extent of p Severity of p
oral health impacts oral health oral health
(n = 641) impacts impacts
% µ (± SD) µ (± SD)
Age (years) ≤ 24 368 66.6 0.102 1.59 (1.95) 0.828 10.30 (7.87) 0.010**
25–34 253 63.6 1.62 (2.25) 11.13 (8.91)
35–44 236 55.9 1.51 (2.00) 10.40 (8.01)
45–54 125 60.8 1.70 (2.37) 12.58 (9.62)
≥ 55 47 57.4 1.87 (2.60) 13.85 (10.12)
Gender Male 532 60.0 0.110 1.63 (2.23) 1.000 11.11 (8.93) 0.591
Female 497 64.8 1.63 (2.02) 10.82 (8.11)
Education Less than 118 50.8 0.008* 1.54 (2.51) 0.440 12.14 (9.22) 0.049**
secondary
Secondary level 618 61.7 1.65 (2.15) 10.98 (8.55)
PUC/Diploma 110 65.5 1.37 (1.79) 9.08 (7.39)
Graduate-Post 183 69.9 1.78 (1.95) 11.29 (8.59)
graduate
Location Karnataka 348 63.8 0.478 1.83 (2.15) 0.031** 11.55 (8.38) 0.118
Kerala 641 61.5 1.53 (2.11) 10.67 (8.61)
Sound teeth Absent 976 63.2 0.009* 1.63 (2.11) 0.933 10.95 (8.49) 0.757
Present 53 45.3 1.61 (2.48) 11.32 (9.44)
Decayed teeth Absent 438 65.5 0.066 1.75 (2.24) 0.103 11.32 (9.16) 0.254
Present 591 59.9 1.54 (2.04) 10.71 (8.05)
Missing teeth Absent 640 60.6 0.157 1.53 (2.01) 0.047** 10.39 (8.40) 0.005**
Present 389 65.0 1.80 (2.30) 11.92 (8.69)
Pain in mouth/teeth/gums Absent 859 59.5 < 0.001* 1.46 (2.03) < 0.001** 10.07 (8.30) < 0.001**
Present 170 76.5 2.47 (2.40) 15.52 (8.29)
Malocclusion Absent 692 58.4 < 0.001* 1.53 (2.07) 0.033** 11.08 (8.59) 0.550
Present 337 70.3 1.83 (2.23) 10.74 (8.44)
Bleeding gums Absent 309 72.2 < 0.001* 2.21 (2.47) < 0.001** 13.48 (9.40) < 0.001**
Present 720 58.1 1.38 (1.91) 9.89 (7.91)
Mobility of teeth Absent 930 61.9 < 0.468 1.67 (2.18) 0.052 11.04 (8.75) 0.388
Present 99 65.7 1.23 (1.48) 10.26 (6.21)
Fractured teeth Absent 1021 62.1 0.140 1.62 (2.13) 0.183 10.95 (8.56) 0.424
Present 8 87.5 2.63 (1.60) 13.38 (5.95)
Grossly decayed teeth Absent 698 63.8 0.161 1.71 (2.16) 0.070 11.20 (8.625) 0.203
Present 331 59.2 1.45 (2.06) 10.47 (8.35)
*p value < 0.05 estimated using Chi-squared test; ** p value < 0.05 estimated using one-way ANOVA.

group ( > = 55 years), lower levels of education, missing an individual’s perception of oral health and its rele-
teeth, pain, and the presence of bleeding gums had the vance and impact on their life in our study are similar
feeling of being self-conscious and tensed were more to the study done by Echeverria MS (2018) [20]. Due
commonly reported than any other impacts. Recent to these factors, there was psychological discomfort,
studies highlight the significant burden placed on psychological limitation, social limitation and feeling
older adults following facial trauma, extending beyond handicapped (91.8%) among the most common OHIP-
the physical injury itself. While dental, dentoskeletal 14 domains affected due to unmet dental needs in our
malocclusion, and maxillofacial trauma in this popula- study.
tion present distinct needs, a common thread emerges: Artificial Neural Network (ANN) uncovered that
the potential for major emotional, social, and physical elevated OHIP (Oral Health Impact Profile) scores
consequences [17–19]. were predominantly associated with dental caries, sub-
Absence of sound teeth, decayed teeth, missing optimal oral health, and concerns regarding dental aes-
teeth, pain in the oral cavity due to different rea- thetics. In essence, these factors emerged as prevalent
sons and bleeding gums were associated with the indicators linked to higher OHIP scores. This implies
greater extent of OHIP-14. The results identified of that dental caries, subpar oral health, and matters
Shetty et al. BMC Oral Health (2024) 24:432 Page 7 of 10

Table 4 Factors associated with prevalence, extent and severity of OHIP-14

Prevalence of oral health Extent of oral health Severity of oral
impacts impacts health impacts
OR (95% CI)a β (95% CI)b β (95% CI)b
Intercept 2.33 (1.65–3.01) 16.24(13.27–19.21)
Age (in years) ≤ 24 1.37 (0.72–2.62) -0.41 (0.32–1.04) -3.93 (-6.39- -1.48)*
25–34 1.28 (0.66–2.49) -0.36 (-1.00-0.28) -2.77 (-5.28- -0.25)*
35–44 1.07 (0.55–2.06) -0.31 (-0.96-0.34) -3.42 (-5.95- -0.88)*
45–54 1.23 (0.60–2.50) -0.28 (-0.97-0.41) -1.79 (-4.52- 0.94)*
≥ 55 Ref Ref Ref
Gender Male 0.88 (0.67–1.15) 0.11 (-0.15-0.36) 0.43 (-0.57-1.44)
Female Ref Ref Ref
Education Less than secondary Ref ----- Ref
Secondary level 0.50 (0.30–0.82)* ----- -1.04 (-2.63- 0.55)
PUC/Diploma 0.71 (0.49–1.03) ----- -3.57 (-5.66- -1.48)*
Graduate-Post graduate 0.76 (0.45–1.29) ----- -1.36 (-3.23- 0.51)
Location Karnataka ----- Ref Ref
Kerala ----- -0.17 (-0.44-0.10) -0.39 (-1.46- 0.69)
Sound teeth Absent Ref ----- -----
Present 0.64 (0.36–1.16) ----- -----
Decayed teeth Absent Ref Ref -----
Present 0.82 (0.62–1.07) -0.24(-0.50-0.02) -----
Missing teeth Absent Ref Ref Ref
Present 1.34 (1.01–1.77)* 0.38 (0.11–0.64)* 1.45 (0.43–2.47)*
Pain in mouth/teeth/gums Absent Ref Ref ref
Present 2.39 (1.60–3.56)* 1.07 (0.72–1.42)* 5.25 (3.92–6.59)*
Malocclusion Absent Ref Ref -----
Present 1.60 (1.17–2.18)* 0.37 (0.08–0.66)* -----
Bleeding gums Absent Ref Ref Ref
Present 0.63 (0.46–0.85)* -0.68 (-0.96- -0.39)* -3.32 (-4.41- -2.22)*
Mobility of teeth Absent Ref Ref -----
Present -0.40 (-0.83-0.04) -----
Fractured teeth Absent Ref Ref -----
Present 5.15 (0.59–45.41) 1.03 (-0.41-2.47) -----
Grossly decayed teeth Absent Ref Ref -----
Present 0.83 (0.62–1.11) -0.31 (-0.58- -0.04)* -----
a
: Multilogistic regression model; b: Generalized linear model; * p value < 0.05 and is statistically significant; OR = Odds ratio; CI = Confidence interval; -----not included
in the model

related to dental aesthetics significantly impact the they got during their education. Currently, there is
quality of life concerning oral health, as signified by considerable interest in evaluating the impact of tooth
OHIP scores (Figs. 3 and 4). loss, as it directly influences the quality of life in this
Echeverria MS (2018) [20] found that an increase age group due to negative impacts on chewing, speak-
in the OHIP-14 score among 40.6% of older persons ing, nutrition, aesthetics, psychological aspects,
with lower levels of education caused considerable self-esteem and social relations [22–25]. Thus, the
psychological distress owing to tooth loss and pain in repercussions of tooth loss in older adults are essential
teeth. The fact that education is the primary media- and should be considered in formulating public oral
tor between socioeconomic level and health status health policies.
explains this finding. The current study’s findings sup- Despite the increase in resources for the implanta-
port previous cross-sectional research, which found tion of regional dental prosthetic laboratories in Bra-
that older persons with fewer teeth have a more con- zil [26] prosthetic rehabilitation treatment at public
siderable influence on OHRQoL than those with more health care services is not yet sufficient to meet the
teeth [3, 13, 21]. high demand, which may be one of the factors that
Given that our study participants were students, it is contributed to the absence of a reduction in the OHIP-
still being determined how much oral health literacy 14 scores for a large number of older adults evaluated
Shetty et al. BMC Oral Health (2024) 24:432 Page 8 of 10

Fig. 3 Artificial Neural Network (ANN)

in the present study. Thus, broadening access to den- diseases is combating their widespread problem. This
tal prosthetic services for older adults could result in a demands a multifaceted approach involving early
better OHRQoL in this age group [27, 28]. detection and intervention, improved access to care,
OHIP-14 investigates how factors such as weight, and holistic management.
sex, and education affect oral health. Emphasizing the
connection between oral health and overall well-being, Conclusion
dental caries, inadequate oral hygiene, and aesthetic The present study demonstrated an association of
concerns play a significant role in reducing quality of OHRQoL with oral health status variables. The most
life. This highlights the essential requirement for effec- considerable impact was related to decayed compo-
tive dental disease prevention programs to enhance nents, missing teeth, tooth pain, and bleeding, which
individual well-being and counteract these adverse positively correlated with the OHIP-14 domains.
effects. Despite ongoing dental issues causing physi- These measures have a future in OHRQoL surveys as
cal and psychological risks, overcoming obstacles like an adjunct to identify the conditions with the most
cost, wait time, and transportation access is crucial potential to compromise patient well-being and QoL.
to enable people to seek care. Prevention programs It is essential to document the impact of oral health on
for oral diseases, such as OHIP-14, play a critical role life quality at any given time to identify the variations
in promoting well-being and mitigating the negative in impact among subgroups of the population for plan-
impacts associated with dental problems. Addressing ning and evaluating care.
barriers like cost, wait time, and transportation access
is essential to ensure that individuals can access and
benefit from these programs [29, 30].
Critical to avoiding the onset of oral conditions
impacting individual psychophysical health is the
implementation of targeted prevention programs
through proactive oral care. Establishing virtuous and
sustainable personal habits requires active health edu-
cation programs. Despite the vitality of these initia-
tives, further action is necessary due to the persistence
of oral diseases. Essential to preventing the physi-
cal, mental, and oral health consequences of dental
Shetty et al. BMC Oral Health (2024) 24:432 Page 9 of 10

Fig. 4 ROC curve. Predicting good(< 7) of bad(> 16) OHIP Score

Acknowledgements Consent for publication

None. Not applicable.

Author contributions Informed consent

S.K; A.S and R.B conceived and planned the experiments. A.S and D.A carried Written informed consent was obtained for inclusion in the study.
collected the data. S.K; A.S and R.B planned and carried out the simulations.
S.K; A.S, D.A and R.B contributed to sample preparation. S.K; E.G contributed to Conflict of interest
the statistical analysis; S.K; A.S and R.B contributed to the interpretation of the None.
results. S.K; A.S; G.M.T; G.A, D.A and R.B took the lead in writing the manuscript.
S.K; A.S; G.M.T, D.A; G.A and R.B provided critical feedback and helped shape Author details
1
the research, analysis, and manuscript. Nitte (Deemed to be University), Department of Periodontics, A B Shetty
Institute of Dental Sciences, Mangalore, Karnataka, India
2
Funding Department of Orthodontics and Dentofacial Orthopedics, Manav
This study was partially funded by Italian Ministry of Health, Current research Rachna International Institute of Research and Studies (MRIIRS), Manav
IRCCS Italy. Rachna Dental College, Faridabad, Haryana, India
3
Nitte (Deemed to be University), Department of Oral Biology and
Data availability Genomic Studies, A B Shetty Memorial Institute of Dental Sciences,
The datasets used and/or analysed during the current study available from the Mangalore, Karnataka, India
4
corresponding author on reasonable request. Villa Santa Maria Institute, Tavernerio, Italy
5
School of Medicine, University of Madrid, Madrid, Spain
6
SC Chirurgia Maxillo-Facciale e Odontostomatologia, Fondazione IRCCS
Declarations Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy

Ethics approval and consent to participate

The ethical approval was taken from Institutional ethical committee of AB Received: 7 November 2023 / Accepted: 20 March 2024
Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University).
The ethical approval number is ABSM/EC8/2019. A written informed consent
was obtained from all participant’s for inclusion in the study.
Shetty et al. BMC Oral Health (2024) 24:432 Page 10 of 10

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