The oral health-related quality of life has recently been reported to be a rather important aspect of general health. Dropping out of dental treatment has long been a problem plaguing oral health. However, the relationship between dropout for dental treatment and the oral health-related quality of life is unclear. The purpose of this study was to investigate the oral health-related quality of life in patients who dropped out of dental treatment.
Materials and methods
We conducted a questionnaire-based investigation using web research. The participants were allocated to two groups (dropout group and maintenance group). The dropout group included participants who had stopped visiting their dental office in the past and had not revisited in the last decade. The maintenance group included patients who visited their dental office continually for a regular checkup. We analyzed the General Oral Health Assessment Index (GOHAI) as an indicator of the oral health-related quality of life and assessed the background characteristics of the subjects.
We analyzed 225 people in the dropout group and 236 people in the maintenance group. The score of GOHAI was significantly different between the 2 groups (dropout group:47.07, maintenance:48.97, p = 0.035), and the more frequent dropouts brought the less GOHAI score (p = 0.012). Furthermore, the results of a logistic regression analysis showed that dropping out of dental treatment was significantly associated with the GOHAI score (p = 0.002).
Citation: Kato T, Umezaki Y, Naito T (2018) Effects of dropping out of dental treatment on the oral health-related quality of life among middle-aged subjects using web research. PLoS ONE 13(10): e0205462. https://doi.org/10.1371/journal.pone.0205462
Editor: Denis Bourgeois, University Lyon 1 Faculty of Dental Medicine, FRANCE
Received: July 13, 2018; Accepted: September 25, 2018; Published: October 31, 2018
Copyright: © 2018 Kato et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: This work was supported by a Grant-in-Aid for Young Scientists (B: No. 26861826) from the Japan Society for the Promotion of Science.
Competing interests: The authors have declared that no competing interests exist.
According to current understanding, periodontal disease has a relationship with systemic diseases [1–4]. It is therefore very important to control periodontal diseases for not only oral health but also general health. For controlling periodontal disease, continuing treatment is very important as supportive periodontal therapy (SPT) [5,6]. On the other hand, dental treatment dropout is one of the strongest risk factors influencing periodontal disease progression . However, only 20%-50% of people , and many patients drop out from visiting dental clinic . A decline in the oral health of these dropout patients is therefore of substantial concern and dropping out of dental treatment is a weighty issue. However, it is difficult to perform an analysis of patients who have dropped out of dental treatment, as they do not visit dental clinic or undergo examinations.
Oral health is reported to be a very important part of one’s well-being according to the World Health Organization , and the oral health-related quality of life shares a relationship with the general quality of life [11,12]. Several studies have explored ways to measure the oral health-related quality of life. The General Oral Health Assessment Index (GOHAI)  has been developed as one such method and is easy to use because of the self-reported aspect of its measurement . In addition, the GOHAI is reported to be significantly associated with the oral health status [15–17], socioeconomic status , nutritional status , and psychological status [20,21]. However, there have been no reports on the relationship between the GOHAI and dropping out of dental treatment, hence the effects of dental treatment dropout on the oral health-related quality of life are unclear. Therefore, we made a hypothesis that dropping out of dental treatment decreased oral health-related quality of life. The purpose of this study was to clarify the relationship between the oral health-related quality of life and dropping out of dental treatment using web research.
Participants and ethical considerations
This study was conducted using web research. Participants who enrolled with an internet research company (JUSTSYSTEMS CORPORATION, Tokyo, Japan) on January 20–24, 2017. According to the Survey of Dental Diseases by Japanese Ministry of Health, Labour and Welfare , more than half of over 45 years people have periodontal disease (existing periodontal pocket >4mm). We therefore set up that over 45 years of age were administered a questionnaire evaluation. The subjects were allocated to two groups: the “dropout” group and the “maintenance” group. The “dropout” included participants who had stopped visiting their dental office in the past and had not revisited in the last 10 years. The “maintenance” included patients who visited their dental office continually for a regular checkup one or more times in the past year. Both participants were evaluated each groups with self-reported on website. Participant consent was also provided on the web, and we set the questionnaires that the only agreed participants could answer on website.
This study was approved by the Ethics Committee for Clinical Research at Fukuoka Gakuen (approval number 324). The research company provided analysts with the results of the questionnaire only, and the analysts had no access to subjects’ individual information.
The sample size was calculated by comparing the average between the two groups, with the α error set to 0.05 and the power to 0.95. A previous study showed that the Δ was 1.5 and the standard deviation 3.5 . We therefore planned to include over 220 subjects in each group.
Background characteristics of the participants
The following background characteristics of the participants in both groups were analyzed: age, gender, marriage status, and child status. These items were based on those described in a previous study. The number of frequency for dropout from dental visiting was counted in the “dropout”.
The assessment of the oral health-related quality of life
The Japanese version of the GOHAI was used to analyze the oral health-related quality of life . Participants were asked to respond using a 5-point scoring scale (always, often, sometimes, seldom and never) regarding the presence of the 12 question items of the GOHAI over the preceding 3 months. The GOHAI comprises three domains of oral health; “physical functions” including eating, speech and swallowing; “psychosocial functions” including worries or concerns about oral health; and “pain or discomfort” including teeth or gums sensitive, pain relief medication, and feeling discomfort when eat anything. The total GOHAI scores range from 12 to 60. A high GOHAI scores indicated a positive self-perception of oral health, while lower scores indicated poorer oral health and reflected oral health problems. In the present study, we analyzed participants with GOHAI-high score for logistic regression models. The median value of the GOHAI national norm for Japanese individuals was 55.0. Therefore, we defined the participants with GOHAI scores of ≥ 55 as the GOHAI-high group.
Statistical analyses were performed using the IBM SPSS Statistics software program (Ver. 22.0; International Business Machine Japan, Tokyo, Japan). In all analyses, the significance was set at p < 0.05. Mann-Whitney U test was used to compare the background characteristics and the GOHAI score between the “maintenance” and “dropout”. The total GOHAI score was analyzed with the Kruskal Wallis test on the differences about numbers of dropout dental visiting.
Characteristics of participants
The characteristics of the study subjects are shown in Table 1. We finished recruiting subjects with 225 people in the “dropout” and 236 people in the “maintenance”. No statistically significant differences were noted between the “dropout” and “maintenance” in the sex, marriage status, and child status.
Differences in the GOHAI between groups
The comparison of the GOHAI total scores for each of the 12 items and 3 domains between the “dropout” and “maintenance” were shown in Table 2. Significant differences were noted between the two groups in the GOHAI total score using the Mann-Whitney U test (p = 0.005). Each of the three domains also showed significant differences, and 10 items were also noted significant differences between the two groups.
Relationship between the total score and number of frequency for dropout experiences
Participants were divided into four groups according to the number of times that they have dropped out from dental treatment. (0, 1–2, 3–5, and >5). Significant differences were noted among the four groups using the Kruskal Wallis H test (Table 3). A low GOHAI score was shown to be associated with a high number of dropouts.
Logistic regression analyses of predictors for inclusion in the GOHAI-high group
Dropping out of dental treatment (≥1 dropout experiences) and sex were shown to be factors significantly associated with inclusion in the GOHAI-high group (Table 4). The odds ratio for dropping out of dental treatment was 0.516 (95% confidence interval 0.340–0.785). The Hosmer-Lemeshow test value of this model was P = 0.103, while the identification rate was 69.8%.
In the present study, people in the “dropout” were seemed significantly lower oral health-related quality of life than people in the “maintenance”, and the more frequent dropouts brought the less GOHAI score. Moreover, dropping out of dental treatment was significantly associated with the GOHAI score by logistic regression analysis. Therefore, it was consider that to prevent dropout dental treatment might be important to prevent decreasing of oral health-related quality of life.
Several previous reports have described the effects of periodontal therapy on the oral health-related quality of life [24,25]. However, none have focused on the effects of dental treatment dropout on the oral health-related quality of life. To our knowledge, this is the first study to demonstrate the relationship between the oral health-related quality of life and dropping out of dental treatment. The fact that the relevant subjects would not visit dental clinics or undergo dental examinations no doubt made it difficult to perform analyses.
Our study showed that dental treatment dropout was associated with a low oral health-related quality of life. No similar studies have been performed, but some reports have shown that undergoing dental treatment is associated with a high oral health-related quality of life . Therefore, our results were reasonable based on these previous reports. However, our study showed that the oral health-related quality of life significantly varied by gender. The oral health-related quality of life is known to be affected by many factors , but no marked differences by gender have been noted in previous reports on the development of assessment indices using this study [14,27]. However, some studies have reported that gender affected[28,29] the oral health-related quality of life. For example, female have shown a tendency to have a low oral health-related quality of life . These results showed the same tendency as in the present study. It was not easy to clear the reason of gender differences, but there were some helpful reports to explain the gender differences by self-administered questionnaire[30,31]. The study about sleep quality reported that female were lower sleep quality than men, and the study of pain threshold level reported that female were lower pain threshold level than men. From the result of these studies, female might feel low well-being themselves, and female might feel low oral health-related quality of life themselves. Further studies should be performed to clarify these gender differences in the oral health-related quality of life.
In this present study, it was seen negative oral health with people in “dropout”, and it was very important to discuss about preventing dropout dental treatment. However, there was no study about preventing dropout dental treatment to our knowledge. On another front, dental diseases were almost lifestyle related diseases, thus it was useful to refer to the preventing dropout with diabetes mellitus. Using mobile applications had effects of decreasing dropouts from diabetic care . Therefore, mobile technologies might have possibilities to prevent dropout dental treatment. However, it was still unclear to prevent dropout dental treatment, and there were limited reports. Therefore, we should conduct further studies to prevent dropout dental treatment.
Our study was limited by its use of a web research platform. Therefore, there were some selection biases. In addition, the questionnaires were also selected by self-certification. However, more than 80% of Japanese people use the Internet recently , and inappropriate respondents were removed to improve response reliability in web research products [34,35], and the web research company used by this study also screened monitors routinely. Comparing phone interview study of which response rate was 5.38% in our prior study, web research like this study might be more rational and reliable.
Our study showed that subjects who dropped out of visiting their dental office had a worse oral health-related quality of life than those who continued to attend visits. Furthermore, dropping out of dental visits seemed to have a negative effect on the oral health-related quality of life.
We thank the patients and Sugiyama Dental Clinic’s staff. We also thank our colleagues for their support during the present study. This work was supported by a Grant-in-Aid for Young Scientists (B: No. 26861826) from the Japan Society for the Promotion of Science.
- 1. Bahekar AA, Singh S, Saha S, Molnar J, Arora R. The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis. Am Heart J. 2007;154: 830–7. pmid:17967586
- 2. Awano S, Ansai T, Takata Y, Soh I, Akifusa S, Hamasaki T, et al. Oral Health and Mortality Risk from Pneumonia in the Elderly. J Dent Res. 2008; 334–339. 87/4/334 [pii] pmid:18362314
- 3. Chambrone L, Pannuti CM, Guglielmetti MR, Chambrone LA. Evidence grade associating periodontitis with preterm birth and/or low birth weight: II. A systematic review of randomized trials evaluating the effects of periodontal treatment. J Clin Periodontol. 2011;38: 902–914. pmid:21736600
- 4. Iwasaki M, Taylor GW, Manz MC, Kaneko N, Imai S, Yoshihara A, et al. Serum antibody to Porphyromonas gingivalis in chronic kidney disease. J Dent Res. 2012;91: 828–33. pmid:22828790
- 5. Axelsson P, Lindhe J. Effect of controlled oral hygiene procedures on caries and periodontal disease in adults. Results after 6 years. J Clin Periodontol. 1981;8: 239–48. Available: http://www.ncbi.nlm.nih.gov/pubmed/6947990 pmid:6947990
- 6. Miyamoto T, Kumagai T, Lang MS, Nunn ME. Compliance as a prognostic indicator. II. Impact of patient’s compliance to the individual tooth survival. J Periodontol. 2010;81: 1280–8. pmid:20397906
- 7. Clarke NG, Hirsch RS. Personal risk factors for generalized periodontitis. J Clin Periodontol. 1995;22: 136–45. Available: http://www.ncbi.nlm.nih.gov/pubmed/7775670 pmid:7775670
- 8. McCracken G, Asuni A, Ritchie M, Vernazza C, Heasman P. Failing to meet the goals of periodontal recall programs. What next? Periodontol 2000. 2017;75: 330–352. pmid:28758296
- 9. Renvert S, Persson GR. Supportive periodontal therapy. Periodontol 2000. 2004;36: 179–95. pmid:15330949
- 10. Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2005;33: 81–92. pmid:15725170
- 11. Saraçlı Ö, Akca ASD, Atasoy N, Önder Ö, Şenormancı Ö, Kaygisız İ, et al. The Relationship between Quality of Life and Cognitive Functions, Anxiety and Depression among Hospitalized Elderly Patients. Clin Psychopharmacol Neurosci. 2015;13: 194–200. pmid:26243848
- 12. Rodakowska E, Mierzyńska K, Bagińska J, Jamiołkowski J. Quality of life measured by OHIP-14 and GOHAI in elderly people from Bialystok, north-east Poland. BMC Oral Health. 2014;14: 106. pmid:25141902
- 13. Atchison KA, Dolan TA. Development of the Geriatric Oral Health Assessment Index. [Internet]. Journal of dental education. 1990. pp. 680–7. pmid:2229624
- 14. Naito M, Suzukamo Y, Nakayama T, Hamajima N, Fukuhara S. Linguistic adaptation and validation of the General Oral Health Assessment Index (GOHAI) in an elderly Japanese population. J Public Health Dent. 2006;66: 273–275. pmid:17225823
- 15. Locker D, Allen F. What do measures of “oral health-related quality of life” measure? Community Dent Oral Epidemiol. 2007;35: 401–11. pmid:18039281
- 16. de Andrade FB, Lebrão ML, Santos JLF, da Cruz Teixeira DS, de Oliveira Duarte YA. Relationship between oral health-related quality of life, oral health, socioeconomic, and general health factors in elderly Brazilians. J Am Geriatr Soc. 2012;60: 1755–60. pmid:22880818
- 17. Ikebe K, Hazeyama T, Enoki K, Murai S, Okada T, Kagawa R, et al. Comparison of GOHAI and OHIP-14 measures in relation to objective values of oral function in elderly Japanese. Community Dent Oral Epidemiol. 2012;40: 406–14. pmid:22469135
- 18. Hernández-Palacios RD, Ramírez-Amador V, Jarillo-Soto EC, Irigoyen-Camacho ME, Mendoza-Núñez VM. Relationship between gender, income and education and self-perceived oral health among elderly Mexicans. An exploratory study. Cien Saude Colet. 2015;20: 997–1004. pmid:25923612
- 19. Gil-Montoya JA, Subirá C, Ramón JM, González-Moles MA. Oral Health-Related Quality of Life and Nutritional Status. J Public Health Dent. 2008;68: 88–93. pmid:18248335
- 20. Locker D, Matear D, Stephens M, Lawrence H, Payne B. Comparison of the GOHAI and OHIP-14 as measures of the oral health-related quality of life of the elderly. Community Dent Oral Epidemiol. 2001;29: 373–81. Available: http://www.ncbi.nlm.nih.gov/pubmed/11553110 pmid:11553110
- 21. Sánchez-García S, Heredia-Ponce E, Juárez-Cedillo T, Gallegos-Carrillo K, Espinel-Bermúdez C, de la Fuente-Hernández J, et al. Psychometric properties of the General Oral Health Assessment Index (GOHAI) and dental status of an elderly Mexican population. J Public Health Dent. 2010;70: 300–7. pmid:20663049
- 22. Survey of Dental Diseases 2016. Available: http://www.mhlw.go.jp/toukei/list/dl/62-28-02.pdf
- 23. Campos CH, Ribeiro GR, Rodrigues Garcia RCM. Oral health-related quality of life in mild Alzheimer: patient versus caregiver perceptions. Spec Care Dent. 2016;36: 271–276. pmid:27059177
- 24. Suzuki E, Aoki H, Tomita S, Saito A. Improvement in Oral Health-related Quality of Life by Periodontal Treatment: A Case Report on Elderly Patient with Chronic Periodontitis. Bull Tokyo Dent Coll. 2016;58: 163–170. pmid:28954951
- 25. Makino-Oi A, Ishii Y, Hoshino T, Okubo N, Sugito H, Hosaka Y, et al. Effect of periodontal surgery on oral health-related quality of life in patients who have completed initial periodontal therapy. J Periodontal Res. 2016;51: 212–220. pmid:26073422
- 26. Yeh D-Y, Kuo H-C, Yang Y-H, Ho P-S. The Responsiveness of Patients’ Quality of Life to Dental Caries Treatment—A Prospective Study. PLoS One. 2016;11: e0164707. pmid:27776148
- 27. Pereira PA, Nunes M, Mendes RA. Oral health-related quality of life of Portuguese adults with mild intellectual disabilities. 2018; 1–14. pmid:29561892
- 28. Yamashita JM, De Moura-Grec PG, De Freitas AR, Sales-Peres A, Groppo FC, Ceneviva R, et al. Assessment of oral conditions and quality of life in morbid obese and normal weight individuals: A cross-sectional study. PLoS One. 2015;10: 1–11. pmid:26177268
- 29. Kishi M, Aizawa F, Matsui M, Yokoyama Y, Abe A, Minami K, et al. Oral health-related quality of life and related factors among residents in a disaster area of the Great East Japan Earthquake and giant tsunami. Health Qual Life Outcomes. Health and Quality of Life Outcomes; 2015;13. pmid:26369321
- 30. van den Berg JF, Miedema HME, Tulen JHM, Hofman A, Neven AK, Tiemeier H. Sex differences in subjective and actigraphic sleep measures: a population-based study of elderly persons. Sleep. 2009;32: 1367–75. Available: http://www.ncbi.nlm.nih.gov/pubmed/19848365 pmid:19848365
- 31. Rosen S, Ham B, Mogil JS. Sex differences in neuroimmunity and pain. J Neurosci Res. 2017;95: 500–508. pmid:27870397
- 32. Yamaguchi S, Waki K, Tomizawa N, Waki H, Nannya Y, Nangaku M, et al. Previous dropout from diabetic care as a predictor of patients’ willingness to use mobile applications for self-management: A cross-sectional study. J Diabetes Investig. 2017;8: 542–549. pmid:28012247
- 33. Information and Communications in Japan 2016 [Internet]. [cited 10 May 2018]. Available: http://www.soumu.go.jp/johotsusintokei/whitepaper/eng/WP2016/2016-index.html
- 34. Chandler J, Mueller P, Paolacci G. Nonnaïveté among Amazon Mechanical Turk workers: consequences and solutions for behavioral researchers. Behav Res Methods. 2014;46: 112–30. pmid:23835650
- 35. Berinsky AJ, Margolis MF, Sances MW. Separating the Shirkers from the Workers? Making Sure Respondents Pay Attention on Self-Administered Surveys. Am J Pol Sci. Wiley/Blackwell (10.1111); 2014;58: 739–753.