We performed a systematic review of studies conducted in Latin America and the Caribbean (LAC) to assess the impact of oral diseases on oral health-related quality of life (OHRQoL).
Materials and methods
Searches were performed of the following PubMed, EMBASE, CINAHL, Scopus, and LILACS databases. Randomized clinical trials, quasi-experimental studies, cohort studies, case and control studies, and cross-sectional studies which included at least 100 participants evaluating the impact of oral diseases on OHRQoL were included. PROSPERO registry number: CRD42020156098.
After exclusion of duplicates, 3310 articles were identified, 40 of which were included in this review. 90% of the studies were conducted in Brazil. The most commonly used OHRQoL measuring instruments were CPQ 11–14 (n = 9), ECOHIS (n-8) and B-ECOHIS (n = 8). The study designs included 32 cross-sectional, 2 cohort and 6 case and control studies. Most of the studies were conducted in children (n = 25) and adolescents (n = 9). Most studies identified an impact on OHRQoL in children, adolescents and adults with oral diseases. Moreover, greater oral disease severity had a greater impact on OHRQoL.
Citation: Yactayo-Alburquerque MT, Alen-Méndez ML, Azañedo D, Comandé D, Hernández-Vásquez A (2021) Impact of oral diseases on oral health-related quality of life: A systematic review of studies conducted in Latin America and the Caribbean. PLoS ONE 16(6): e0252578. https://doi.org/10.1371/journal.pone.0252578
Editor: Frédéric Denis, Centre Hospitalier Regional Universitaire de Tours, FRANCE
Received: March 13, 2021; Accepted: May 19, 2021; Published: June 2, 2021
Copyright: © 2021 Yactayo-Alburquerque 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: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Oral health is recognized as an essential component of quality of life; however, historically more attention has been paid to its mainly local clinical consequences, regardless of the impact these can have on people’s daily lives . The World Health Organization (WHO) defines oral health as a disease- and disorder-free state that limits a person’s ability to bite, chew, smile and speak, as well as their psychosocial status . Thus, the presence of oral diseases can affect a person’s growth and development, as well as their psychic, productive and social capacity.
Oral diseases are a highly prevalent group of pathologies in the world. The 2017 Global Disease Burden Study reported that 3.5 billion people suffered from oral disease in 2016, representing nearly 50% of the world’s population . In Latin America, a significantly higher prevalence and incidence of untreated cavities in permanent teeth, severe periodontal disease and total tooth loss compared to global averages in 2015  has also been reported. This situation is a priority, as it generates direct and indirect expenditures that affect the limited budgets of health systems in the countries in this region. Thus, while direct expenses are related to costs resulting from oral treatments, indirect expenses are related, for example, to the loss of productivity and quality of life as a result of pain, infections, loss of school days and family life disturbances caused by oral diseases .
At the beginning of the 1980s the concept of "oral health related quality of life" (OHRQoL) was introduced, which consists of a multidimensional construct that reflects the degree of perception of comfort and satisfaction of a person in their daily life regarding their oral health . The complexity of measuring this construct in the different population groups created the need to develop specific instruments for its measurement and evaluation worldwide in order to determine how it is affected by the presence of oral diseases. Thus, systematic reviews have now been published assessing the impact of oral diseases on OHRQoL; however, these are limited to the study of certain pathologies such as: tooth decay , dental trauma injuries (TDI)  and malocclusion  mainly in minors. Therefore there is an underrepresentation of this type of studies in other oral pathologies such as periodontal diseases, temporomandibular dysfunctions, pathologies of the salivary glands, cleft lip and palate, and edentulism, as well as in the population of adults and older adults. In addition, the representation of Latin American and Caribbean (LAC) countries in the above systematic reviews is extremely poor, making further studies evaluating the relationship of oral diseases and OHRQoL in the region necessary.
In short, knowing the effect of oral diseases on OHRQoL is critical to public health systems, research, and decision-making on strategies to be implemented in the prevention and promotion of oral health in different countries. In addition, it is of concern that oral health care is often the first service considered to be expendable by decision makers, due to its high costs and the perception of being a non-essential service especially in developing countries . Therefore, the objective of this study was to conduct a systematic review of studies conducted in LAC to assess the impact of oral diseases on OHRQoL.
Materials and methods
For the systematic review report, the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guide and the declaration of reference items for publishing systematic reviews and meta-analysis (PRISMA) [11, 12] were followed. The systematic review protocol was registered with PROSPERO with reference number CRD42020156098.
The review included randomized clinical trials, quasi-experimental studies, cohort studies, case-control and cross-sectional studies with at least 100 participants assessing the impact of oral diseases (dental cavities, malocclusion, TDI, periodontal diseases, temporomandibular dysfunction, salivary gland pathologies, cleft lip and palate, and edentulism) on OHRQoL in people of all ages in LAC published over the past 10 years. For duplicate data in more than one publication, the study with the largest sample was selected.
In vitro or animal studies, editorials, systematic reviews, letters to the editor, conference proceedings, case reports, studies not conducted in LAC were excluded. In addition, studies evaluating oral pathologies associated with systemic diseases or secondary diseases in the oral cavity were excluded.
Sources of information
A systematic electronic search was conducted in the databases of PubMed, Embase, CINAHL, Scopus, and LILACS (Latin American and Caribbean Literature in Health Sciences) of articles published until July 18, 2020.
A search strategy initially designed in PubMed was adapted to the other databases. A librarian (DC) developed the search strategies that were validated by two of the authors (AHV and DA). The search terms are detailed in S1 Table of the supporting information. The search was performed without restrictions of study design, publishing status, or publishing language.
Selection of studies
Electronic search results were imported into EndNote X9 (Clarivate Analytics, Philadelphia, PA, USA). Subsequently, all duplicate records were deleted according to the methodology described by Bramer et al. . An additional search in the reference lists of the studies included was carried out to identify other publications not identified by the systematic search. Duplicate records were evaluated by title and abstract to verify compliance with the inclusion criteria by two independent reviewers (MTYA and MLAM) using the Rayyan web application (https://rayyan.qcri.org/) . Records meeting the inclusion criteria were evaluated in full text by the same two reviewers to determine their inclusion. Any disagreement at the end of the selection procedure was resolved between the two reviewers and if a decision could not be made, a third reviewer participated in the discussion (DA).
Data extraction process
An ad-hoc form prepared by the authors in the Microsoft Excel program (Microsoft Corporation, Redmond, Washington, USA) was used for the extraction of data from the studies included in the systematic review. The information was independently extracted by two reviewers (MTYA and MLAM). Subsequently, a third reviewer conducted an assessment of the information extracted from 10 randomly selected studies. In case of inconsistencies, the two reviewers (MTYA and MLAM) were informed to re-evaluate the information and correct inconsistencies.
The articles included sought the reporting of information related to the presence/absence and/or severity of oral pathologies. The oral pathologies considered were tooth decay, malocclusion, TDI, periodontal diseases, temporomandibular dysfunction, salivary gland pathologies, cleft lip and palate, and edentulism. The outcome of interest was the OHRQoL report evaluated by specific instruments such as: CPQ11-14, ECOHIS, ECOHIS-B, OHIP-14, etc. In addition, the general characteristics of each study were extracted, such as: country in which the study was carried out, year of publication, first author of the study, journal, title, study design, age group of the evaluated sample, OHRQoL instrument used, diagnostic indices of oral diseases, and language of publication, among others.
Synthesis of results
A formal narrative synthesis of the collected data was performed. The synthesis focused mainly on the qualitative analysis of OHRQoL pathologies and results, separated by country of origin, age group evaluated, OHRQoL instrument used, among others. The limitations of the studies included were discussed.
For the assessment of the impact of oral diseases on OHRQoL, the results of differences in average quality of life were reported based on the presence/absence and/or severity of oral diseases, as well as the association of the strength of the results in a crude or adjusted manner, such as: relative risks (RR), odds ratios (OR) and prevalence ratios (PR). In cases in which any researcher disagreed with respect to the extracted data, the full-text article was revised again to verify the extracted data or to correct errors.
Due to the heterogeneity among the studies included, we considered a meta-analysis inappropriate, and therefore, we focused on the qualitative synthesis of the studies.
Evaluation of study quality
Two authors (MTYA and MLAM) independently evaluated the quality of the studies using the U.S. National Institutes of Health tool . This tool presents a different number of questions depending on the design of the study evaluated (14 questions for cohort or cross-sectional studies, and 12 for case-control studies). Each question has five possible answers: ’yes’, ’no’, ’cannot be determined’, ’not applicable’ and ’not determined’. After completing all the questions, each article was graded as good, fair, or poor quality. Disagreements were resolved by consensus with a third reviewer (DA).
Features of the studies included
Following the evaluation of 3310 articles by title and abstract, 46 articles were included for full-text evaluation, of which 40 articles were included in the systematic review (Fig 1). Table 1 provides an overview of the 40 studies included. Of these, 36 (90%) were carried out in Brazil [16–51], one was from Peru (2.5%) , another study was from Chile (2.5%) , one study was from Trinidad and Tobago (2.5%)  and one other study was performed in Colombia (2.5%) . In relation to the study design, 32 were cross-sectional studies, 2 were cohort studies and there were 6 case and control studies. With regard to the classification of studies included according to age group, 24 studies were performed in children [16–19, 25, 27, 29–37, 39, 40, 43, 45, 47, 51, 52, 54, 55], 10 were in adolescents [20, 22–24, 26, 28, 44, 46, 48, 50], 4 were adult studies [21, 38, 42, 53] and 2 study included more than one age group [41, 49]. They all also evaluated the impact of oral disease over OHRQoL, classified according to exposure to one or more oral diseases, tooth decay, malocclusion, TDI, periodontal diseases, temporomandibular dysfunction, salivary gland pathologies, cleft lip and palate, and edentulism and found studies related to dental caries (n = 7) [20, 25, 32, 36, 37, 43, 54], malocclusion (n = 2) [24, 26], TDI (n = 3) [29, 39, 44], periodontal disease (n = 1) , cleft lip and palate (n = 1) , temporomandibular dysfunction (n = 1) , edentulism (n = 1) , salivary glands disease (n = 1)  and more than one oral disease evaluated (n = 23) [16–19, 21–23, 27, 28, 30, 31, 33–35, 42, 45, 47–52, 55].
The quality of life measurement instruments used in the different studies were as follows; CPQ8-10 [27, 31, 35, 36, 40, 47, 49], CPQ11-14 [20, 22–24, 26, 28, 48–50], ECOHIS [16, 29, 33, 37, 45, 52, 54], B-ECOHIS [18, 19, 25, 30, 32, 39, 43, 51],OHIP-14 [21, 42, 46, 53],OHIP [38, 41],C-ECOHIS , SOHO-5 , B-SOHO-5  and Child-OIDP , the most frequent being CPQ11-14(n-9), B-ECOHIS(n-8). The association between quality of life and oral diseases was expressed using RR, OR and PR and mean difference hypothesis tests and beta coefficients.
Tooth decay and OHRQoL
Thirty studies investigating the relationship between tooth decay and OHRQoL were identified (Table 1). Twenty-seven studies were conducted in Brazil, one in Peru, one in Trinidad and Tobago and one in Colombia. Twenty-eight studies were developed in populations under the age of 18, while two studies included a population of 18–80 years [21, 42]. To assess the presence of tooth decay in the population, 9 studies used the DMFT index, 11 the dmft index, 5 the ICDAS scale, 1 activity injury assessment (ALA), 2 ranked according to the WHO, 1 Pufa index, and 1 study used DMFT/dmft. In addition, 3 studies [25, 27, 45] used more than one instrument to evaluate tooth decay. Of the 30 studies evaluated (Table 2), only three showed no significant association between the presence of tooth decay and OHRQoL [20, 22, 51]. One of the studies included reported that tooth decay affected OHRQoL only when associated with periodontitis . In addition, Correa-Faria et al.  reported that only cavities with clinical consequences are associated with poor OHRQoL. On the other hand, Simões et al.  reported a significant association between tooth decay and OHRQoL in children between the age of 8 and 10 compared to pre-adolescents between the age of 11 and 14.
Malocclusion and OHRQoL
Twenty studies investigating the association between malocclusion and OHRQoL were identified (Table 1), 18 in Brazil, one in Peru and one in Colombia. Of these, 12 studies included children between 2 and 10 years old [16, 18, 19, 27, 31, 33, 35, 45, 47, 51, 52, 55], 7 included the pre-adolescent population between 11 and 14 years old [22–24, 26, 28, 48, 50], and one was in children between 8 and 12 years old . Of the total studies, 12 assessed malocclusions according to the criteria of the dental aesthetic index (DAI) while 9 evaluated the absence or presence of the disease. As for the results obtained by these 20 studies (Table 2), 9 studies reported a significant negative impact of malocclusion on OHRQoL [22, 26, 27, 31, 33, 47–50], 11 did not describe a significant association between this pathology and OHRQoL. One of the studies  found no significant association between severe malocclusion and OHRQoL, except in cases of definite and handicapping malocclusion. In addition, two studies reported that the most severe states of malocclusion were associated with worse OHRQoL, even though the less severe states of the condition were not associated [24, 49].
TDI and OHRQoL
Of the 22 studies on TDI evaluated (Table 1), 20 were conducted in Brazil, 1 in Peru and one in Colombia. Fifteen of the 22 articles identified investigated children between the ages of 2 and 10, while 6 were on adolescents between the ages of 11 and 14 and one studied children between the ages of 8 and 12. To evaluate TDI, the following instruments were used: 13 articles used Andreasen’s classification [16, 22, 23, 28, 29, 31, 33, 35, 39, 45, 51, 52, 55], 3 the O’Brien classification [44, 49, 50], 3 [17–19] the Glendor et al.  and 3 did not indicate which instrument was used for the diagnosis of TDI [30, 34, 48]. Of the total studies, 13 found a significant negative association between TDI and OHRQoL (Table 2). Nine studies [16, 23, 28, 35, 48–52] reported that quality of life was not influenced by the presence of TDI.
Periodontal disease and OHRQoL
Three studies in Brazil evaluated the association between periodontal disease and OHRQoL. (Table 1). One study  included 12-year-olds, while two studies [38, 42] included adult populations. The Tomazoni et al. study evaluated the impact of gingival bleeding in children on OHRQoL, as measured with the CPQ 11–14 tool. It was concluded that a degree of bleeding ≥15% increased the risk of having a worse OHRQoL, and this association was maintained even after adjustment according to clinical, social demographic and economic variables. In their study, Meusel et al. evaluated the impact of the severity of periodontal disease on OHRQoL in adults measured with the OHIP-14Br tool, and concluded that individuals with severe periodontal disease had a worse OHRQoL than those with mild/moderate periodontal disease . Finally, the Passos-Soares study reported that periodontal disease combined with tooth decay was significantly associated with increased involvement of OHRQoL.
Temporomandibular dysfunction and OHRQoL
Only one study  evaluated the association between temporomandibular dysfunction and OHRQoL (Table 1) measured with the OHIP-14 instrument in Brazil in people from 16 to 80 years of age. Three types of temporomandibular dysfunction were recorded: muscle disorder, jaw displacement and arthralgia, and arthritis and osteoarthritis. The study reported that the presence of muscle disorder had a significant negative impact on OHRQoL, while the presence of mandibular displacement and arthralgia, and arthritis and osteoarthritis had no significant impact on OHRQoL.
Salivary gland pathology and OHRQoL
Only one study reported the impact of salivary gland pathologies (presence of xerostomy) on OHRQoL in Chile (Table 1) in individuals aged 18 to 63. The total OHIP-14 score was used for OHRQoL measurement. The study reported that the presence of xerostomy significantly reduces OHRQoL compared to the absence of this disease .
Cleft lip, cleft palate and OHRQoL
Only one case control study that assessed the association between cleft lip, cleft palate and OHRQoL was identified (Table 1) . The study was carried out in Brazil in children between 8 and 10 years old. The cases were represented by children with cleft lip and palate belonging to the Hospital of Rehabilitation of Craniofacial anomalies and the University of Sao Paulo, while the controls were children without this condition recruited from national schools. The association between orofacial dysfunction and OHRQoL was evaluated in children with cleft lip and palate. For the measurement of orofacial dysfunction, the NOT-S instrument was used, based on the dimensions of sensory function, breathing, habits, chewing and swallowing, drooling and dry mouth, and CPQ 8–10 was used for OHRQoL. Significant differences were only identified in social welfare areas, but not in the overall outcome of CPQ 8–10, among children with and without orofacial dysfunction.
Edentulism and OHRQoL
Two studies conducted in Brazil evaluated the association between edentulism and OHRQoL (Table 1). One study  included a population of individuals over the age of 12 and reported that a loss of previous teeth was negatively associated with OHRQoL. The second study evaluated included adults between the age of 20 and 64 and reported no significant association between the number of teeth lost and OHRQoL .
Quality assessment of studies
With regard to the evaluation of the quality of the studies, eight were of good quality [20, 21, 26, 31–33, 49, 53], 22 were of intermediate quality [16–19, 22, 23, 25, 27–29, 34, 35, 37, 42, 43, 45, 47, 48, 50, 51, 54, 55] and ten were of poor quality [24, 30, 34, 36, 38, 39, 41, 44, 46, 52] (Table 3).
The purpose of this study was to conduct a systematic review to assess the impact of oral diseases on OHRQoL in people of countries from LAC. Forty studies with an observational design were included, 36 of which were developed in Brazil, one in Peru, one in Chile, one in Trinidad and Tobago, and one in Colombia. Of the total studies included, 30 evaluated tooth decay, 20 malocclusion, 22 TDI, three periodontal diseases, one cleft lip and palate, one temporomandibular dysfunction, two edentulism, and one salivary gland pathology. Twenty-five studies included children, nine were performed in adolescents, five were on adults, and one study evaluated more than one age group. The OHRQoL instruments most commonly used in the studies evaluated were CPQ11-14, ECOHIS, and B-ECOHIS. Despite the variety of instruments used to measure OHRQoL, and the different oral disease definitions of the studies included, most of the studies evaluated reported that OHRQoL was affected by the different oral diseases evaluated in children, adolescents and adults in concordance with the results of previous reviews with information specific to the LAC [57, 58].
Some negative associations between the presence of tooth decay and OHRQoL [16–19, 21, 23, 25, 27, 28, 30–37, 42, 43, 45, 47–50, 52, 54, 55] were identified in 27 of 30 studies included. These results have been reported in previous systematic reviews evaluating pre-school children and adolescents, in which this association was also considered as negative [7, 59]. This finding is of interest in LAC, as it is one of the regions worldwide with the highest prevalence and incidences of untreated tooth decay in deciduous and permanent teeth . In addition, within the same region the prevalence of cavities in deciduous and permanent teeth is unequally distributed, with the prevalence being 10% to 20% lower in Brazil compared to other countries in LAC . Thus, there is a need for a greater number of studies on the relationship between tooth decay and OHRQoL in other countries in the region, since 90% of the studies evaluated in this review were conducted in Brazil, and the problem related to cavities seems to be of greater magnitude in other countries of the region.
Moreover, only seven of the 20 studies included evaluation of the relationship between malocclusion and OHRQoL and concluded that the greater the degree of severity or the presence of malocclusion the greater the impact on OHRQoL [23, 24, 26, 27, 47–49]. However, most studies that did not identify this association did take into account the analysis of the presence or absence of disease; that is, individuals identified with the condition may have had both mild and severe forms, which may have led to an underestimation of the associations identified, bearing in mind that two of the studies evaluated described a relationship between malocclusion and OHRQoL according to the severity of malocclusion and reported that only the most severe forms negatively impacted OHRQoL [24, 49]. On the other hand, malocclusion is commonly associated with cavities and periodontal disease, mainly because tooth bad positions promote bacterial plaque buildup and hinder proper oral hygiene  and thus, OHRQoL can be even more affected by the presence of other comorbidities. In addition, some parents of children or adolescents with malocclusion may underestimate the impact of this disease, and it may remain unnoticed except in the case of obvious abnormalities which have a psychological or social impact on the sufferer  while less severe cases, remain unnoticed. Also, it is relevant that LAC is mainly composed of low- and middle-income countries, which is an important factor considering the high cost of orthodontic treatments and maxillary orthopedics, which are generally not covered by the public health systems of this region, thereby reducing the probability of these patients receiving treatment.
With regard to the relationship between TDI and OHRQoL, of the 22 studies evaluated, 13 identified a significant negative association between TDI and OHRQoL [17–19, 22, 29–31, 33, 34, 39, 44, 45, 55] while nine studies did not [16, 23, 28, 35, 48–52]. Most of these latter studies did not include adolescents but rather school- and preschool-age children, and therefore, the impact of TDI may not have been significant given that this age group may have less aesthetic concerns and less social impact in the presence of fractures or previous tooth loss as a result of a TDI. As in our study, previous systematic reviews have also shown heterogeneous results in regard to this association. While the systematic review by Borges et al. described a negative impact of this pathology on OHRQoL in preschool children , the systematic review by Antunes RS  reported that the negative association between TDI and OHRQoL was significant for all dimensions of OHRQoL only in pre-adolescents between the ages of 11 and 14, and when the CPQ 11–14 instrument is used, while only the symptom domain of the OHRQoL is affected in children. Therefore, the association between TDI and OHRQoL may vary depending on the age of the population and the OHRQoL measuring instruments used [8, 63]. Higher-level methodological studies and long-term follow-up are required to learn more about this association and the groups that are most affected.
In general, studies reporting on the impact of periodontal diseases (n-2) [38, 50], temporomandibular dysfunction (n-1) , salivary gland pathology (n-1) , cleft lip and palate(n-1)  and edentulism (n-2) [21, 46] on OHRQoL are scarce in the population of LAC. In this regard, in countries of other regions in the world, mainly developed countries, a greater number of studies have been reported in relation to the association of periodontal diseases, edentulism and xerostomy with OHRQoL . However, in addition to the psychological and social repercussions of these oral diseases, they also may have consequences in the general health. Previous reviews have demonstrated this association. For example, the systematic review of Stepan et al.  reported that in addition to the psychological effect, temporomandibular dysfunction may cause pain, synovitis, limitation of the opening of the mouth and locking of the jaw. Likewise, Romandini et al.  reported that periodontal diseases and its more advanced sequela, edentulism, are associated with a higher risk of mortality from cardiovascular diseases, neoplasms, cerebrovascular diseases and respiratory infections. Also, in addition to the difficulty in chewing and speaking caused by cleft lip and palate, this condition is associated with recurrent ear infections, and even hearing loss that can generate a negative effect on the OHRQoL as reported by the systematic review of Al-Namankany and Alhubaishi . On the other hand, Pina et al.  concluded that to date, because of the limited evidence available, it is not clear to what extent a reduction in the level of salivary production impairs the OHRQoL. This highlights the need to perform further studies on the relationship of the diseases mentioned and OHRQoL in the population of LAC, with the aim of understanding the extent to which these diseases and their consequences affect OHRQoL, and to allow developing informed measures regarding these conditions at the health system level.
It is important to mention that of the 42 countries that make up LAC, only 5 are represented in this study, with 90% of the studies having been conducted in Brazil. This highlights the presence of a significant research gap on the subject of OHRQoL in the region of LAC countries, which has previously been identified in the area of dental public health , as well as in relation to scientific production in general, with Brazil having greater representation . This is probably due to investment in research in Brazil, which reaches approximately 1.3% of the GDP, with the largest percentage in the region and with approximately two-thirds of total full-time researchers in South America . Therefore, an adaptation of this measures to other contexts in the region is important so as not to leave other countries behind. On the other hand, in previous systematic reviews assessing the impact of oral diseases on general quality of life and OHRQoL globally, the representativeness of LAC countries is very low [7–9, 59], except for Brazil, demonstrating the lack of research in the area of oral health in this region.
The most common instruments used to measure OHRQoL were CPQ11-14 (n-8), ECOHIS (n-8) and B-ECOHIS (n-8). In this regard, a systematic review carried out by Zaror et al. (2018) made a standardized comparison of the instruments available for evaluating OHRQoL in the population of children and adolescents, which included 18 instruments evaluated using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. The study concluded that ECOHIS in preschool children and CPQ11-14 were the best rated with good reliability, responsiveness and interpretability . Another reason for the frequent use of these instruments is that they have been validated in several languages, including English, Portuguese and Spanish, allowing them to be widely used in other regions, with the exception of B-ECOHIS which can only be applied in Brazil . On the other hand, although Spanish as the first language is predominant in LAC, there is a wide variety of intraregional dialects, which requires translation, adaptation and validation procedures of the OHRQoL instruments available in that language, being a preliminary step necessary for the development of studies on this subject in the different countries of the region.
Among the main limitations of this systematic review are the differences in diagnostic criteria for oral diseases, the instruments used for OHRQoL evaluation, and measures of association reported in the studies included. Given this heterogeneity, the usefulness of combining association estimators through meta-analysis would be very limited. On the other hand, some studies published as grey literature or in thematic and regional bibliographic databases that were not considered in the search for this systematic review may not have been included. Nonetheless, this is one of the first systematic reviews to assess the impact of oral diseases on OHRQoL in the context of LAC, which, in similar previously published systematic reviews, has had little representativeness [7–9, 58, 64]. In addition, an extensive systematic search for information was conducted in five databases, including LILACS, which houses much of the peer-reviewed research in LAC, in order to achieve maximum representativeness of studies on the subject from countries in the region. Similarly, this study included the evaluation of oral conditions, and age groups, not considered in previous systematic reviews. Furthermore, the 10-year cut-off for the publication date of the eligible studies could be considered as a limitation. However, we took into account the fact that most of the studies validating OHRQoL instruments in LAC were published in the first decade of the 2000s [73–77]. Therefore, it is be expected that within only a few years after validation these instruments began to be used in larger-scale studies. Finally, since this systematic review represents an overview of studies evaluating the impact of various oral conditions on OHRQoL, we recommend that future studies should perform calculations of association estimators taking into account the impact of specific oral diseases on OHRQoL.
In conclusion, this systematic review shows that most studies in LAC identified a negative relationship between the presence and/or severity of oral conditions and OHRQoL. However, there is an under-representation in the scientific research in this area in most of the countries in the region. This problem requires the implementation of research, science and technology policies, together with increased investment at the state level, in order to encourage the development of these studies, which are of social interest and with a public health approach. In addition, a greater number of prospective longitudinal studies and including adult and older adult populations are needed, to further provide information to enable better decision-making and investment of the limited health budgets that are common in most LAC countries.
S1 Table. Search Strategies.
S1 File. Data file of the study.
- 1. Spanemberg JC, Cardoso JA, Slob EMGB, López-López J. Quality of life related to oral health and its impact in adults. J Stomatol Oral Maxillofac Surg 2019;120:234–9. pmid:30763780
Organización Mundial de la Salud. Salud bucodental 2020.
- 3. Dye BA. The Global Burden of Oral Disease: Research and Public Health Significance. J Dent Res 2017;96:361–3. pmid:28318392
- 4. Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, et al. Global, Regional, and National Prevalence, Incidence, and Disability-Adjusted Life Years for Oral Conditions for 195 Countries, 1990–2015: A Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors. J Dent Res 2017;96:380–7. pmid:28792274
- 5. Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a global public health challenge. Lancet Lond Engl 2019;394:249–60. pmid:31327369
- 6. Bennadi D, Reddy CVK. Oral health related quality of life. J Int Soc Prev Community Dent 2013;3:1–6. pmid:24478972
- 7. Matamala-Santander A, Rivera-Mendoza F, Zaror C. Impacto de la Caries en la Calidad de Vida Relacionada con la Salud Oral de Adolescentes: Revisión Sistemática y Metaanálisis. Int J Odontostomatol 2019;13:219–29. https://doi.org/10.4067/S0718-381X2019000200219.
- 8. Borges TS, Vargas-Ferreira F, Kramer PF, Feldens CA. Impact of traumatic dental injuries on oral health-related quality of life of preschool children: A systematic review and meta-analysis. PLOS ONE 2017;12:e0172235. pmid:28245226
- 9. Sun L, Wong HM, McGrath CP. Relationship Between the Severity of Malocclusion and Oral Health Related Quality of Life: A Systematic Review and Meta-analysis. Oral Health Prev Dent 2017;15:503–17. pmid:28944350
- 10. Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S, et al. Ending the neglect of global oral health: time for radical action. Lancet Lond Engl 2019;394:261–72. pmid:31327370
- 11. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009;62:e1–34. pmid:19631507
- 12. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008–12. pmid:10789670
- 13. Bramer WM, Giustini D, de Jonge GB, Holland L, Bekhuis T. De-duplication of database search results for systematic reviews in EndNote. J Med Libr Assoc JMLA 2016;104:240–3. pmid:27366130
- 14. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan-a web and mobile app for systematic reviews. Syst Rev 2016;5:210. pmid:27919275
National Heart Lung and Blood Institute. Study Quality Assessment Tools-NHLBI 2016.
- 16. Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bönecker M, Raggio DP. Impact of oral diseases and disorders on oral health-related quality of life of preschool children: Oral health-related quality of life in preschool children. Community Dent Oral Epidemiol 2011;39:105–14. pmid:21029148
- 17. Abanto J, Tsakos G, Paiva SM, Carvalho TS, Raggio DP, Bönecker M. Impact of dental caries and trauma on quality of life among 5- to 6-year-old children: perceptions of parents and children. Community Dent Oral Epidemiol 2014;42:385–94. pmid:24460685
- 18. Abanto J, Tello G, Bonini GC, Oliveira LB, Murakami C, Bönecker M. Impact of traumatic dental injuries and malocclusions on quality of life of preschool children: a population-based study. Int J Paediatr Dent 2015;25:18–28. pmid:24387748
- 19. Aldrigui JM, Abanto J, Carvalho TS, Mendes FM, Wanderley MT, Bönecker M, et al. Impact of traumatic dental injuries and malocclusions on quality of life of young children. Health Qual Life Outcomes 2011;9:78. pmid:21943368
- 20. Alves LS, Damé-Teixeira N, Susin C, Maltz M. Association among quality of life, dental caries treatment and intraoral distribution in 12-year-old South Brazilian schoolchildren. Community Dent Oral Epidemiol 2013;41:22–9. pmid:22882480
- 21. Batista MJ, Lawrence HP, Rosário de Sousa M da L. Impact of tooth loss related to number and position on oral health quality of life among adults. Health Qual Life Outcomes 2014;12:165. pmid:25433483
- 22. Bendo CB, Paiva SM, Varni JW, Vale MP. Oral health-related quality of life and traumatic dental injuries in Brazilian adolescents. Community Dent Oral Epidemiol 2014;42:216–23. pmid:24124669
- 23. Bittencourt JM, Martins LP, Bendo CB, Vale MP, Paiva SM. Negative effect of malocclusion on the emotional and social well-being of Brazilian adolescents: a population-based study. Eur J Orthod 2017;39:628–33. pmid:28371848
- 24. Bretz YPM, Souza GLN, Corradi-Dias L, Serra-Negra JM, Paiva SM, Abreu LG. Severe malocclusion negatively impacts adolescents’ quality of life. Rio Jan Dent J Rev Científica CRO-RJ 2019;4:41–7. https://doi.org/10.29327/24816.4.1-8.
- 25. Corrêa-Faria P, Daher A, Freire M do CM, de Abreu MHNG Bönecker M, Costa LR. Impact of untreated dental caries severity on the quality of life of preschool children and their families: a cross-sectional study. Qual Life Res 2018;27:3191–8. pmid:30097914
- 26. da Rosa GN, Del Fabro JP, Tomazoni F, Tuchtenhagen S, Alves LS, Ardenghi TM. Association of malocclusion, happiness, and oral health-related quality of life (OHRQoL) in schoolchildren: Malocclusion impacts happiness and OHRQoL. J Public Health Dent 2016;76:85–90. pmid:26223886
- 27. Dutra SR, Pretti H, Martins MT, Bendo CB, Vale MP, Dutra SR, et al. Impact of malocclusion on the quality of life of children aged 8 to 10 years. Dent Press J Orthod 2018;23:46–53. pmid:29898157
- 28. Feldens CA, Ardenghi TM, Dos Santos Dullius AI, Vargas-Ferreira F, Hernandez PAG, Kramer PF. Clarifying the Impact of Untreated and Treated Dental Caries on Oral Health-Related Quality of Life among Adolescents. Caries Res 2016;50:414–21. pmid:27458722
- 29. Feldens CA, Day P, Borges TS, Feldens EG, Kramer PF. Enamel fracture in the primary dentition has no impact on children’s quality of life: implications for clinicians and researchers. Dent Traumatol 2016;32:103–9. pmid:26400828
- 30. Firmino RT, Gomes MC, Clementino MA, Martins CC, Paiva SM, Granville-Garcia AF. Impact of oral health problems on the quality of life of preschool children: a case-control study. Int J Paediatr Dent 2016;26:242–9. pmid:26147122
- 31. Freire-Maia FB, Auad SM, Abreu MHNG de, Sardenberg F, Martins MT, Paiva SM, et al. Oral Health-Related Quality of Life and Traumatic Dental Injuries in Young Permanent Incisors in Brazilian Schoolchildren: A Multilevel Approach. PLOS ONE 2015;10:e0135369. pmid:26287386
- 32. Guedes RS, Ardenghi TM, Piovesan C, Emmanuelli B, Mendes FM. Influence of initial caries lesions on quality of life in preschool children: a 2-year cohort study. Community Dent Oral Epidemiol 2016:n/a-n/a. pmid:26892250
- 33. Kramer PF, Feldens CA, Helena Ferreira S, Bervian J, Rodrigues PH, Peres MA. Exploring the impact of oral diseases and disorders on quality of life of preschool children. Community Dent Oral Epidemiol 2013;41:327–35. pmid:23330729
- 34. Maia ACD-SA, Pithon MM, Silva HKJ, Coqueiro RDS. Perception on the quality of life related to oral health in preschool children. Rio Jan Dent J Rev Científica CRO-RJ 2019;4:43–53. https://doi.org/10.29327/24816.4.3-8.
- 35. Martins MT, Sardenberg F, Bendo CB, Abreu MH, Vale MP, Paiva SM, et al. Dental caries remains as the main oral condition with the greatest impact on children’s quality of life. PLOS ONE 2017;12:e0185365. pmid:28981545
- 36. Martins-Júnior PA, Oliveira M, Marques LS, Ramos-Jorge ML. Untreated dental caries: impact on quality of life of children of low socioeconomic status. Pediatr Dent 2012;34:49–52. pmid:22795145
- 37. Martins-Júnior PA, Vieira-Andrade RG, Corrêa-Faria P, Oliveira-Ferreira F, Marques LS, Ramos-Jorge ML. Impact of Early Childhood Caries on the Oral Health-Related Quality of Life of Preschool Children and Their Parents. Caries Res 2013;47:211–8. pmid:23257929
- 38. Meusel DRDZ, Ramacciato JC, Motta RHL, Júnior RBB, Flório FM. Impact of the severity of chronic periodontal disease on quality of life. J Oral Sci 2015;57:87–94. pmid:26062856
- 39. Milani AJ, Fonseca Alves N, Martins do Espiroto-Santo T, Gonçalves Ribeiro L, Ammari MM, Antunes LS, et al. Impact of Traumatic Dental Injuries on Oral Health-Related Quality of Life of Preschool Children and Their Families Attending a Dental Trauma Care Program. Port J Public Health 2019;37:19–25. https://doi.org/10.1159/000501525.
- 40. Montes ABM, Oliveira TM, Gavião MBD, Barbosa T de S, Montes ABM, Oliveira TM, et al. Orofacial functions and quality of life in children with unilateral cleft lip and palate. Braz Oral Res 2019;33. pmid:31531563
- 41. Oliveira de Lima C, Soares Miranda J, Liparini Caetano P, Veloso Malta N, Gonçalves Leite I, Pêssoa Pereira Leite F. Evaluation of the life quality in patients with Temporomandibular Disorders. Braz Dent Sci 2015;18:77. https://doi.org/10.14295/bds.2015.v18i3.1144.
- 42. Passos-Soares J de S, Santos LP de S, Cruz SS da, Trindade SC, Cerqueira E de MM, Santos KOB, et al. The impact of caries in combination with periodontitis on oral health-related quality of life in Bahia, Brazil. J Periodontol 2018;89:1407–17. pmid:30030846
- 43. Piva F, Pereira JT, Luz PB, Hugo FN, de Araújo FB. Caries progression as a risk factor for increase in the negative impact on OHRQOL—a longitudinal study. Clin Oral Investig 2018;22:819–28. pmid:28667398
- 44. Ramos-Jorge J, Paiva SM, Tataounoff J, Pordeus IA, Marques LS, Ramos-Jorge ML. Impact of treated/untreated traumatic dental injuries on quality of life among Brazilian schoolchildren. Dent Traumatol 2014;30:27–31. pmid:23617685
- 45. Ramos-Jorge J, Pordeus IA, Ramos-Jorge ML, Marques LS, Paiva SM. Impact of untreated dental caries on quality of life of preschool children: different stages and activity. Community Dent Oral Epidemiol 2014;42:311–22. pmid:24266653
- 46. Rocha EKTG, Vanderlei AD, Ribeiro CMB, Lima AL de O, Santos AF dos, Filho EMT. Impact of Tooth Loss on Quality of Life. Pesqui Bras Em Odontopediatria E Clínica Integrada 2016;16:69–78.
- 47. Sardenberg F, Martins MT, Bendo CB, Pordeus IA, Paiva SM, Auad SM, et al. Malocclusion and oral health-related quality of life in Brazilian school children. Angle Orthod 2013;83:83–9. pmid:22612389
- 48. Scapini A, Feldens CA, Ardenghi TM, Kramer PF. Malocclusion impacts adolescents’ oral health–related quality of life. Angle Orthod 2013;83:512–8. pmid:23210545
- 49. Simões RC, Goettems ML, Schuch HS, Torriani DD, Demarco FF, Simões RC, et al. Impact of Malocclusion on Oral Health-Related Quality of Life of 8–12 Years Old Schoolchildren in Southern Brazil. Braz Dent J 2017;28:105–12. pmid:28301027
- 50. Tomazoni F, Zanatta FB, Tuchtenhagen S, da Rosa GN, Del Fabro JP, Ardenghi TM. Association of Gingivitis With Child Oral Health–Related Quality of Life. J Periodontol 2014;85:1557–65. pmid:24942231
- 51. Vieira-Andrade RG, Siqueira MBL, Gomes GB, D’Avila S, Pordeus IA, Paiva SM, et al. Impact of traumatic dental injury on the quality of life of young children: a case–control study. Int Dent J 2015;65:261–8. pmid:26311004
- 52. López-Ramos RP, García-Rupaya CR. Calidad de vida y problemas bucales en preescolares de la provincia de Huaura, Lima. Rev Estomatológica Hered 2014;23:139. https://doi.org/10.20453/reh.v23i3.24.
- 53. Niklander S, Veas L, Barrera C, Fuentes F, Chiappini G, Marshall M, et al. Risk factors, hyposalivation and impact of xerostomia on oral health-related quality of life. Braz Oral Res 2017;31. pmid:28099580
- 54. Naidu R, Nunn J, Donnelly-Swift E. Oral health-related quality of life and early childhood caries among preschool children in Trinidad. BMC Oral Health 2016;16:128. pmid:27923355
- 55. Díaz S, Mondol M, Peñate A, Puerta G, Boneckér M, Martins Paiva S, et al. Parental perceptions of impact of oral disorders on Colombian preschoolers’ oral health-related quality of life. Acta Odontol Latinoam AOL 2018;31:23–31. pmid:30056463
- 56. Glendor U, Halling A, Andersson L, Eilert-Petersson E. Incidence of traumatic tooth injuries in children and adolescents in the county of Västmanland, Sweden. Swed Dent J 1996;20:15–28. pmid:8738905
- 57. Omara M, Stamm T, Bekes K. Four‐dimensional oral health‐related quality of life impact in children: A systematic review. J Oral Rehabil 2020:joor.13066. pmid:32757443
- 58. Haag DG, Peres KG, Balasubramanian M, Brennan DS. Oral Conditions and Health-Related Quality of Life: A Systematic Review. J Dent Res 2017;96:864–74. pmid:28581891
- 59. Nora ÂD, da Silva Rodrigues C, de Oliveira Rocha R, Soares FZM, Minatel Braga M, Lenzi TL. Is Caries Associated with Negative Impact on Oral Health-Related Quality of Life of Pre-school Children? A Systematic Review and Meta-Analysis. Pediatr Dent 2018;40:403–11. pmid:31840639
- 60. Gimenez T, Bispo BA, Souza DP, Viganó ME, Wanderley MT, Mendes FM, et al. Does the Decline in Caries Prevalence of Latin American and Caribbean Children Continue in the New Century? Evidence from Systematic Review with Meta-Analysis. PLOS ONE 2016;11:e0164903. pmid:27768737
- 61. Kolawole KA, Folayan MO. Association between malocclusion, caries and oral hygiene in children 6 to 12 years old resident in suburban Nigeria. BMC Oral Health 2019;19:262. pmid:31775712
Vieira-Andrade RG, de Paiva SM, Marques LS. Impact of Malocclusions on Quality of Life from Childhood to Adulthood. In: Bourzgui F, editor. Issues Contemp. Orthod., InTech; 2015. https://doi.org/10.5772/59485.
- 63. Antunes LAA, Lemos HM, Milani AJ, Guimarães LS, Küchler EC, Antunes LS. Does traumatic dental injury impact oral health‐related to quality of life of children and adolescents? Systematic review and meta‐analysis. Int J Dent Hyg 2020;18:142–62. pmid:31828930
- 64. van de Rijt LJM, Stoop CC, Weijenberg RAF, de Vries R, Feast AR, Sampson EL, et al. The Influence of Oral Health Factors on the Quality of Life in Older People: A Systematic Review. The Gerontologist 2020;60:e378–94. https://doi.org/10.1093/geront/gnz105.
- 65. Stepan L, Shaw C-KL, Oue S. Temporomandibular disorder in otolaryngology: systematic review. J Laryngol Otol 2017;131:S50–6. pmid:27786149
- 66. Romandini M, Baima G, Antonoglou G, Bueno J, Figuero E, Sanz M. Periodontitis, Edentulism, and Risk of Mortality: A Systematic Review with Meta-analyses. J Dent Res 2021;100:37–49. pmid:32866427
- 67. Al-Namankany A, Alhubaishi A. Effects of cleft lip and palate on children’s psychological health: A systematic review. J Taibah Univ Med Sci 2018;13:311–8. pmid:31435341
- 68. Pina G de MS, Mota Carvalho R, Silva BS de F, Almeida FT. Prevalence of hyposalivation in older people: A systematic review and meta‐analysis. Gerodontology 2020;37:317–31. pmid:32965067
- 69. Azañedo D, Hernández-Vásquez A. Worldwide scientific production in dental public health. Why it matters for the reduction of oral health inequalities? Rev Fac Odontol Univ Antioquia 2019;31.
- 70. Van Noorden R. The impact gap: South America by the numbers. Nature 2014;510:202–3. pmid:24919906
- 71. Zaror C, Pardo Y, Espinoza-Espinoza G, Pont À, Muñoz-Millán P, Martínez-Zapata MJ, et al. Assessing oral health-related quality of life in children and adolescents: a systematic review and standardized comparison of available instruments. Clin Oral Investig 2019;23:65–79. pmid:29569021
- 72. Scarpelli AC, Oliveira BH, Tesch FC, Leão AT, Pordeus IA, Paiva SM. Psychometric properties of the Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). BMC Oral Health 2011;11:19. pmid:21668959
- 73. Souza RF, Patrocínio L, Pero AC, Marra J, Compagnoni MA. Reliability and validation of a Brazilian version of the Oral Health Impact Profile for assessing edentulous subjects. J Oral Rehabil 2007;34:821–6. pmid:17919248
- 74. Goursand D, Paiva SM, Zarzar PM, Ramos-Jorge ML, Cornacchia GM, Pordeus IA, et al. Cross-cultural adaptation of the Child Perceptions Questionnaire 11–14 (CPQ11–14) for the Brazilian Portuguese language. Health Qual Life Outcomes 2008;6:2. pmid:18194552
- 75. Oliveira BH, Nadanovsky P. Psychometric properties of the Brazilian version of the Oral Health Impact Profile-short form. Community Dent Oral Epidemiol 2005;33:307–14. pmid:16008638
- 76. Lopez R, Baelum V. Spanish version of the Oral Health Impact Profile (OHIP-Sp). BMC Oral Health 2006;6:11. pmid:16827940
- 77. Pires CP dos AB, Ferraz MB, Abreu MHNG de. Translation into Brazilian portuguese, cultural adaptation and validation of the oral health impact profile (OHIP-49). Braz Oral Res 2006;20:263–8. pmid:17119711