Does Maternal Oral Health Predict Child Oral Health-related Quality of Life in Adulthood?

Dara M Shearer; W Murray Thomson; Jonathan M Broadbent; Richie Poulton

Health and Quality of Life Outcomes. 2011;9

Abstract and Introduction

Abstract

Background: A parental/family history of poor oral health may influence the oral-health-related quality of life (OHRQOL) of adults.
Objectives: To determine whether the oral health of mothers of young children can predict the OHRQOL of those same children when they reach adulthood.
Methods: Oral examination and interview data from the Dunedin Study's age-32 assessment, as well as maternal self-rated oral health data from the age-5 assessment were used. The main outcome measure was study members' short-form Oral Health Impact Profile (OHIP-14) at age 32. Analyses involved 827 individuals (81.5% of the surviving cohort) dentally examined at both ages, who also completed the OHIP-14 questionnaire at age 32, and whose mothers were interviewed at the age-5 assessment.
Results: There was a consistent gradient of relative risk across the categories of maternal self-rated oral health status at the age-5 assessment for having one or more impacts in the overall OHIP-14 scale, whereby risk was greatest among the study members whose mothers rated their oral health as "poor/edentulous", and lowest among those with an "excellent/fairly good" rating. In addition, there was a gradient in the age-32 mean OHIP-14 score, and in the mean number of OHIP-14 impacts at age 32 across the categories of maternal self-rated oral health status. The higher risk of having one or more impacts in the psychological discomfort subscale, when mother rated her oral health as "poor/edentulous", was statistically significant.
Conclusions: These data suggest that maternal self-rated oral health when a child is young has a bearing on that child's OHRQOL almost three decades later. The adult offspring of mothers with poor self-rated oral health had poorer OHRQOL outcomes, particularly in the psychological discomfort subscale.

Introduction

Oral-health-related quality of life (OHRQOL) measures examine the extent to which oral disease affects an individual's well-being. They aim to determine the subjective functional and psycho-social impacts of oral disease, and complement traditional objective clinical indicators to facilitate a more holistic approach to oral health.^[1] Research has indicated a range of influences on oral-health-related quality of life (OHRQOL). These include direct oral health factors such as untreated caries and missing teeth,^[2–5] periodontal disease,^[2,6,7] malocclusion,^[5] and xerostomia.^[8,9] In addition, age,^[3] sex,^[10,11] socio-economic status,^[2,12,13] socio-cultural factors,^[3,14,15] psychosocial factors,^[16,17] dental care services attendance pattern,^[12,13,18] and dental anxiety^[19,20] can all impact on OHRQOL.

A potential impact on OHRQOL that remains unexamined is the effect of parental/family history of poor oral health. It is likely that intergenerational processes link maternal oral health (and maternal oral health beliefs, attitudes and behaviours) to oral health and disease risk in offspring.^[21–28] If maternal oral health is associated with offspring oral health, and oral health is associated with OHRQOL, then it is reasonable to believe that maternal oral health is also associated with offspring OHRQOL through this pathway. However, is it possible that maternal oral health also exerts an influence on her offspring's OHRQOL via other mechanisms?

Population oral health and population OHRQOL, while inextricably linked, are not the same. While it can be debated whether the primary objective of public health measures should be the improvement of oral health or OHRQOL, it is likely that the burden of impaired OHRQOL is substantial. For this reason, putative predisposing factors for poor OHRQOL require careful and comprehensive examination. This will allow the identification of those who are at greatest risk of suffering poor OHRQOL due to poor oral health, but also independently of clinical oral health factors. Thus, the current study sought to determine whether the oral health of mothers of young children can predict the OHRQOL of those same children when they reach adulthood. It tested the hypothesis that mothers' self-rated oral health when children are young can predict her offspring's OHRQOL many years later.

1 2 3 4 5

Next Section

Abstract and Introduction
Methods
Results
Discussion
Conclusions
References

Table 1. Comparison of study members who attended with their mother at the age-5 assessment who were examined, and completed OHIP-14, at age 32, versus those who were not examined, or did not complete OHIP-14, at age 32
	Examined and completed OHIP-14 at age 32 (N = 827)	Not examined or did not complete OHIP-14 at age 32 (N = 86)
Study members at age 5 assessment
Male (%)	419 (50.7)	49 (57.0)
SES from birth to age 15¹
High (%)	130 (15.8)^a	6 (7.1)
Medium (%)	529 (64.2)	53 (62.4)
Low (%)	165 (20.0)	26 (30.6)
Caries-free at age 5 (%)	335 (40.5)	39 (45.3)
Mean dmfs at age 5 (SD)	3.7 (5.6)	3.3 (4.9)
Mothers at age 5 assessment
Self-rated oral health as fairly poor/very poor or was edentulous (%)	238 (28.8)^b	38 (44.2)

¹Not all participants could be classified for the SES from birth to age 15 variable; ¹N = 909
^ap < 0.05; chi-square test. ^bp < 0.01; chi-square test.

Table 2. Study members' oral health-related QOL at age 32 by mothers' self-rated oral health status at the age-5 assessment (an impact is measured by a "fairly often" or "very often" response to OHIP-14 scale items)
	Mother self-rated oral health at age 5 assessment
	Excellent or fairly good (N = 271)	Average N = 318)	Fairly poor, very poor or edentulous (N = 238)	Total (827)
Age 32 OHRQOL (OHIP-14 scale)
Prevalence 1+ impacts (%)
1+ impacts overall	54 (19.9)^a	68 (21.4)	75 (31.5)	197 (23.8)
Severity of impacts (SD)
Mean total OHIP score	6.6 (6.9)^bc	8.4 (8.0)^b	9.3 (8.9)^c	8.1 (8.0)
Mean count of total number impacts	0.4 (1.0)^d	0.5 (1.2)^e	0.8 (1.8)^de	0.5 (1.4)

^ap < 0.005; chi-square test
^{b, c, d, e} p < 0.005 Kruskal-Wallis test; Estimates with different symbols are significantly from each other (by post hoc criteria)

Table 3. Adjusted* estimates for study members' relative risk of having 1+ impacts on overall OHIP-14 score, mean OHIP-14 score, and mean number of different OHIP-14 impacts at age 32, by maternal self-rated oral health 27 years earlier (modified Poisson regression model)
	Study members' relative risk of 1+ impacts on overall OHIP-14 score by age 32 (95% CI)		Study members' mean OHIP-14 score by age 32 (95% CI)		Study members' mean number of different OHIP-14 impacts by age 32 (95% CI)
Mother's self-rated oral health 27 years earlier
Excellent/fairly good	1.00		6.77	(6.46, 7.09)	0.35	(0.28, 0.42)
Average	1.02	(0.75, 1.40)	8.24	(7.93, 8.56)	0.44	(0.37, 0.51)
Fairly poor, very poor or edentulous	1.27	(0.93, 1.74)	8.14	(7.78, 8.51)	0.59	(0.50, 0.69)

*Controlling for low SES, high caries trajectory, 1+ missing teeth.

Table 4. Modified Poisson regression model for study members' prevalence of one or more impacts on OHIP-14 scale subsets, and prevalence of one or more impacts on OHIP-14 overall scale at age 32
	Low SES at age 32	High caries trajectory	1+ missing teeth	Mother self-rated oral health as average	Mother self-rated oral health as poor/edentulous
1+ impacts on OHIP-14 subscales and overall scale at age 32
RR (95% confidence intervals)
1+ impacts - overall (any subscale)	1.45 (1.14, 1.85)	1.28 (0.96, 1.72)	1.89 (1.45, 2.44)	1.02 (0.75, 1.40)	1.27 (0.93, 1.74)
1+ impacts - functional limitation	1.61 (0.73, 3.56)	1.72 (0.60, 4.94)	1.91 (0.74, 4.94)	1.18 (0.32, 4.32)	2.72 (0.84, 8.75)
1+ impacts - physical pain	1.02 (0.61, 1.72)	2.06 (1.18, 3.62)	2.47 (1.43, 4.27)	1.48 (0.73, 3.04)	1.71 (0.87, 3.36)
1+ impacts - psychological discomfort	1.31 (0.87, 1.99)	1.50 (0.91, 2.48)	2.62 (1.65, 4.16)	1.49 (0.83, 2.66)	2.08 (1.16, 3.72)
1+ impacts - physical disability	1.50 (0.99, 2.28)	1.17 (0.72, 1.91)	1.77 (1.15, 2.70)	0.90 (0.56, 1.45)	0.90 (0.54, 1.49)
1+ impacts - psychological disability	1.09 (0.63, 1.89)	1.80 (0.98, 3.31)	2.40 (1.35, 4.27)	1.36 (0.66, 2.82)	1.49 (0.71, 3.11)
1+ impacts - social disability	1.90 (0.84, 4.28)	0.63 (0.23, 1.76)	2.89 (1.30, 6.42)	0.97 (0.36, 2.59)	1.85 (0.75, 4.47)
1+ impacts - handicap	1.83 (0.76, 4.37)	1.14 (0.36, 3.64)	2.15 (0.85, 5.47)	0.54 (0.19, 1.54)	0.81 (0.29, 1.54)

Reference categories: low SES at age 32 (high/medium SES coded 0), high caries trajectory (low caries trajectory coded 0), 1+ missing teeth at age 32 (no missing teeth coded 0), Mother self-rated oral health as average (Mother self-rated oral health as excellent coded 0), Mother self-rated oral health as poor/edentulous (Mother self-rated oral health as excellent coded 0)
RR, relative risk; SES, socioeconomic status.

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.