Clinical, individual and environmental factors related to children’s health-related quality of life following treatment under general anaesthetic for dental caries: a path analysis

R Knapp,Zoe Marshman,Fiona Gilchrist,Mario Vettore,Helen Rodd

doi:10.1007/s40368-022-00695-w

Abstract

ObjectiveTo examine the impact of clinical, individual, and environmental factors on children’s oral health-related quality of life (OHRQoL) and overall health-related quality of life (HRQoL) following dental caries management under general anaesthetic (GA).MethodsParticipants comprised 5- to 16-year-old children who were referred to a British Dental Hospital, for the management of their dental caries under GA. The Caries Impacts and Experiences Questionnaire for Children (CARIES-QC) and the Child Health Utility 9D (CHU9D) were used to assess child-reported OHRQoL and HRQoL, respectively, at baseline and 3-months follow up. A theoretical conceptual model, based on the Wilson and Cleary model of HRQOL, was evaluated using path analysis to explore indirect and direct relationships of the clinical, individual, and environmental variables on the quality of life outcomes following treatment.Results85 children completed the study. Path analyses revealed that 47% of the variance in OHRQoL scores was accounted for by the variables in the model. There were significant relationships between change in OHRQoL score and treatment type [extraction only vs. combination care (β = 1.41, p = 0.07)] and number of extractions (β = 0.46, p < 0.001). A higher number of tooth extractions was associated with poorer OHRQoL and HRQoL following treatment.ConclusionsTreatment type, via number of extractions, may significantly impact on child OHRQoL and HRQoL following treatment under GA. However, to identify any other factors, that might affect these key outcomes, further enquiry is warranted with a bigger sample.

Highlights

Dental caries affect around 573 million worldwide (Kassebaum et al 2017) and, for some young patients, treatment under general anaesthetic (GA) remains a common treatment approach
Oral health-related quality of life (OHRQoL) measures have been increasingly used to evaluate the impact of oral diseases and the effect of dental treatment from a patient perspective
Several studies have investigated the overall impact of dental treatment under GA on children’s OHRQoL, but surprisingly little is known about the modifying effects of other clinical and environmental factors on these outcomes

Summary

Introduction

Dental caries affect around 573 million worldwide (Kassebaum et al 2017) and, for some young patients, treatment under general anaesthetic (GA) remains a common treatment approach. A well-known model, developed by Wilson and Cleary (1995) incorporates individual, environmental, and clinical factors which may potentially impact OHRQoL and has proven an appropriate approach to underpin previous dental intervention studies (Baker et al 2007; Hasmun et al 2020). The broad aim of this study was to determine which key clinical, individual, and environmental factors impact children’s OHRQoL and HRQoL following treatment for dental caries under GA according to the Wilson and Cleary theoretical model. Greater understanding of both direct and indirect effects of these variables has important implications for clinical practice and policy, for example, by identifying modifiable environmental, clinical or individual factors which could improve outcomes

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