Influence of dental caries spectrum on happiness and life satisfaction among adult dental patients – A cross-sectional study

INTRODUCTION

Happiness and life satisfaction are the two terms that are most imperative for the subjective well-being (SWB) of a person.^[1] Happiness is a mental or emotional state of well-being characterized by positive or pleasant emotions ranging from gratification to intense joy. Conversely, life satisfaction is the way a person assesses his or her life and how he or she feels about. Both happiness and life satisfaction have positive outcomes on health and longevity in adults by developing good social relationships and increased productivity.^[2] A growing body of evidence shows that greater SWB has been attributed to reduced mortality in prospective epidemiological cohort studies.^[3,4] In a study by Chida and Steptoe,^[3] associations between SWB and reduced incidence of serious diseases have been reported. People who experience low enjoyment of life and depressive symptoms could expect to live 5 extra years with chronic disease compared with those reporting high affective well-being.^[5] The Global Burden of Disease Study^[6] estimated that oral diseases affect close to 3.5 billion people worldwide, with caries of permanent teeth being the most common condition. Globally, it is estimated that 2.3 billion people suffer from caries of permanent teeth.^[7] It is well proven that stress, depression, and ineffective coping may contribute to the development of periodontal diseases and dental caries, which are the two major and most prevalent oral diseases, constituting the primary reason for tooth mortality.^[7]

According to previous research,^[7,8] good oral health is independently connected with greater SWB. Poor oral functions, such as loss of teeth and other oral conditions, such as burning mouth and loss of taste, cause psychological and social disturbances in the elderly people. It was also seen that social relations are crucial to the environment, which is a significant determinant of SWB in elder adults.^[8]

MATERIALS AND METHODS

A cross-sectional questionnaire survey was conducted to know the influence of dental caries spectrum on happiness and life satisfaction among adult dental patients visiting the outpatient Department of Oral Medicine and Radiology. Ethical clearance was obtained from the Institutional Review Board at Osmania Medical College, Hyderabad, Telangana. Sample size was calculated using previous literature^[9] using formula (n = Z²PQ/d²); therefore, with an expected proportion of 0.50 and with a precision of 5% at a confidence interval of 95%, the sample size of the study was 384. Subjects aged 18 years and above and who gave informed consent were included in this study. Those 18 years and older were considered as they are eligible to give informed consent independently. Subjects who cannot read and understand the English language and are not willing to take an oral examination were excluded from the study.

The demographic data, socioeconomic status (SES) based on updated B.G. Prasad’s scale,^[10] were recorded in a prepared format. A self-administered questionnaire deploying two scales, the Subjective Happiness Scale (SHS) by Lyubomirsky and Lepper^[9] and Satisfaction with Life Scale (SLS) by Diener et al.,^[11] was utilized for the study. SHS is a 4-item questionnaire graded on a 7-point Likert scale (1 is not a very happy person and 7 is a very happy person) with only one item negatively rewarded (Item No.4). The total scores range from 1.0 to 7.0, with higher scores reflecting greater happiness. SLS is a 5-item scale on a 7-point Likert scale (1 is strongly disagree and 7 is strongly agree). The possible ranges of scores were 5–35, with a score of 20 representing a neutral point on the scale. Scores 5–9 indicate that the respondent is extremely dissatisfied with life, whereas scores between 31 and 35 indicate that the respondent is extremely satisfied. Clinical oral examination to determine dental caries was based on the caries assessment spectrum and treatment (CAST) index given by Frencken et al.^[12] The scoring criteria range from 0 to 9. Score 0–2 indicates healthy tooth, 3 – pre morbidity which as distinct visible changes in enamel, score 4–5 is morbidity there is distinct cavitations in dentin, score 6–7 is serious morbidity in which caries extended into the pulp of tooth and formation of abscess or fistula, score 8 indicates mortality – loss of tooth, and score 9 corresponds to any of other description. The data were analyzed using the Statistical Package for the Social Sciences version 25.0 (IBM company Chicago, Illinois, USA). Descriptive statistics were used for sociodemographic details (age, gender, and SES). Chi-square test was used to check the association between sociodemographic variables with subjective happiness and life satisfaction, and regression analysis was used to interpret the effect of subjective happiness, life satisfaction, and sociodemographic variables on the CAST Index. The mean age of the population will be considered a cutoff for comparison based on age.

RESULTS

The mean age of the study population was 35 ± 0.6 years, with 35 years used as the cutoff. Although participants below 35 years were generally happier (59.27%, 3.6 ± 1.1), the difference in happiness compared to those aged above 35 years was not statistically significant. Males (57.1%) reported lower happiness levels than females (42.9%), but this difference was not significant (P = 0.473). In addition, when SES was analyzed, a significantly higher proportion of individuals from the upper middle class (60.6%) reported lower happiness levels compared to other groups (P = 0.000*) [Table 1]. The study results indicated that individuals above 35 years were the most dissatisfied with life (53.6%), whereas those below 35 years reported higher life satisfaction (62.2%). Participants under 35 years had a lower mean score on the SLS (19.4 ± 7.1) compared to older individuals (22.1 ± 7.0), with the difference being statistically significant (P = 0.009). Males (57%) were more dissatisfied than females (43%), although this difference was not statistically significant (P = 0.181). In addition, when comparing SES, the majority of upper middle-class participants (65.8%) reported dissatisfaction, while a significant proportion of upper-class individuals (61.7%) expressed satisfaction, showing a statistically significant difference (P = 0.000*) [Table 2].

Table 3 presents a comparison based on CAST code, categorized by age, gender, and SES. Table 4 shows that dental caries was significantly more prevalent among individuals below 35 years of age (53.5%) compared to those above 35 years (46.5%) (P = 0.034). Regarding SES, the highest percentage of dental caries was observed in the upper middle class (50.5%), followed by the upper class (37.5%), with the lowest prevalence among the lower middle class (0.3%), a difference that was statistically significant (P = 0.000). Furthermore, when assessed using the SHS, individuals with lower happiness scores had a significantly higher prevalence of dental caries (70.4%) compared to those with higher happiness scores (29.6%) (P = 0.000). Similarly, life satisfaction was also linked to dental caries prevalence, with individuals who reported being satisfied with life having a higher occurrence of dental caries (57.1%) compared to those who were dissatisfied (44.4%). Participants with a neutral level of life satisfaction had the lowest prevalence of dental caries (3.9%), a statistically significant finding (P = 0.004). Logistic regression analysis further confirmed significant associations between SES, happiness levels, and life satisfaction with the presence of dental caries. Participants from the middle-income class had significantly higher odds of developing dental caries (OR = 3.510, P = 0.000). Similarly, those with lower happiness levels (OR = 2.7, P = 0.011) and individuals dissatisfied with life (OR = 2.9, P = 0.000) were more likely to experience dental caries. However, no statistically significant associations were identified for age and gender [Table 5].

DISCUSSION

Health, happiness, and life satisfaction are the key factors that influence the SWB of an individual. With oral health being an important component of general health and well-being, its association with happiness and life satisfaction, though has been assessed in a few studies,^[13-16] was carried out separately. Therefore, the present study aimed to assess and correlate oral health status with subjective happiness and life satisfaction among adult dental patients. In this study, the presence of dental caries accounted for significantly less happiness and higher dissatisfaction among the study subjects. A similar finding was demonstrated among Brazilian adolescents, where the number of cavitated carious lesions at baseline influenced happiness after 2 years.^[17] A significant association between life satisfaction and oral health status was also observed among school teachers.^[18] However, Romanian subjects with untreated caries showed no significant association with happiness and life satisfaction in a study by Dumitrescu et al.^[19]

Another astonishing finding of this study was that more than half of the study population was less happy (66.1%). In contrast, a higher percentage of Guyana adults were happy (77.9%), which might be due to sociocultural variations.^[20] A higher percentage of younger age group (<35 years), males (57.1%), and those belonging to the upper middle class were less happy and less satisfied with life. Females, on the other hand, might have been able to juggle a better balance between the multiple demands of life and also have not been regarded as the primary caretaker of the family in Indian culture; therefore are more happier and satisfied than males. SES has been a significant independent factor for life happiness among South African adults^[16] and adolescents of Luthiana,^[21] and hence was considered in this study. Education, employment, and income were shown to be the most influential variables on life satisfaction in a study among the Chinese population,^[22] Russian and Ukrainian adults,^[23] and among Western Iranian society.^[24] However, in the Indian scenario, education might not determine the employment and income of an individual; therefore, only income using Prasad’s scale was assessed.

Based on the caries severity according to CAST, the majority of the younger adults were having caries in the pre-morbidity and morbidity stage, which might be due to their poor oral hygiene maintenance, abnormal dietary and behavioral patterns, and lack of knowledge or negative attitude toward oral health. M ortality condition of a tooth was seen among elderly subjects, which indicates negligence of subjects in the early stages leading to the extraction of teeth. Further, a higher percentage of male subjects had healthy teeth, and a higher percentage of female teeth were in premorbid, morbid, and mortal conditions. Nonetheless, the CAST status based on age and gender did not reveal any significant difference. The overall caries prevalence as derived from CAST scoring was very high among the study subjects (86.2%). Young adults, males, and subjects from high SES had higher caries prevalence in comparison to their counterparts. Nonetheless significant association was not seen with gender. As subjects of high SES were constituted for most of the study population, this might be one of the reasons for the higher prevalence of caries. However, low caries prevalence with no significant association with age, gender, and SES was seen among adults of Delhi in a study by Mehta.^[25] This difference might be due to differences in study sample composition and the use of a different scale for assessing SES.

Sample size calculation, recording by pre-trained and pre-calibrated examiners, usage of standardized questionnaires with good psychometric properties and internal consistency, utilization of a comparable caries index, and measuring SES attributes to the strengths of the study. CAST index^[12] was used to assess caries status as it covers the overall caries progression stages from enamel to pulp with information on the consequences of untreated caries. The SES is a vital factor that influences individuals and family health and is also one of the important tools that assesses the accessibility, affordability, and utilization of resources. In the present study, SES was assessed using the updated Prasad BG scale,^[10] as it is applicable for both rural and urban populations. Oral health behavior (frequency of toothbrushing, dental visits, etc.,) and other demographic variables (level of education, etc.,) were not included in the study, owing to the aim of the study and therefore can contribute to the limitations of this study. Likewise, other confounding variables (economic conditions, interpersonal relationships, etc.,) which determine happiness and life satisfaction were not considered due to logistic reasons. Future research should confidently utilize longitudinal methods, incorporate behavioral and psychological factors, and prioritize population-based sampling to enhance external validity. In addition, employing diverse and representative samples, considering socioeconomic and environmental influences, and utilizing advanced analytical techniques can provide deeper insights.

CONCLUSION

In this study, over half of the participants reported lower levels of happiness. Younger individuals, males, and those from the upper middle class were more likely to experience reduced happiness and life satisfaction. An association with dental caries was observed, with the presence of carious lesions significantly linked to lower happiness and greater dissatisfaction. In addition, individuals from the upper middle and middle classes had higher odds of experiencing dental caries compared to other socioeconomic groups.