Factors affecting oral health and hygiene among adult patients visiting a Saudi Arabian dental school: a cross-sectional study

Technical Summary: Factors Affecting Oral Health and Hygiene Among Adult Patients Visiting a Saudi Arabian Dental School

Problem Statement
Oral health is a critical component of general well-being, yet research specifically addressing the interplay between oral health-related quality of life (OHRQoL) and oral hygiene indicators within the Saudi Arabian population remains limited. While national studies have documented high prevalence rates of dental caries in children and adults, there is a lack of research simultaneously connecting OHRQoL with clinical oral hygiene measures (such as plaque, calculus, and staining) in Saudi adults. This study addresses this gap by assessing the clinical and sociodemographic factors that influence oral health and hygiene among adult patients visiting a dental school in Saudi Arabia.

Methodology
The researchers conducted a cross-sectional analytical study involving 148 adult patients visiting a dental teaching hospital in Makkah, Saudi Arabia, between November 2018 and April 2019. The study adhered to the STROBE checklist for observational studies and received ethical approval from the Institutional Review Board of Umm Al-Qura University.

• Participants: The cohort included adults (mean age 33.6 ± 13.9 years) with a slight female majority (51.4%) and a significant proportion of non-Saudi nationals (59.5%). Individuals with systemic conditions directly affecting oral health (e.g., advanced cancer therapy) were excluded.
• Data Collection: Data were gathered via structured face-to-face interviews and clinical examinations.
  • OHRQoL Assessment: Measured using the Arabic or English versions of the Oral Health Impact Profile-14 (OHIP-14), with scores categorized into low (0–9), moderate (10–19), and high (20–56) impact.
  • Clinical Indicators: Plaque, supra-calculus, sub-calculus, and dental stain were scored. Caries experience was quantified using Decayed, Missing, and Filled Teeth (DMFT) and Surfaces (DMFS) indices, categorized according to WHO/FDI recommendations.
• Statistical Analysis: Descriptive statistics were calculated for demographic and clinical variables. Univariate, multivariate, and multinomial logistic regression models were employed to identify predictors of OHRQoL, oral hygiene, plaque accumulation, and calculus deposits. Analyses were adjusted for age, gender, and income, with statistical significance set at p < 0.05.

Key Contributions and Results

1. Prevalence of Oral Disease: The study population exhibited a high burden of oral disease. Approximately 64.9% of patients had high caries experience, with mean DMFT and DMFS scores of 11.9 ± 10.8 and 12.7 ± 6.8, respectively.
2. Predictors of OHRQoL (OHIP Score):
   • Multivariate analysis identified Saudi nationality (p=0.001), subgingival calculus (p=0.025), and DMFT score (p=0.025) as significant independent predictors of OHRQoL.
   • Specifically, Saudi nationals were significantly less likely to fall into the "low impact" category of OHRQoL compared to non-Saudis (Relative Risk Ratio [RRR] = 0.431), suggesting a higher perceived negative impact on quality of life among nationals.
   • Higher DMFT scores were also associated with a reduced likelihood of being in the low-impact category.
3. Predictors of Oral Hygiene:
   • Plaque (β=0.382; p=0.001) and supra-calculus (β=0.288; p=0.046) were identified as significant predictors of overall oral hygiene scores.
   • Dental stain was a significant predictor of plaque accumulation (β=0.533; p=0.004), indicating a strong association between visible staining and plaque levels.
4. Predictors of Calculus and Stain:
   • Subgingival calculus was a significant predictor of supra-calculus deposits.
   • In the multivariate analysis for tooth stain, plaque emerged as the strongest independent predictor (Odds Ratio = 14.10; p=0.012), outweighing factors like smoking and gender which were significant only in univariate analysis.
5. Socioeconomic Factors and Caries:
   • Income was the only sociodemographic factor significantly associated with DMFS scores in both univariate and multivariate analyses (β=3.963; p=0.047).
   • The authors note a "treatment paradox": higher income was associated with higher DMFS scores, which the study interprets not as worse health, but as better access to dental treatment (restorative care) that increases the "Filled Surfaces" count, thereby inflating the index without necessarily reflecting higher current disease severity.

Significance and Claims
The paper concludes that OHRQoL in this Saudi adult population is significantly influenced by dental caries (DMFT) and oral hygiene factors (specifically subgingival calculus). The study highlights a "triangular pathology" where dental stain influences plaque, which in turn influences oral hygiene status.

The authors claim that their findings underscore the necessity of integrating clinical indicators with patient-reported outcomes (like OHIP-14) for a comprehensive oral health assessment. They suggest that enhanced public health awareness, targeted prevention strategies, and early interventions are required to improve oral health outcomes. Furthermore, the study posits that the observed relationship between income and DMFS reflects disparities in access to preventive and restorative care rather than disease severity alone, advocating for equitable dental access and multi-disciplinary preventive strategies that consider patient-related, disease-related, and quality-of-life parameters.

The authors explicitly acknowledge limitations, noting that the cross-sectional design prevents causal inference and that the setting (a dental teaching hospital) may limit generalizability to the broader public, potentially overrepresenting lower socioeconomic groups due to free services. They call for future longitudinal studies to validate these associations.