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BMC Oral Health
Published in: BMC Oral Health 1/2021

01-12-2021 | Mood Disorders | Research article

The relationship between psychosocial distress and oral health status in patients with facial burns and mediation by oral health behaviour

Authors: Farooq Ahmad Chaudhary, Basaruddin Ahmad

Published in: BMC Oral Health | Issue 1/2021

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Abstract

Background

There is limited discussion on the influence of psychosocial factors on the oral health of patients with a facial burn injury. This report investigated the relationship between oral health and psychosocial distress in patients with facial burns and the role of oral health behaviour in mediating the relationship.

Methods

The data were part of a cross-sectional study that had systematically and randomly selected patients with > 10% total burn surface area from a burn centre in Pakistan. The oral health status (DMFT, CPI, OHI-S) and severity of facial disfigurement were assessed. Validated instruments in the Urdu language were self-administered and information relating to oral health behaviour (brushing and dental visits), oral health-related quality of life (OHIP-14), satisfaction with appearance, self-esteem, anxiety and depression, resilience, and social support were collected. The statistical analyses included simple linear regression, Pearson correlation, t-test, and ANOVA. Mediation analysis was carried out to examine the indirect effect by oral health behaviour.

Results

From a total of 271 participants, the majority had moderate to severe facial disfigurement (89%), low self-esteem (74.5%), and moderate to high levels of social support (95%). The level of satisfaction with appearance was low, whereas anxiety and depression were high. Disfigurement and satisfaction with appearance were associated with lower self-esteem and social support (p < 0.05). Greater severity of disfigurement, higher levels of anxiety and dissatisfaction with appearance, and lower levels of self-esteem and social support were associated with greater DMFT and OHIP-14 scores, worse periodontal and oral hygiene conditions, and less frequent tooth brushing and dental visits (p < 0.05). The main barriers to oral healthcare utilization were psychological and social issues (p < 0.05). The indirect effect by oral health behaviour was not significant for anxiety but was significant for disfigurement, satisfaction with appearance, self-esteem, and social support.

Conclusion

There is an association between the psychosocial factors and oral health of patients with facial burns through a direct effect and mediation by oral health behaviour.
Literature
1.
2.
Kelter BM, Holavanahalli R, Suman OE, Ryan CM, Schneider JC. Recognizing the long-term sequelae of burns as a chronic medical condition. Burns. 2020;46(2):493–6.PubMedCrossRef
3.
Wang Y, Beekman J, Hew J, Jackson S, Issler-Fisher AC, Parungao R, Lajevardi SS, Li Z, Maitz PK. Burn injury: challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev. 2018;123:3–17.CrossRefPubMed
4.
Van Loey NE, Maas CJ, Faber AW, Taal LA. Predictors of chronic posttraumatic stress symptoms following burn injury: results of a longitudinal study. J Trauma Stress. 2003;16(4):361–9.PubMedCrossRef
5.
Lawrence JW, Heinberg LJ, Roca R, Munster A, Spence R, Fauerbach JA. Development and validation of the satisfaction with appearance scale: Assessing body image among burn-injured patients. Psychol Assess. 1998;10(1):64.CrossRef
6.
Elsherbiny OEE, Salem MA, El-Sabbagh AH, Elhadidy MR, Eldeen SMA. Quality of life of adult patients with severe burns. Burns. 2011;37(5):776–89.PubMedCrossRef
7.
Clayton NA, Ward EC, Maitz PKM. Orofacial contracture management outcomes following partial thickness facial burns. Burns. 2015;41(6):1291–7.PubMedCrossRef
8.
Clayton NA, Ledgard JP, Haertsch PA, Kennedy PJ, Maitz PK. Rehabilitation of speech and swallowing after burns reconstructive surgery of the lips and nose. J Burn Care Res. 2009;30(6):1039–45.PubMed
9.
Miettinen O, Lahti S, Sipilä K. Psychosocial aspects of temporomandibular disorders and oral health-related quality-of-life. Acta Odontol Scand. 2012;70(4):331–6.PubMedPubMedCentralCrossRef
10.
Hoogewerf CJ, van Baar ME, Middelkoop E, van Loey NE. Impact of facial burns: relationship between depressive symptoms, self-esteem and scar severity. Gen Hosp Psychiatry. 2014;36(3):271–6.PubMedCrossRef
11.
Anttila S, Knuuttila M, Ylöstalo P, Joukamaa M. Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need. Eur J Oral Sci. 2006;114(2):109–14.PubMedCrossRef
12.
Chaudhary FA, Ahmad B, Bashir U. Dental health status and oral health behaviours of patients with facial burn in Pakistan. BMC Oral Health. 2019;19(1):127.PubMedPubMedCentralCrossRef
13.
Katz MR, Irish JC, Devins GM, Rodin GM, Gullane PJ. Reliability and validity of an observer-rated disfigurement scale for head and neck cancer patients. Head Neck. 2000;22(2):132–41.PubMedCrossRef
14.
WHO. Oral health surveys: basic methods. 5th ed. Geneva: World Health Organization; 2013.
15.
16.
Furuta M, Ekuni D, Irie K, Azuma T, Tomofuji T, Ogura T, Morita M. Sex differences in gingivitis relate to interaction of oral health behaviors in young people. J Periodontol. 2011;82(4):558–65.PubMedCrossRef
17.
Patton LL, Strauss RP, McKaig RG, Porter DR, Eron JJ Jr. Perceived oral health status, unmet needs, and barriers to dental care among HIV/AIDS patients in a North Carolina cohort: impacts of race. J Public Health Dent. 2003;63(2):86–91.PubMedCrossRef
18.
Slade GD. Derivation and validation of a short-form oral health impact profile. Commun Dent Oral Epidemiol. 1997;25(4):284–90.CrossRef
19.
Javed O, Bernabé E. Oral Impacts on quality of life in adult patients with Class I, II and III malocclusion. Oral Health Prev Dent. 2016;14(1):27–32.PubMed
20.
Chaudhary FA, Ahmad B, Butt DQ, Hameed S, Bashir U. The cultural adaptation and validation of an Urdu version of the satisfaction with appearance scale (SWAP-U) for Pakistani burn patients. Burns Open. 2019;3(3):83–8.CrossRef
21.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.CrossRefPubMed
22.
Mumford D, Tareen I, Bajwa M, Bhatti M, Karim R. The translation and evaluation of an Urdu version of the hospital anxiety and depression scale. Acta Psychiatr Scand. 1991;83(2):81–5.PubMedCrossRef
23.
Zafar N, Saleem S, Mahmood Z. The Development of a Self-Esteem Scale for University Students. FWU Journal of Social Sciences. 2012;6(1):26B.
24.
Farid M, Akhar M. Self esteem of secondary schools students in Pakistan. Middle-East J Sci Res. 2013;14(10):1325–30.
25.
Akhtar A, Rahman A, Husain M, Chaudhry IB, Duddu V, Husain N. Multidimensional scale of perceived social support: psychometric properties in a South Asian population. J Obstet Gynaecol Res. 2010;36(4):845–51.PubMedCrossRef
26.
Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988;52(1):30–41.CrossRef
27.
Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: assessing the ability to bounce back. Int J Behav Med. 2008;15(3):194–200.PubMedCrossRef
28.
Mahmood K, Ghaffar A. The relationship between resilience, psychological distress and subjective well-being among dengue fever survivors. Glob J Hum-Soc Sci Res. 2014;14:13–20.
29.
Hayes AF. Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Publications; 2017.
30.
Warren KR, Postolache TT, Groer ME, Pinjari O, Kelly DL, Reynolds MA. Role of chronic stress and depression in periodontal diseases. Periodontol 2000. 2014;64(1):127–38.PubMedCrossRef
31.
Kisely S, Sawyer E, Siskind D, Lalloo R. The oral health of people with anxiety and depressive disorders – a systematic review and meta-analysis. J Affect Disord. 2016;200:119–32.PubMedCrossRef
32.
Zimmermann H, Zimmermann N, Hagenfeld D, Veile A, Kim T-S, Becher H. Is frequency of tooth brushing a risk factor for periodontitis? A systematic review and meta-analysis. Commun Dent Oral Epidemiol. 2015;43(2):116–27.CrossRef
33.
Worsley DJ, Marshman Z. Few studies addressing toothbrushing frequency and periodontitis. Evid Based Dent. 2015;16(1):15–15.PubMedCrossRef
34.
Peres MA, Nascimento GG, Peres KG, Demarco FF, Menezes AB. Oral health-related behaviours do not mediate the effect of maternal education on adolescents’ gingival bleeding: A birth cohort study. Commun Dent Oral Epidemiol. 2018;46(2):169–77.CrossRef
35.
36.
Mannan A, Ghani S, Clarke A, White P, Salmanta S, Butler P. Psychosocial outcomes derived from an acid burned population in Bangladesh, and comparison with Western norms. Burns. 2006;32(2):235–41.PubMedCrossRef
37.
Robert R, Meyer W, Bishop S, Rosenberg L, Murphy L, Blakeney P. Disfiguring burn scars and adolescent self-esteem. Burns. 1999;25(7):581–5.PubMedCrossRef
38.
Griffiths C, Guest E, White P, Gaskin E, Rumsey N, Pleat J, Harcourt D. A systematic review of patient-reported outcome measures used in adult burn research. J Burn Care Res. 2017;38(2):e521–45.PubMedCrossRef
39.
Levine E, Degutis L, Pruzinsky T, Shin J, Persing JA. Quality of life and facial trauma: psychological and body image effects. Ann Plast Surg. 2005;54(5):502–10.PubMedCrossRef
40.
Weiss MG, Ramakrishna J, Somma D. Health-related stigma: rethinking concepts and interventions. Psychol Health Med. 2006;11(3):277–87.PubMedCrossRef
41.
Waqas A, Naveed S, Bhuiyan MM, Usman J, Inam-ul-Haq A, Cheema SS. Social support and resilience among patients with burn injury in Lahore, Pakistan. Cureus. 2016;8(11).PubMedPubMedCentral
42.
Gomes AC, Rebelo MAB, de Queiroz AC, de Queiroz Herkrath APC, Herkrath FJ, Rebelo Vieira JM, Pereira JV, Vettore MV. Socioeconomic status, social support, oral health beliefs, psychosocial factors, health behaviours and health-related quality of life in adolescents. Qual Life Res. 2020;29(1):141–51.PubMedCrossRef
43.
Tsakos G, Sabbah W, Chandola T, Newton T, Kawachi I, Aida J, Sheiham A, Marmot MG, Watt RG. Social relationships and oral health among adults aged 60 years or older. Psychosom Med. 2013;75(2):178–86.PubMedCrossRef
44.
Block J, Kremen AM. IQ and ego-resiliency: conceptual and empirical connections and separateness. J Pers Soc Psychol. 1996;70(2):349.PubMedCrossRef
45.
Bonanno GA, Mancini AD. The Human Capacity to Thrive in the Face of Potential Trauma. Pediatrics. 2008;121(2):369–75.PubMedCrossRef
46.
Abbas J, Aqeel M, Abbas J, Shaher B, Jaffer A, Sundas J, Zhang W. The moderating role of social support for marital adjustment, depression, anxiety, and stress: Evidence from Pakistani working and nonworking women. J Affect Disord. 2019;244:231–8.PubMedCrossRef
47.
Sohn W, Ismail AI. Regular dental visits and dental anxiety in an adult dentate population. J Am Dent Assoc. 2005;136(1):58–66.PubMedCrossRef
48.
Schuller AA, Willumsen T, Holst D. Are there differences in oral health and oral health behavior between individuals with high and low dental fear? Commun Dent Oral Epidemiol. 2003;31(2):116–21.CrossRef
49.
Jagnoor J, Bekker S, Chamania S, Potokar T, Ivers R. Identifying priority policy issues and health system research questions associated with recovery outcomes for burns survivors in India: a qualitative inquiry. BMJ Open. 2018;8(3):e020045.PubMedPubMedCentralCrossRef
50.
Madianos MG, Papaghelis M, Ioannovich J, Dafni R. Psychiatric disorders in burn patients: a follow-up study. Psychother Psychosom. 2001;70(1):30–7.PubMedCrossRef
51.
Low JA, Dyster-Aas J, Willebrand M, Kildal M, Gerdin B, Ekselius L. Chronic nightmares after severe burns: risk factors and implications for treatment. J Burn Care Rehabil. 2003;24(4):260–7.PubMedCrossRef
52.
Lawrence JW, Fauerbach JA, Heinberg L, Doctor M. The 2003 clinical research award: visible vs hidden scars and their relation to body esteem. J Burn Care Rehabil. 2004;25(1):25–32.PubMedCrossRef
53.
Cademartori MG, Gastal MT, Nascimento GG, Demarco FF, Corrêa MB. Is depression associated with oral health outcomes in adults and elders? A systematic review and meta-analysis. Clin Oral Invest. 2018;22(8):2685–702.CrossRef
54.
Peeters F, Vissink A. Risks for oral health with the use of antidepressants. Gen Hosp Psychiatry. 1998;20(3):150–4.PubMedCrossRef
55.
Christensen L, Somers S. Comparison of nutrient intake among depressed and nondepressed individuals. Int J Eat Disord. 1996;20(1):105–9.PubMedCrossRef
56.
Sisko Anttila S, Knuuttila MLE, Sakki TK. Relationship of depressive symptoms to edentulousness, dental health, and dental health behavior. Acta Odontol Scand. 2001;59(6):406–12.CrossRef
57.
Tikhonova S, Booij L, D’Souza V, Crosara KTB, Siqueira WL, Emami E. Investigating the association between stress, saliva and dental caries: a scoping review. BMC Oral Health. 2018;18(1):41.PubMedPubMedCentralCrossRef
58.
Rosania AE, Low KG, McCormick CM, Rosania DA. Stress, Depression, Cortisol, and Periodontal Disease. J Periodontol. 2009;80(2):260–6.PubMedCrossRef
59.
Bennett KS, Shepherd JM. Depression in Australian women: The varied roles of spirituality and social support. J Health Psychol. 2013;18(3):429–38.PubMedCrossRef
60.
Baillie SE, Sellwood W, Wisely JA. Post-traumatic growth in adults following a burn. Burns. 2014;40(6):1089–96.PubMedCrossRef
61.
Robinson E, Ramsey N, Partridge J. An evaluation of the impact of social interaction skills training for facially disfigured people. Br J Plast Surg. 1996;49(5):281–9.PubMedCrossRef
62.
Newell R, Marks I. Phobic nature of social difficulty in facially disfigured people. Br J Psychiatry. 2000;176(2):177–81.PubMedCrossRef
63.
Partridge J. Survival, socialisation, and advocacy. J Burn Care Rehabil. 2005;26:S32.
Metadata
Title
The relationship between psychosocial distress and oral health status in patients with facial burns and mediation by oral health behaviour
Authors
Farooq Ahmad Chaudhary
Basaruddin Ahmad
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2021
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-021-01532-0

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