IMPACT OF DENTAL CARIES AND ITS TREATMENT ON THE QUALITY OF LIFE OF ADOLESCENTS IN BENIN, NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Adolescents are acknowledged as a crucial component of the worldwide public health landscape. An approach linked to the quality of life can enhance comprehension and awareness of adolescents' health, as well as facilitate the development of policies that foster their overall health and well-being (Xavier et al., 2021). The discourse surrounding the connection between health and quality of life illustrates that this is a societal construct rooted in subjective criteria, such as well-being, happiness, and goals tailored to the specific requirements of a certain population (Sanchez, 2020). 

Dental health-related quality of life refers to the extent to which dental problems impact an individual's daily life (Chen et al., 2019). Oral health is a complex concept that encompasses various aspects of health and is now widely acknowledged as a crucial component of overall well-being. It plays a significant role in understanding patients' subjective evaluations and experiences with oral healthcare, as well as in determining their needs assessment (Singh et al., 2021). The societal impact of oral health disorders is characterised by the consequences associated with the restrictions on functional skills and the fulfilment of expected tasks. Oral health issues, such as dental caries, have been linked to increased absenteeism and reduced academic performance in children and adolescents (Matthew et al., 2020).

Dental caries is a prominent worldwide public health issue and is one of the most common dental health problems experienced by children and adolescents (Singh et al., 2021). According to Xian et al. (2017), the worldwide occurrence of tooth decay in permanent teeth is 34.1% among teenagers aged 12-19 years. Adolescents are especially susceptible to dental caries due to various causes, including inadequate compliance with preventive measures such as frequent dental check-ups and proper oral hygiene practices (Sebastian, 2019). The effectiveness of dental caries preventative methods is hindered by insufficient awareness, social and cultural effects, and restricted availability of oral healthcare services (Singh et al., 2021). 

Basil (2020) contends that gender dynamics significantly influence the oral health behaviours of teenagers, with females exhibiting a greater tendency towards favourable preventive oral health practices and physical attractiveness compared to their male counterparts. The disparity in gender may arise from societal norms that prioritise girls' personal cleanliness and beauty (Hammond et al., 2020). In contrast, boys may prioritise alternative aspects of physical health above oral hygiene, leading to a reduced adoption of oral preventative practices (Singh et al., 2021). 

The incidence of dental caries in permanent teeth reaches its highest point during adolescence, a period of life that is socially and psychologically susceptible, and carries the potential for long-lasting consequences (Singh et al., 2021). Adolescents who have poor oral health may have pain, tooth loss, decreased oral functioning, deformity, missing school days, and increased risk of death from oral cancer. Consequently, their quality of life might be negatively impacted and they may have lower life outcomes (Marshal, 2019). In Nigeria, a substantial proportion of teenagers aged 15 and above, ranging from 15% to 58%, are diagnosed with periodontal diseases. These conditions have a notable impact on their quality of life (Adedigun & Emeka, 2022). According to statistics, dental caries is more prevalent among adolescents in Nigeria, with a frequency as high as 80%, compared to roughly 35% in the UK (Abayomi et al., 2022). 

Dental caries, also referred to as tooth decay, is a highly widespread chronic ailment that impacts teenagers on a global scale. It presents substantial health obstacles, affecting both the physical health of persons and their mental and social well-being (Abayomi et al., 2022). Benin, the capital city of Edo State, Nigeria, harbours a substantial population of adolescents who are in a crucial phase of their growth and maturation. Dental caries continues to be a prominent public health issue in this area, frequently worsened by restricted availability of dental care services and inadequate public health knowledge (Sanusi, 2023). Examining the impact of dental caries and its treatment on the quality of life of teenagers can offer significant knowledge for creating specific health interventions. Therefore, the necessity for doing this investigation arises.

1.2 Statement of the problem

Despite the progress made in dental treatment, a significant number of adolescents in Benin continue to experience untreated dental caries, leading to adverse impacts on their everyday activities. The consequences encompass physical pain, discomfort, challenges in consuming food, and diminished self-confidence, all of which might subsequently affect their scholastic achievements and social engagements. It is essential to determine the magnitude of these effects and evaluate the efficacy of existing interventions in order to enhance the health outcomes of adolescents.

A viable approach entails including oral health within the current community health response programme. Nigeria has made significant investments in community health workers to enhance health education and promote preventive measures (Bode et al., 2019). Advocacy is essential for integrating oral health education into these activities, with a focus on emphasising the significance of brushing teeth twice a day for excellent oral hygiene (Amadi et al., 2021).  This method seeks to decrease the intake of processed carbohydrates in between meals and promote the prompt utilisation of dental services for preventative dental care.  Presently, the primary motivation for seeking dental services is predominantly for curative reasons, whereas adolescents demonstrate a lack of understanding of the advantages of preventative treatment (Mba, 2021). Obstacles to the utilisation of healthcare services in Nigeria encompass inadequate accessibility, high costs, and a cultural aversion to preventive treatment (Chima, 2019).  An all-encompassing, diverse approach is necessary to reduce the occurrence of tooth decay in a nation with a deficient and unresponsive oral healthcare system that lacks emphasis on preventive measures.

Moreover, research indicates that adolescents have low utilisation of dental treatments (Julius et al., 2023). Presently, individuals mostly seek dental services for the aim of treating existing issues, and teenagers have a limited understanding of the advantages of preventative treatment (Mba, 2021).  Obstacles to the utilisation of healthcare services in Nigeria encompass limited accessibility, high costs, and cultural resistance towards preventive treatment (Ekpenyong et al., 2023). An all-encompassing, diverse approach is crucial to reduce the prevalence of caries in Nigeria, where the oral health system is inadequate, leading to insufficient preventive care, and the oral health behaviours of teenagers contribute to a high risk of caries.

In light of the escalating poverty rates in Nigeria, it is conceivable that the general population would choose to use toothpaste without fluoride. This might potentially lead to a higher incidence of dental decay, especially among individuals who only brush their teeth once a day (Silas & Iniubong, 2023). The dentistry community should initiate targeted initiatives to promote and advocate for the practice of brushing teeth twice a day using toothpaste containing fluoride. Therefore, the necessity for doing this investigation arises.

Objectives of the study

The primary objective of this study is to critically analyse the impact of dental caries and its treatment on the quality of life of adolescents in Benin, Nigeria. Specific objectives of this study are to:

To assess the prevalence of dental caries among adolescents in Benin, Nigeria.

To explore the factors associated with dental caries among adolescents in Benin, Nigeria.

To investigate the impact of untreated dental caries on the oral health-related quality of life of adolescents in Benin, Nigeria

To identify barriers to accessing dental care and treatment among adolescents in Benin, Nigeria.

To propose recommendations for improving dental health education and oral health promotion among adolescents in Benin, Nigeria

1.4 Research Questions

The following research questions will be answered in this study:

What is level of prevalence of dental caries among adolescents in Benin, Nigeria?

What are the factors associated with dental caries among adolescents in Benin, Nigeria?

What is the impact of untreated dental caries on the oral health-related quality of life of adolescents in Benin, Nigeria?

What are the barriers to accessing dental care and treatment among adolescents in Benin, Nigeria?

What are the recommendations for improving dental health education and oral health promotion among adolescents in Benin, Nigeria?

1.5 Research Hypotheses

The following research hypotheses are formulated to guide the study:

Ho: There is no significant impact of untreated dental caries on the quality of life of adolescents in Benin, Nigeria.

Ha: There is significant impact of untreated dental caries on the quality of life of adolescents in Benin, Nigeria.

1.6 Significance of the study

This study is important since it focuses on the prevalent problem of dental caries among adolescents, emphasising its influence on their quality of life. The project seeks to enhance public health policies and dental care practices in Benin and similar contexts by comprehending the specific obstacles and assessing the efficacy of existing treatments. This will ultimately lead to improved health outcomes for adolescents.

Moreover, the study's findings can provide policymakers with valuable guidance in creating focused oral health programmes and policies that give priority to the oral health of adolescents. This encompasses enhancing the availability of dental care services and incorporating oral health into wider healthcare programmes. 

Furthermore, the study can enhance community involvement in oral health promotion initiatives by increasing awareness about the significance of oral health among adolescents and their carers. This can promote a nurturing atmosphere for long-term enhancements in oral health. The findings obtained from this study can provide valuable information for developing targeted preventive measures for adolescents in Benin. Encouraging good oral hygiene habits and scheduling frequent dental examinations can effectively prevent dental caries and the negative consequences it has on one's quality of life.

In addition, improving the comprehension, convictions, and actions concerning oral health in secondary school pupils can lead to long-lasting health benefits. Optimal oral hygiene is linked to overall well-being, including improved nutrition, clear communication, and greater social interaction. Timely intervention in oral health issues might mitigate the economic burden associated with the management of intricate dental disorders.

Finally, this research enhances the existing knowledge on oral hygiene habits among adolescents, specifically within the Nigerian setting. This research can provide a basis for future investigations into many elements of oral health education and behaviour among different age groups and populations.

1.7 Scope of the study

Broadly, this study focus is to critically analyse the impact of dental caries and its treatment on the quality of life of adolescents in Nigeria. Specifically, this study seeks assess the prevalence of dental caries among adolescents in Nigeria, explore the factors associated with dental caries among adolescents in Nigeria, investigate the impact of untreated dental caries on the oral health-related quality of life of adolescents in Nigeria, identify the barriers to accessing dental care and treatment among adolescents in Nigeria and it also offer recommendations for improving dental health education and oral health promotion among adolescents in Nigeria.

The study is carried out in Benin, Edo state. The respondents of this study are adolescents within the age of 12 to 15 years old.

1.8 Limitations of the study

As with any human endeavor, the researchers faced many minor constraints during the investigation. The main limitation was the lack of extensive literature on the subject, due to the limited availability of data regarding impact of dental caries and its treatment on the quality of life of adolescents in Benin, Nigeria. Hence, a significant allocation of time and exertion was necessary to ascertain the appropriate materials, books, or information and amass data. 

Furthermore, this study is constrained by its small sample size and narrow geographical scope, focusing solely on Benin, Edo state. Therefore, the conclusions of this study cannot be extended to other situations, thus requiring further investigation. 

Moreover, the researcher's restrictions were mostly due to financial constraints, as they are a student without any source of income to sustain themselves. The exorbitant transportation costs at the research location, exacerbated by the prevailing inflation in Nigeria, posed a significant challenge in meeting the expenses associated with transportation.

Furthermore, the researcher faced a time constraint due to the need to do this research while still fulfilling the obligations of attending lectures and participating in other educational activities.

1.9 Definition of terms

Oral disease: Oral diseases encompass a range of diseases and conditions that include dental caries, periodontal (gum) disease, tooth loss, oral cancer, oro-dental trauma, noma and birth defects such as cleft lip and palate.

Oral health: Oral health is the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompasses psychosocial dimensions such as self-confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment.

Dental caries: Dental caries, or dental decay, is an infectious condition that deteriorates the structure of teeth. The most common result of dental caries is a cavity—a hole or space in the teeth. Without proper treatment, dental caries can cause pain, tooth loss—and in rare cases when the infection spreads to the brain—even death.