Relationship between non-carious cervical lesions and dentine hypersensitivity and their impacts on oral health-related quality of life among adult patients attending Muhimbili dental clinics in Dar es salaam, Tanzania

Abstract

ABSTRACT Background: Oral health related quality of life in dentistry focuses on how individuals perceive the impact of their oral health on their overall well being, assessing whether their current oral health status affects their quality of life. NCCLs describe tooth wear at the cementoenamel junction (CEJ) unrelated to caries or bacteria. The prevalence and severity of cervical tooth wear increase with age due to factors like bio corrosion (erosion), friction (abrasion), and occlusal stress (abfraction). Erosion refers to the role of acids in tooth wear. NCCLs can appear as smooth saucer like depressions or V shaped notches, contributing to tooth hypersensitivity, increased caries incidence, compromised structural stability, and impacted plaque retention. DH is a prevalent condition causing temporary tooth pain triggered by various external factors. It can disrupt daily activities such as eating, drinking, tooth brushing, and even breathing. DH causes discomfort and inconvenience, impacting a person's ability to enjoy meals, maintain oral hygiene, and function during routine activities. The patient's quality of life may be significantly affected by these limitations. Recognizing the impact of DH is crucial for dental practitioners to provide appropriate management and improve the overall well being of affected individuals Objective: The aim of the study was to determine the relationship between non carious cervical lesions and dentine hypersensitivity and their impacts on oral health related quality of life among adult patients attending Muhimbili dental clinics in Dar es Salaam. Methods: This was a hospital based analytical cross sectional study among 384 adult patients aged 18 years and above who attended the MUHAS and MNH OPD dental clinics in Dar es Salaam from April to June 2024. A consecutive sampling technique was used. All patients awaiting dental treatment on a daily basis, totalling 325 participants aged 18 years and above who consented and met the inclusion criteria, were recruited into the study. Data on sociodemographic, economic characteristics and oral health related quality of life were assessed using Oral Impact on Daily Performance (OIDP) were recorded using a structured questionnaire. Oral examinations were performed, and NCCLs was scored according to the Smith and Knight index (1984). The presence and severity of DH were determined using the tactile stimulus response according to the Schiff ordinal scale (1994). The combination of these clinical variables resulted in categories of the independent variable: without DH or NCCL, NCCL without DH, DH without NCCL, and both DH with NCCL. The covariables were socio--demographic, education level and economic factors. Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 26.0. Mean and standard deviation of variables were calculated. Association between dependent and independent variables were assessed through cross--tabulations and Chi--square tests. Modified poison regression analysis was used to evaluate variables related to OIDP. A Chi--square test was computed to determine statistically significant associations, with the threshold of significance set at a p<0.05. Odd ratios were calculated to indicate a statistically significant relationship between variables. A p--value of p<0.05 was set as a level of significance. Results: A total of 325 (response rate of 91.3%) patients with age ranging from 18 to 77 years participated in the study with a mean age of 45±7 years. Majority of the participants were female 67.1% and majority (39.5%) being in the age group 36 – 55 years with most of the participants having no steady income (56.3%) and secondary level of education and above of (81.8%, n=266). The prevalence of NCCLs and DH were 45.8% and 36.5% respectively, NCCLs are more prevalent in males compared to females, while DH is more commonly observed in females. The occurrence of DH was predominantly moderate, with 15.1% reporting discomfort or pain. Most participants with dentin hypersensitivity (DH) experienced mild to moderate pain (78.4%), while nearly half of those with non-carious cervical lesions (NCCLs) had mild pain (45.1%). Severe pain was less common, affecting only 21.6% of DH participants and 15.2% of NCCL participants. A strong association was found between NCCLs and DH, with 88.8% of individuals with NCCLs also experiencing DH (p = 0.000). Conversely, 92.0% of individuals without NCCLs did not report DH. Of 277 adults, 85.2% had oral health impact and the most affected performance was eating and chewing food (76.0%), followed by difficult cleaning (43.1%, n =140). Higher frequency of OIDP was observed in adults with DH and NCCLs. Modified Poisson regression analysis indicated that OIDP was significantly associated with DH alone. The analysis showed that those with DH had higher ODDs of reporting at least one oral impact (aOR=2.83; 95% CI 1.04-1.25, p=0.005) Conclusion: NCCLs and DH are prevalent conditions among adults, with DH having a notably higher impact on oral health. Irrespective of NCCL presence, DH significantly impacts the physical pain dimension of OHRQoL.