Relationship between the perception of oral health and the quality of life of hospital staff

Introduction

Oral health is an essential component of overall well-being, as it directly impacts oral health-related quality of life (OHRQoL) through the ability to perform basic functions such as communicating, eating well, and maintaining satisfactory social relationships.¹ Oral diseases not only affect oral functions but also psychological, social, and economic outcomes, causing discomfort, pain, and loss of self-esteem, and impacting the subjective perception of oral well-being.^2,3 The impact of oral health on OHRQoL underlines its direct contribution to achieving Sustainable Development Goal 3, which aims to ensure that all people achieve good health, with oral health being a fundamental component.

In this context, oral health is considered one of the basic global priorities for international organizations such as the International Dental Federation (FDI) and the World Health Organization (WHO), since its impact on the global quality of life linked to the area of oral health is undoubtedly significant. The World Health Organization conceptualizes oral health as a comprehensive condition that encompasses the physical, mental and social well-being of the individual, in relation to the functionality and state of the oral cavity, and not simply the absence of diseases or ailments in this area (WHO, 2022) and the FDI (2021) introduces an integrative perspective that relates oral well-being with sustainable public health policies.^4,5

Oral diseases constitute a global public health problem affecting approximately 3.5 billion people worldwide, with a higher prevalence in developing and middle-income countries, where around 75% of cases are concentrated.⁴ Untreated cases of caries are the most prevalent condition, reflecting deep inequalities in access to preventive services and basic treatments.^6,7 In Latin America, periodontal diseases represent an epidemic that significantly impairs oral health-related quality of life (OHRQoL). In countries such as Peru, the magnitude of the problem is exacerbated by the low priority given to oral health within health agendas, evidenced by low public investment and high oral cancer rates: 2.60 per 100,000 women and 1.97 in men between 2000 and 2017.⁸ This scenario is associated with limited resource allocation, the absence of effective preventive strategies, and the lack of early detection programs.⁹ Faced with this challenge, the WHO and other international organizations have promoted a series of initiatives. Hence the definitive IED Vision 2030 Report and the Resolution (2021) on oral health, which emphasize that oral health should be part of Universal Health Coverage (UHC) systems and in line with the global agenda to combat non-communicable diseases (NCDs).

According to the 2022 World Oral Health Report,⁴ it is essential to reorient public health policies to give a central role to the promotion and production of scientific knowledge in oral health, through national plans supported by the vision and international strategies proposed by the WHO in the aforementioned report.⁹ The support and collaboration of institutions such as UNESCO or UNDP are essential to include oral health factors within well-being and sustainable human development policies.^10,11 The oral health of healthcare personnel can be measured through oral health perception (OHP), having found that the practice of OHP can also influence not only oral well-being, but can also condition the quality of life based on oral health (OHRQoL), as well as the quality of oral health. Similarly, OHP can be conditioned by other contextual factors such as the significant limitation of accessibility to dental services or the workload.^12–14 Negative OHP will affect self-esteem and interpersonal relationships, and will justify its assessment through OHRQoL in the health of healthcare personnel.^8,15

The purpose of this study is to examine the potential relationship between quality of life and oral health-related aspects (OHRQoL) and the perception of oral well-being in the staff of a type II-1 hospital in northern Peru, taking into account their dimensions and interactions. This research provides relevant evidence for designing strategies that promote the oral well-being of healthcare staff and, consequently, guarantee comprehensive, patient-centered care based on quality criteria.^16,17

Methods

Results

Table 1 It is observed that 38.90% of staff with excellent QoL reported a low OHP of 52.80%, while the 34.70% with poor QoL presented a more balanced distribution across OHP categories. Likewise, a low (r = 0.391), but significant (p = 0.001), positive correlation was evident between QoL and OHP. Likewise, ordinal logistic regression analysis, with a Nagelkerke pseudo R-squared of 0.198 (p = 0.001), confirmed a significant influence of QoL on OHP, accounting for 19.80%. To ensure inferential accuracy, confidence intervals (CI) and Nagelkerke pseudo R-squared values were included in all regression tests, as detailed in Tables 1 and 4.

Table 2 The findings show that quality of life is predominantly grouped into three distinct categories or levels: excellent (38.90%), poor (34.70%), and fair (26.40%). Furthermore, when analyzing the dimensions of quality of life, it is observed that all reached high percentages at the excellent level. Functional limitation was the most common, with 44.40%, followed by physical pain, which reached 52.80%. Psychological distress also reached 54.20%, while physical and psychological disability registered 69.40%. Social disability reached 76.40%, and finally, disability had the highest percentage, at 83.30%.

Table 3 It indicates that the Oral Health Perception (OHP) is distributed mainly into three levels: low (52.80%), excellent (29.20%), and average (18.00%). When examining the different dimensions, it was identified that the Knowledge Perception registered 100% at a low level. On the other hand, the Attitude Perception showed 44.4% at a low level, while the Behavior Perception was located at 62.5% at a fair level.

Table 4 This paper presents a detailed analysis showing the relationships between the Quality of Life (QoL) dimensions and Oral Health Perception (OHP), highlighting important differences in the magnitude of these relationships. In particular, the psychological distress dimension showed the most significant connection with OHP, supported by a moderate correlation coefficient (r = 0.421) and a solid level of statistical significance (p = 0.000). Furthermore, Nagelkerke’s Pseudo R-squared obtained a value of 0.111 (p = 0.027), which explains that this dimension predicts 11.1% of the variability of OHP. Physical disability, on the other hand, showed a significant correlation with OHP, although with a smaller effect size than the previous dimension. The correlation coefficient was 0.319 (p = 0.006), while the Pseudo R-squared value was 0.167 (p = 0.004), indicating a 16.7% effect on OHP. In contrast, the dimension associated with functional limitations indicated a much weaker relationship with OHP, with a correlation coefficient of 0.096 (p = 0.424) and a Pseudo R-squared of 0.014 (p = 0.649), suggesting a practically null effect on the target variable.

Overall, these findings confirm the existence of a positive relationship between quality-of-life dimensions and oral health problems. However, it is evident that the dimensions of psychological distress and physical disability have a greater influence on oral health, underscoring the need to implement specific interventions targeting these critical areas.

Discussion

Quality of life (QoL) and oral health perception (OHP) are essential elements that directly influence the general well-being of hospital staff. In this study, the relationship between these variables was established in a total of 72 workers from a hospital located in northern Peru during the year 2024, with the purpose of identifying and establishing areas of opportunity that allow the execution of strategies that address the specific needs of the group. First, these results suggest in Table 1 show that there is a low-level positive correlation (r = 0.391), but statistically significant (p < 0.05). Furthermore, it was shown that QoL influences OHP by 19.8%. It should be noted that the highest frequency of cases corresponds to healthcare personnel who reported an optimal QoL, despite experiencing low levels of OHP (29.2%). These findings are similar to those obtained by Miranda and Alcocer in 2021, who found that the sociodemographic characteristics of older adults influence the perception of quality of life and its link to oral health, without generating significant negative impacts. In their study, they identified that a high percentage of participants maintained excellent (45.4%) or moderate (34.6%) levels of quality of life. Therefore, when healthcare professionals experience a favorable quality of life, problems associated with oral health tend to go unnoticed, as they do not significantly interfere with their daily activities or work performance.^2,12

Table 2 shows that quality of life (QoL) is distributed into three main categories: excellent at 38.9%, poor at 34.7%, and fair at 26.4%. Furthermore, when analyzing the seven dimensions of QoL, it is observed that all reached high percentages at the excellent level. First, Functional Limitation obtained 44.40%, followed by Physical Pain at 52.80%. Likewise, Psychological Distress reached 54.20%, while Physical and Psychological Disability registered 69.40%. On the other hand, Social Disability reached 76.40%, and finally, Handicap reached the highest percentage at 83.30%. The data are similar to those obtained by Espinoza et al. (2022), who conducted a study on the quality of life and its relationship with the oral health of the members of a geriatric center in Lima. Their findings revealed that quality of life was excellent in 66.8% of cases and that oral health did not negatively affect this perception.³⁰ These results may be explained by the importance healthcare professionals attach to oral health care, which is reflected in a positive perception of their quality of life. Theory suggests that good oral health is closely related to a better quality of life, as it reduces pain and discomfort, and improves functional and social capacity.⁴⁰

Table 3 presents the most relevant data on OHP and its dimensions among healthcare personnel at a hospital in northern Peru. OHP was mainly distributed into three levels: low (52.8%), excellent (29.2%), and regular (18.0%). Likewise, the analysis of the specific dimensions showed that the low level predominated with 100% in the Perception of Knowledge. Meanwhile, the Perception of Attitude registered 44.4%, also at a low level. Finally, the Perception of Behavior was mostly located at the regular level with 62.5%. These findings differ considerably from previous studies, such as that of López (2021), who indicated that the level of knowledge about OHP among healthcare workers at EsSalud Hospital II during the Covid-19 pandemic was high, reaching 81.5%, demonstrating a good command of this dimension in this context.⁴¹ Therefore, the limited perception of knowledge could be linked to the lack of ongoing oral health (OH) training programs for healthcare personnel. This is consistent with previous studies highlighting that training and education are essential elements for strengthening knowledge and promoting appropriate occupational health practices. Furthermore, attitude and behavior reflect not only the level of knowledge but also cultural beliefs and traditions related to occupational health, which can influence the adoption of preventive habits and the search for appropriate treatments.^42,43

Table 4 presents the results on the relationship between functional limitation and perceived oral health in workers. It was observed that the highest percentage corresponds to those with an excellent quality of life (QoL) but with low OLP, representing 25.0%. However, the statistical analysis showed that there is no significant correlation (r = 0.096) or a relevant influence between this dimension and the variable (p > 0.05). When comparing these results with previous research, similar findings are identified. As García-Cortés et al. (2020) reported that OLP did not show a statistically significant relationship with QoL in a study conducted with healthcare professionals in Spain.⁴⁴ Similarly, López-Jiménez et al. (2019) reported that, although functional limitations existed, these did not significantly affect OLP in a sample of nurses in Mexico.⁴⁵ On the other hand, some studies have found a significant relationship between these variables in different contexts. For example, Martínez-Rodríguez et al. (2018) found that functional limitations did affect OHP in a sample of older adults in Chile.⁴⁶

Regarding the influence of physical pain and the perception of oral health in workers, a low-intensity positive correlation was identified (r = 0.266), with a limited influence of 9.3% of this dimension on the OHP. Likewise, the highest percentage was found in workers with excellent QoL, but with low OHP (33.30%). These data are similar to the research by Campos et al. (2014) who conducted an analysis of how job performance is affected by alterations in the oral cavity and that, in relation to physical pain, this had a negative influence of 82.90%.⁴⁷ This indicates that the absence of physical pain attributed to alterations in the oral cavity may lead to the OHP going unnoticed.⁴⁸

Similarly, when evaluating the relationship between psychological distress and OHP in workers, a moderate correlation was observed (r = 0.421) with a high level of statistical significance (p < 0.01) and a relevant influence of 11.1% of this dimension on OHP. The highest percentage corresponds to workers with an excellent CV, but with a low OHP (10.41). These results are similar to those found by Espinoza (2017), who identified a negative impact of 61.4% in relation to psychological distress.³⁰ This suggests that the absence of psychological distress related to the oral cavity may lead to OHP not being considered.⁴⁸

Regarding the link between physical disability and OHP in workers, a significant, low-magnitude correlation was observed (r = 0.319, p < 0.05), with a notable influence of 16.7% of this dimension on Oral Health Perception (OHP). These findings contrast with the results of Bellamy and Moreno (2014), who reported that physical disability was one of the most affected dimensions in patients with removable prostheses and tooth loss, reaching 32.5%.⁴⁹ Thus, when there is no physical disability, OHP goes unnoticed; and, conversely, if this dimension is present, oral health is prioritized.⁵⁰

Likewise, in relation to psychological disability and the OHP of workers, a low correlation was identified (r=0.232) with a significant influence of 16.7% on the OHP. In addition, the highest percentage corresponded to those workers with an excellent quality of life and low OHP (41.7%). Similarly, when the disability psychological³⁰ is at a regular level, the OHP is at regular or excellent levels, with 6.9% in both cases. These findings are consistent with those reported by Espinoza (2017), who showed a negative influence of oral health on QoL, reflecting a 31.5% impact in relation to psychological disability. In this sense, when workers do not have psychological disability, OHP is not usually a priority. On the other hand, when there is psychological disability, it favors the adoption of actions that directly influence oral health.⁵⁰

Regarding the link between social disability and oral health (OHP) among hospital care workers, a significant (p<0.05) correlation was found, a low (r=0.242) correlation, and a significant influence of 12.4% of the dimension on oral health (OHP). It should be noted that the highest percentage was achieved by workers with excellent QoL but low OHP (43.10%). Likewise, if the social disability is poor, OHP is exclusively outstanding (4.20%). These data can be contrasted with those evidenced by Espinoza (2017), who found an inverse relationship between oral health and quality of life, highlighting a 23.40% share in the social disability dimension.³⁰ Therefore, when workers do not have social disabilities, the OHP is not considered important; otherwise, if workers have social disabilities, this favors practical behaviors that influence SO.⁵¹

Finally, regarding the link between disability and workers’ CPS, a significant correlation of low magnitude was identified (r = 0.298, p < 0.05), with an influence of 13.1% of this dimension on the Perceived Oral Health (CPS). Furthermore, the highest percentage corresponded to workers with excellent quality of life and low CPS, reaching 50.0%. Similarly, when the disability is present at moderate levels, the CPS was distributed between excellent and regular, with 5.6% in each category. These data are similar to those reported by Espinoza et al. (2022), who showed a negative link between oral health and QoL, reflecting an impact of 17.0% in relation to disability.³⁰ Thus, when workers do not show signs of disability, CPS often takes a backseat. In contrast, when some type of disability is present, this condition can motivate the implementation of differentiated behaviors and practices that directly impact the state of oral health.⁵¹

Conclusion

The study shows a statistically significant correlation between oral health-related quality of life (OHRQoL) and perceptions of oral health among healthcare professionals at a Level II-1 hospital located in northern Peru. The Spearman correlation coefficient was 0.391 and the Nagelkerke pseudo R-squared was 0.198, both with a statistical significance of 0.001. Higher oral health-related quality of life (OHRQoL) is significantly related to more favorable perceptions of oral health. Furthermore, relevant relationships were identified in the dimensions of physical disability (Rho = 0.319, p < 0.05; Nagelkerke = 0.167), psychological disability (Rho = 0.232, p = 0.05; Nagelkerke = 0.167), social disability (Rho = 0.242, p < 0.05; Nagelkerke = 0.124), and general disability (Rho = 0.298, p < 0.05; Nagelkerke = 0.131). These conclusions could corroborate that reinforcing the factors that positively impact teachers’ oral health-related quality of life could be related to a more favorable perception of their oral health. In this sense, the results provide contextual evidence that could be a reference for other similar contexts, without losing sight of the fact that sociocultural aspects are different in each context.