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

Introducción

Oral health is an essential component of overall well-being and is directly associated with oral health–related quality of life (OHRQoL) through the ability to perform basic functions such as communicating, eating properly, and maintaining satisfactory social relationships.¹ Oral diseases affect not only oral functions but also psychological, social, and economic outcomes, causing discomfort, pain, and loss of self-esteem, and shaping the subjective perception of oral well-being.^2,3 The association between oral health and OHRQoL underscores its direct contribution to achieving Sustainable Development Goal 3 (good health and well-being), in which oral health is a fundamental component.

Within this framework, oral health is considered a global priority by international organizations such as the FDI World Dental Federation (FDI) and the World Health Organization (WHO), given its clear relationship with OHRQoL. The WHO conceptualizes oral health as a comprehensive state that encompasses physical, mental, and social well-being in relation to the functionality and condition of the oral cavity, not merely the absence of disease (WHO, 2022), while FDI Vision 2030 (2021) advances an integrative perspective that links 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 higher prevalence in low- and middle-income countries, where about 75% of cases are concentrated.⁴ Untreated dental caries is the most prevalent condition, reflecting deep inequities in access to preventive services and basic treatments.^6,7 In Latin America, periodontal diseases represent a widespread burden that significantly impairs 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 limited public investment and elevated oral cancer rates (2.60 per 100,000 women and 1.97 per 100,000 men between 2000 and 2017).⁸ This scenario is associated with constrained resource allocation, the absence of effective preventive strategies, and insufficient early-detection programs.⁹ In response, WHO and other organizations have promoted key initiatives—most notably FDI Vision 2030 and the 2021 World Health Assembly Resolution on oral health—which emphasize integrating oral health into Universal Health Coverage (UHC) and aligning actions with the global agenda against non-communicable diseases (NCDs).

According to the WHO Global Oral Health Status Report (2022),⁴ it is essential to reorient public policies to prioritize the promotion and production of scientific knowledge in oral health through national plans aligned with WHO’s strategic vision.⁹ Collaboration with institutions such as UNESCO and UNDP is also relevant to embed oral health determinants within well-being and sustainable human development policies.^10,11 Among healthcare personnel, perceived oral health (POH) can be measured and has been associated not only with oral well-being but also with OHRQoL. POH may be influenced by contextual factors such as limited accessibility to dental services and workload.^12–14 Negative POH can affect self-esteem and interpersonal relationships, which justifies evaluating staff well-being using OHRQoL metrics.^8,15

Purpose. This study examines the relationship between OHRQoL and POH among staff at a Level II-1 hospital in northern Peru, considering their dimensions and interactions. The findings provide evidence to guide strategies that promote the oral well-being of healthcare staff and, consequently, support comprehensive, patient-centered care based on quality criteria.^16,17

Methods

Research type and design. This study employed applied research aimed at solving a specific problem in order to propose solutions to the challenges faced by hospital staff.^18–20 The research scope was correlational, as it sought to identify the relationship between the variables and analyze the strength and direction of this relationship.²¹ A non-experimental, cross-sectional design was adopted, which allowed data to be collected at a single point in time without manipulating the variables, thus preserving the natural context of observation.²²

Population. The group was initially comprised of 80 members of the professional and technical team providing care at a Level II-1 healthcare facility in northern Peru. This group included 21 physicians, 10 obstetricians, 1 dentist, 1 pharmaceutical chemist, 17 nurses, 2 psychologists, 3 biologists, 5 microbiologists, 2 medical technologists, 13 nursing technicians, 4 pharmacy technicians, and 1 laboratory technician. After applying the inclusion criteria —designated or assigned personnel and CAS (Administrative Contracting of Services), ≥6 months of seniority, agreement to complete both questionnaires, and signed/stamped informed consent—the exclusion criteria considered workers with <6 months of seniority, vacation or sick leave, outsourced modality, those carrying out SERUMS (Rural and Marginal Urban Health Service), and those who did not agree to participate. A non-probabilistic intentional convenience sampling strategy was used, obtaining a final sample of n = 72 participants, which allowed the collection of sufficient data for correlational analyses given feasibility and accessibility during the study period. Additionally, to estimate the sample size, a power analysis (G*Power) was performed, establishing as parameters an expected medium correlation (ρ = 0.30), 95% confidence level, and 80% power. Under these parameters, the minimum required size was 67 participants; therefore, the achieved sample (n = 72) was adequate for the planned correlational analysis.²³

Variables. Two main variables were evaluated: oral health–related quality of life (OHRQoL) and perceived oral health (POH). OHRQoL is conceived as the individual’s appraisal of how oral conditions are associated with different aspects of daily life—physical, emotional, and social.²⁴ For its assessment, the Oral Health Impact Profile (OHIP-14) developed by Slade and Spencer was used. This instrument comprises 14 items organized into seven domains: functional limitation, psychological discomfort, physical pain, psychological disability, physical disability, social disability, and handicap. The overall score indicates the extent to which oral health is associated with OHRQoL, without extending to general QoL.

POH refers to the subjective evaluation of oral status and its relationship with QoL,²⁵ and in this study it was addressed using a modified version of the Hiroshima University–Dental Behavioral Inventory (HU-DBI), initially developed by Kawamura (1988) and adapted to the Peruvian context by Midolo (2023).^26,27 This version was internally validated by Alvarado and Lora (2024) for healthcare personnel. The instrument considers three dimensions: perception of knowledge, perception of behavior, and perception of attitude. POH served as an indicator of awareness, disposition, and practice regarding one’s oral health.

Data collection technique and instruments. The survey technique was used to facilitate systematic data collection from hospital professionals and technical staff via standardized questionnaires, without altering the environment or the object of study.²⁸

For OHRQoL, the OHIP-14—originally designed by Slade and Spencer (1994), adapted by Espinoza (2017)²⁹ and subsequently validated and published by Espinoza et al. (2022)³⁰—was administered (14 items; seven domains; Likert 0 = never to 4 = very frequently). For interpretability, three categories were used following Espinoza’s methodological criteria: excellent (0–2 points), regular (3–9 points), and poor (≥10 points) OHRQoL.

For POH, the modified HU-DBI^31,32 was used, validated for hospital settings by Alvarado and Lora, 2024. It consists of 20 dichotomous items (Yes = 1; No = 0) across the three dimensions noted above, and total scores were categorized as poor (0–9), regular (10), and excellent (11–20).

Content validity for both instruments was established by a five-member expert panel, assessing internal consistency, conceptual clarity, thematic relevance, and informative sufficiency, yielding Aiken’s V = 1.00. Reliability from the pilot showed Cronbach’s α = 0.847 (OHIP-14) and α = 0.804 (HU-DBI), indicating acceptable internal consistency.

For methodological transparency and replication, all materials (OHIP-14, modified HU-DBI , expert-review matrix, and pilot reliability outputs) are publicly available on Zenodo: https://doi.org/10.5281/zenodo.15236712.³¹

Procedure. The study began with a formal cover letter from the Graduate School, Universidad César Vallejo, to the administrative department of the La Libertad Level II-1 Hospital requesting authorization to administer the instruments. After approval, on-site sessions were scheduled; the objectives, procedures, confidentiality safeguards, and anonymity were explained, and participants provided written informed consent. Instruments were completed in discrete areas within workspaces and required approximately 8 minutes per person, minimizing distractions and contextual bias.

Information analysis. Statistical analysis was performed in IBM SPSS Statistics v25 (https://www.ibm.com/products/spss-statistics ). Normality was tested with Kolmogorov–Smirnov; results indicated non-normality (p < 0.05), so non-parametric tests were used. Associations between OHRQoL and POH were examined with Spearman’s ρ (ordinal data). Ordinal logistic regression was then fitted; Nagelkerke’s pseudo-R ² and 95% confidence intervals were reported. As an alternative, R (The R Project for Statistical Computing) was considered. The analysis identified a statistically significant association between OHRQoL and POH among hospital staff.^32–35

Ethics. The study protocol, entitled “Quality of life and perception of oral health of the staff of a Level II-1 hospital in La Libertad, 2024”, received a favorable opinion from the Research Ethics Committee of the Master’s Program in Health Services Management, Universidad César Vallejo (Report No. 00298-2024/CEI-PMGSS, January 30, 2025). The committee authorized its implementation in accordance with institutional and international ethical standards, including CIOMS (2016),³⁸ the Belmont Report (1979),³⁹ and the Declaration of Helsinki (WMA, 2013).⁴⁰ All participants signed written informed consent before data collection, ensuring confidentiality, voluntary participation, and the right to withdraw at any time. Furthermore, the study followed the university’s Research Ethics Code,⁴¹ guaranteeing originality, transparency, and methodological rigor throughout all phases.

Resultados

Overall findings. Among staff, OHRQoL showed a predominance of the “Excellent” category (38.90%), while POH concentrated at the regular level (62.50%). At the bivariate level, OHRQoL and POH were positively associated (Spearman’s ρ = 0.391; p = 0.001), indicating that better perceived oral health was linked to better OHRQoL.

Table 2 shows that oral health–related quality of life (OHRQoL) was primarily distributed across three levels: Excellent (38.90%), Regular (26.40%), and Poor (34.70%). Among the OHIP-14 domains, social disability (76.40%) and handicap (83.30%) reached the highest percentages in the Excellent level, while functional limitation recorded 44.40% in the Poor level. This pattern reveals heterogeneity across domains, with greater impact on basic functions despite comparatively favorable social and global performance. Overall, the results suggest prioritizing interventions targeted by dimension (e.g., education for self-care, pain management, and functional rehabilitation) along with general strategies for the promotion of oral health among hospital staff.

Table 3 shows that oral health perception (POH) was primarily distributed across three levels, with a predominance of the Low level (52.80%), followed by Excellent (29.20%) and Regular (18.00%). When analyzing the dimensions, Knowledge Perception showed 100.00% at the Low level, revealing a critical knowledge gap among the evaluated staff. In contrast, Attitude Perception presented 44.40% at the Low level and 43.10% at the Regular level, reflecting a polarization between incipient and moderate attitudes. Meanwhile, Behavior Perception concentrated its highest proportion at the Regular level (62.50%), suggesting acceptable but suboptimal habitual practices.

This pattern of markedly low knowledge, intermediate attitudes, and mostly regular behaviors indicates a knowledge–attitude–behavior gap associated with unstructured learning processes and operational barriers (e.g., service access times, organizational culture). Overall, the findings highlight the need for a stepwise intervention approach: strengthening knowledge (targeted training), reframing attitudes (motivational messaging and service standards), and reinforcing behaviors (reminders, access facilities, follow-up).

Table 4 presents an analysis of the associations between the OHIP-14 dimensions and oral health perception (POH) (Spearman’s coefficient and ordinal logistic regression). The psychological discomfort dimension showed the highest correlation with POH (ρ = 0.421; p < 0.001) and a Nagelkerke pseudo R² = 0.111; p = 0.027. Physical disability also presented a significant association (ρ = 0.319; p = 0.006) with pseudo R² = 0.167; p = 0.004. Social disability and handicap revealed moderate associations (ρ = 0.242; p = 0.040 and ρ = 0.298; p = 0.011, respectively) with pseudo R² = 0.124; p = 0.017 and pseudo R² = 0.131; p = 0.013, underscoring their predictive relevance for POH. In contrast, functional limitation showed a weak and non-significant relationship (ρ = 0.096; p = 0.424; pseudo R² = 0.014; p = 0.649), indicating a minimal contribution to POH variability.

Overall, the findings confirm a positive association between the OHIP-14 dimensions and POH, with the greatest magnitudes in psychological discomfort and physical disability; therefore, psychosocial and functional interventions are prioritized for healthcare personnel.

Discusión

Oral health–related quality of life (OHRQoL) and oral health perception (POH) are essential determinants of healthcare personnel’s overall well-being. This study analyzed the relationship between these variables in 72 healthcare workers from northern Peru in 2024, aiming to identify priority areas for oral health interventions.

Table 1 revealed a significant association between OHRQoL and POH: 38.9% of participants with excellent OHRQoL reported a high perception of their oral health, whereas 34.7% of those with poor OHRQoL reported a low POH. The positive correlation (Spearman’s ρ = 0.391; p = 0.001) explained 19.8% of the variance according to the Nagelkerke pseudo R², highlighting the interdependence of clinical and subjective oral health factors.

These findings align with Díaz-Reissner et al.,¹³ who demonstrated that sociodemographic and clinical determinants significantly influence OHRQoL and, consequently, POH. However, Espinoza et al. (2022) reported a 66.8% prevalence of excellent OHRQoL, markedly higher than the 38.9% observed in our study, possibly due to contextual differences such as institutional infrastructure, access to dental services, and occupational health policies. Similarly, the World Health Organization emphasizes that oral health is intrinsically linked to overall well-being, affecting both quality of life and subjective health perceptions.⁴³

Taken together, these results underscore the importance of designing multilevel interventions: improving access to preventive dental care, implementing workplace-based oral health programs, and providing continuous education on oral self-care practices. Such strategies could enhance OHRQoL, promote preventive behaviors, and contribute to better occupational performance among healthcare personnel.

Regarding Table 2, the staff’s oral health–related quality of life (OHRQoL) was classified mainly as Excellent (38.9%), followed by Poor (34.7%) and Regular (26.4%). The domains with the highest proportions within the Excellent level were social disability (76.4%) and handicap (83.3%), whereas functional limitation showed lower values. Although this suggests the presence of some functional constraints, the overall pattern indicates a reduced social and participation impact, pointing to good integration and adaptation. This situation may be explained by the fact that healthcare professionals typically have greater access to information, resources, and dental services, which facilitates maintaining adequate oral health and minimizes its social impact. The literature supports that better oral health is associated with reduced physical pain, improved function, and better performance in daily and work activities,² consistent with the positive perception observed in most personnel. Similar findings were reported by Espinoza et al.^30,44 in a geriatric center in Lima and by Díaz-Reissner et al.,^13,42 who emphasize that clinical and sociodemographic factors significantly influence OHRQoL, reinforcing the need to consider both functional and psychosocial aspects in interventions. In sum, maintaining adequate oral care and access to dental resources benefits not only functional status but also the social integration of hospital staff, strengthening their quality of life and professional performance.^2,13,30

Additionally, Table 3 presents the distribution of oral health perception (POH) and its dimensions among healthcare personnel in northern Peru. POH was mainly concentrated in the Low level (52.8%), followed by Excellent (29.2%) and Regular (18.0%). At the dimensional level, knowledge was the category with the highest proportion in the Low level, revealing limitations in the understanding of basic oral health concepts. This predominance of low perceptions may be related to the absence of permanent programs for professional development and training in oral health in the regional context. Organizational constraints, limited access to information, and lack of incentives for continuous education could contribute to maintaining low perceptions and restricted knowledge among personnel.

Franco-Giraldo emphasizes that oral health should be approached as an integral part of systemic and public health, reinforcing the importance of professional training to modify attitudes and preventive practices.² However, these results contrast with López García,⁴⁵ who reported that 81.5% of healthcare staff at the EsSalud Hospital II – Abancay had a high level of POH knowledge during the COVID-19 pandemic, suggesting contextual, organizational, or informational differences. Likewise, reviews such as that of Pineda Rivera et al.⁴⁶ point out that deficits in oral health knowledge and attitudes are common among healthcare personnel in the absence of systematic continuing education programs, and Espinoza et al.³⁰ highlight that continuous education is essential to strengthen knowledge, modify attitudes, and improve preventive practices.

Overall, these findings highlight the urgency of implementing educational strategies and occupational health policies that promote better oral health perception and knowledge, integrating culturally relevant content and reinforcing continuous training as a central axis of intervention.^2,30,46

Similarly, Table 4 presents a detailed analysis of the relationships between the dimensions of oral health–related quality of life (OHRQoL) and oral health perception (POH) among hospital staff.

Functional limitation showed the highest proportion among participants with excellent OHRQoL but low POH, although the correlation was not statistically significant (ρ = 0.096; p > 0.05). This finding is consistent with López García,⁴⁵ who reported that actual oral health status or knowledge does not always translate into favorable perceptions, and with Remuzgo Huamán and Remuzgo Huamán,⁵² who argue that administrative barriers and insufficient public policy management can mediate the relationship between functional status and perception in healthcare professionals. Conversely, Espinoza et al.³⁰ observed in older adults that functional limitations negatively impacted POH, suggesting that age and comorbidities may strengthen this association in specific populations. Other studies on healthcare personnel (López-Jiménez et al.⁴⁸) and vulnerable groups (León Mantero et al.⁵⁰; Carrillo Espichán⁵¹) also highlight the influence of organizational and contextual factors on oral health perception and quality of life.

Regarding physical pain, the analysis revealed a low but significant positive correlation (ρ = 0.266) explaining 9.3% of the model variability (Nagelkerke pseudo R² = 0.093). The highest proportion was found among workers with excellent OHRQoL but low POH, suggesting that the absence of pain may reduce awareness of oral health care needs. Similar results were reported by Campos Guerra et al.,⁴⁹ who documented a strong negative association between oral pain and job performance, emphasizing the influence of physical discomfort on health perception. Espinoza et al.³⁰ further suggested that individuals without oral pain may underestimate their oral health status since discomfort often triggers health-seeking behaviors.

Psychological discomfort showed a moderate positive correlation with POH (ρ = 0.421; p < 0.001), explaining 11.1% of its variability. The highest frequency was again observed among participants with excellent OHRQoL but low POH, indicating that the absence of psychological discomfort could reduce oral health awareness. These findings align with Espinoza et al.,³⁰ who reported a negative association between psychological discomfort and POH, emphasizing the psychological determinants of health perception.

Physical disability was also significantly correlated with POH (ρ = 0.319; p < 0.05), explaining 16.7% of the variation. Our findings differ from Bellamy Ortiz and Moreno,⁴⁷ who identified physical disability as one of the most affected dimensions among patients with removable dentures and tooth loss—populations in which oral functionality plays a central role in health perception. In our context, the absence of physical disability may reduce attention to oral health, whereas its presence may increase awareness and prioritization of oral care needs.

Psychological disability showed a low positive correlation with POH (ρ = 0.232; p < 0.050), explaining 16.7% of the variation. The highest proportion was recorded among participants with excellent OHRQoL but low POH, suggesting that in the absence of psychological impairment, oral health may be perceived as less relevant. These findings are consistent with Espinoza et al.,³⁰ who found an inverse association between psychological disability and oral health, indicating that mental well-being mediates the subjective evaluation of health status.

Social disability exhibited a weak but statistically significant correlation with POH (ρ = 0.242; p < 0.05), explaining 12.4% of its variability. Workers with excellent OHRQoL but low POH predominated in this category, while those with low social disability frequently reported excellent oral health perception. Espinoza et al.³⁰ documented an inverse relationship between social disability and POH, suggesting that social restrictions may intensify health problems and motivate preventive behaviors.

Finally, general disability (handicap) showed a low but significant association with POH (ρ = 0.298; p < 0.05), explaining 13.1% of the variance. Participants with excellent OHRQoL but low POH constituted the largest group in this dimension. Similar findings were reported by Espinoza et al.,³⁰ who identified a negative association between oral health and perceived disability in Peruvian populations.

Overall, these results highlight that while some dimensions, such as functional limitation, show minimal association with oral health perception, others—particularly psychological discomfort, physical disability, and social disability—present stronger relationships. This evidence underscores the need for occupational health strategies addressing the physical and psychosocial determinants of oral health perception, ensuring early detection, preventive education, and comprehensive care approaches for healthcare personnel.

Conclusion

The study demonstrates a statistically significant association between oral health–related quality of life (OHRQoL) and oral health perception (POH) among healthcare professionals at a Level II-1 hospital in northern Peru. Spearman’s correlation was ρ = 0.391; p = 0.001, and the ordinal logistic regression model yielded a Nagelkerke pseudo R = 0.198, indicating a low but consistent association; higher levels of OHRQoL were associated with a more favorable POH.

Moreover, significant associations were confirmed for specific OHIP-14 dimensions: physical disability (ρ = 0.319; p = 0.006; pseudo R² = 0.167), psychological disability (ρ = 0.232; p = 0.050; pseudo R² = 0.167), social disability (ρ = 0.242; p = 0.040; pseudo R² = 0.124), and handicap (ρ = 0.298; p = 0.011; pseudo R² = 0.131).

These findings suggest that strengthening factors that improve OHRQoL—through continuous education, periodic screening, timely access to dental care, and psychosocial support—could lead to more favorable oral health perceptions among hospital staff. The evidence provides contextual references for similar institutional settings, recognizing the influence of sociocultural and institutional variables on these outcomes.

Data availability