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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 223-228

Association of impaired sleep, impaired awakening, vitality, and fatigue related to dental caries


Department of Public Health Dentistry, Sharad Pawar Dental College, DMIMS (DU), Wardha, Maharashtra, India

Date of Web Publication15-Dec-2017

Correspondence Address:
Shriya Jain
Department of Public Health Dentistry, Sharad Pawar Dental College, DMIMS (DU), Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_105_17

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  Abstract 

Background: For humans, sleep is a vital indicator of overall health and well-being. It is a major public health problem. Insomnia has effect on oral health. Individuals with greater sleep disturbance or individuals getting less sleep are at higher risk of impaired oral health status and behavior. Aim: To evaluate association between sleep disturbance, vitality, fatigue, and oral health-related quality of life. Materials and Methods: A total of 150 nonmedical participants of age group 18 years and above were selected on the basis of individuals getting sleep ≤6 h. Data were collected using a self-administered questionnaire and standardized sleep disturbance scale (Karolinska Sleep Questionnaire), vitality scale (subjective vitality scale), and fatigue scale (fatigue assessment scale). The participants underwent an oral checkup wherein the decayed-missing-filled teeth (WHO modification) were recorded. The data were analyzed using STATA version 9.2 and ANOVA test was applied. Results: Individuals who perceived their oral health as poor/very poor reported with the highest score for impaired sleep (2.53 ± 1.02), awakening (2.50 ± 0.87), and vitality (3.12 ± 0.63) whereas the lowest score for fatigue (33.61 ± 8.47). Conclusion: An individual's lifestyle, health care habits, and behavior have an impact on overall well-being of the person.

Keywords: Dental caries, fatigue, Karolinska Sleep Questionnaire, sleep disturbance, vitality


How to cite this article:
Jain S, Bhombe K, Deolia S, Patil S, Rajnalwar B, Sen S. Association of impaired sleep, impaired awakening, vitality, and fatigue related to dental caries. Arch Med Health Sci 2017;5:223-8

How to cite this URL:
Jain S, Bhombe K, Deolia S, Patil S, Rajnalwar B, Sen S. Association of impaired sleep, impaired awakening, vitality, and fatigue related to dental caries. Arch Med Health Sci [serial online] 2017 [cited 2018 Sep 22];5:223-8. Available from: http://www.amhsjournal.org/text.asp?2017/5/2/223/220816




  Introduction Top


For humans, sleep is a vital indicator of overall health and well-being. Healthy sleeping habits can make a big difference in individual's quality of life. Sleep has an important role in controlling the other body systems critical for normal functioning and well-being of the individual.[1] Lack of sleep has been identified as a major public health problem, including diabetes, stroke, and heart failure. Insomnia and other sleep disorders can even have an effect on some unexpected areas of health. Many patients are surprised to find out that insomnia can have an effect on oral health.[2]

Sleep disturbances are frequent in modern society as the prevalence of insomnia symptoms may be estimated at 30% and specific insomnia disorders at 5%–10% of individuals.[3] The presence of a long sleep latency, frequent nocturnal awakenings, or prolonged periods of wakefulness during the sleep period or even frequent transient arousals is taken as evidence of insomnia. Insomnia impairs cognitive and physical functioning and is associated with a wide range of impaired daytime functions across a number of emotional, social, and physical domains.[2]

The consistent risk factors for insomnia include female sex, increasing age, and depressed mood.[16] Other risk factors are snoring, decreasing levels of physical activity, nocturnal micturition, onset of menses, regular use of hypnosis, previous insomnia complaints, and increased levels of stress.[3] Approximately 40% of individuals along with insomnia have a comorbid psychiatric condition such as substance abuse, depression, anxiety, dependence, and suicide. Insomnia might also develop a psychiatric disorder separately. The reason for psychiatric condition to affect oral health might be because of the changes on the behavioral level such as negligence in oral habits, dietary habits, sleep pattern, and adaptation of deleterious habits such as smoking.[4],[5] Individuals having chronic insomnia are at higher risk for heart diseases, hypertension, and gastrointestinal, neurological, urinary, and breathing difficulties.[3] It is also believed that there are direct consequences of insomnia to personal and social background.[17]

The symptoms reported frequently by patients include fatigue, decreased alertness, sleepiness, inability to nap, irritability, tension, hyperarousal, depressed mood, impaired memory functioning, and decreased ability to concentrate.[14] The individuals are likely to receive medical care for the above-mentioned symptoms rather than insomnia.

Vitality or liveliness is subjective feeling of being full of energy.[6] It can also be defined as a positive state of feeling alive and alert or the energy available to self. It is considered as an aspect of eudaimonic well-being which means vitality or energy is a sign of being fully functional and psychologically well.[7] Vitality is experienced by different individuals in varied ways which are not only physical influences but also psychological factors, and thus, lack of regulation in these areas reflects diminished vitality.[8]

Fatigue is estimated in around 7%–45% of individuals. Irregular lifestyle habits and physical inactivity are also the risk factors for fatigue, apart from insomnia.[18] Fatigue can be physiological, psychological, physical, and mixed.[9] It is important to know that fatigue is a symptom and not a disease.[8] Fatigue is also classified as recent, prolonged, and chronic fatigue based on the time of evolution.[10] Often, fatigue is described into physical and mental components. Physical fatigue is due to overstressed muscles, following vigorous physical activities, while mental fatigue refers to diminished psychological capacity.[11]

Patients are becoming more involved to know the information regarding sleep bruxism, xerostomia, hypersalivation, gastroesophageal reflux, and apnea with respect to oral health.[20]

Individuals with greater sleep disturbance or individuals getting less sleep are at higher risk of impaired oral health status and behavior.[1] The compartmentalization of differentiating the general health from the oral health should be stopped as any changes in general health have effects on oral health and vice versa.[12],[19] The need of the study was to identify the whether individual's lifestyle, daily health care habits and behaviors affect oral health so that appropriate measures can be taken to reduce the impact for betterment of the society. The study was aimed to find the correlation between sleep disturbance, vitality, fatigue, and dental caries.


  Materials and Methods Top


Sample

The study was started after obtaining the approval from the Institutional Ethical Committee. The duration of the study was 9 months (November 2016–July 2017). A total of 150 nonmedical individuals of age group 18 years and above were selected from a college in Central India region. Before starting the examination, permission was obtained from the respective authorities of the institution. The study population was selected on the basis of the presence of the sleep disturbances or individuals getting sleep ≤6 h since 6 months or more as reported by the individuals. The individuals gave their informed consent to participate in the study. Data were collected using a self-administered questionnaire and standardized sleep disturbance, vitality, and fatigue scales. The participants underwent an oral checkup wherein the decayed-missing-filled teeth (DMFT) (WHO modification) were recorded, which is the simplest and commonly used one for surveys of dental caries.[13] A drum of autoclaved instruments containing 30 plain mouth mirrors and 30 CPI probes was carried to the survey site every day. The examination was carried out in a proper sterilized environment. The examination was carried out in an institutional common room where the participants were made to sit on a normal chair, and under adequate natural light, DMFT were recorded. Twenty-five individuals were examined per day and the time taken for each participant was approximately 5 min by a single calibrated examiner along with a trained recorder who was seated on the right side to ensure the examiner visibility.

Instruments

A structured questionnaire was prepared for the study that contained sociodemographic factors (age, gender, hours of sleep, and smoking), oral health habits (tooth brushing frequency, flossing frequency, mouth rinse frequency, and dental visit frequency), and perceived oral health (oral health, nontreated caries, extracted teeth, satisfaction by appearance of own teeth, dental pain, gingival condition, and gum bleeding).

The first component of the questionnaire was sleep disturbance which was obtained using Karolinska Sleep Questionnaire (Kecklund and Škerstedt, 1992), which included difficulty in falling asleep, disturbed sleep, repeated awakenings, premature awakening, difficulties in awakening, not well rested on awakenings, nightmares, and heavy snoring. The responses were coded in five options from “never” to “always” scores ranging as 1–5, respectively. The mean of individual items was taken with respect to impaired sleep, impaired awakening, vitality, and fatigue, as presented by Škerstedt et al. (2002).

The second component of the questionnaire was fatigue which was assessed with a 10-item self-reported fatigue assessment scale (FAS) (Michielsen et al., 2004). Five items assessed the physical and five mental fatigue. Each item is scored on 5-point Likert-type scale, with total score ranging from 1 to 5. Higher scores indicate higher fatigue levels. The FAS scores of ≥22 were indicative of fatigue which was used as cutoff score to distinguish fatigued and nonfatigued participants (Michielsen et al., 2004).

Moreover, the last component was vitality which was assessed using a subjective vitality scale (Ryan and Frederick, 1997) which is a seven-item survey assessing feeling of aliveness and energy on a 5-point Likert-type scale. The scale score is determined by averaging the individual's item score. The subjective vitality scale has been broadly authenticated as it shows both high reliability and covariation with somatic as well as psychological factors.[8] The data were collected and were entered in Microsoft Excel sheet 2010 (developed by Microsoft Redmond, WA, USA) and analyzed using STATA version 9.2 (StataCorp LP, College Station, TX, USA). ANOVA test was applied for analysis. The P < 0.05 is considered statistically significant.


  Results Top


[Table 1] shows significant differences in sleep disturbance, vitality, and fatigue in relation to the oral health habits. It was observed that individuals with brushing frequency of more than once a day reported with higher scores for fatigue (34.50 ± 6.72), vitality (3.02 ± 0.64), impaired sleep (2.38 ± 0.68), and impaired awakening (2.45 ± 0.72). Highest score of impaired sleep (2.57 ± 0.96) and impaired awakening (3.12 ± 0.83) was found in population having the flossing frequency of once a week, whereas the highest score was seen in the category once a month for vitality (3.57 ± 1.04), while for fatigue (42.50 ± 10.60), it was seen in duration of more than once a week. Participants using mouthwash for more than once a week were found to have higher scores for impaired sleep (2.92 ± 0.67) and vitality (3.75 ± 0.97) and low scores were found in participants using mouthwash once a month for impaired awakening (2.16 ± 0.61) and once a week for fatigue (29.90 ± 7.90). Participants who visited dentist in < 6 months were reported to have higher level for fatigue (30.70 ± 8.7). Participants who visited a dentist in duration of 6–12 months have higher scores for impaired sleep (2.68 ± 0.79) and impaired awakening (2.73 ± 0.78), whereas the highest score was observed in duration of 1–2 years for vitality (3.06 ± 0.75) and fatigue (35.68 ± 6.25) both.
Table 1: Comparison of sleep disturbance, vitality, and fatigue (mean±standard deviation) according to self-reported oral health habits

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[Table 2] shows significant differences in sleep disturbance, vitality, and fatigue in relation to the self-reported oral health status. Individuals who perceived their oral health as poor/very poor reported with the highest score for impaired sleep (2.53 ± 1.02), impaired awakening (2.50 ± 0.87), and vitality (3.12 ± 0.63) whereas the lowest score for fatigue (33.61 ± 8.47). Individuals with nontreated caries were found to have high scores for impaired sleep (2.79 ± 0.73), impaired awakening (2.53 ± 0.71), and fatigue (33.90 ± 7.04), whereas score for vitality (2.90 ± 0.74) was higher in population without nontreated caries. Individuals having a history of current extraction have higher scores for impaired sleep (2.66 ± 0.81), impaired awakening (2.67 ± 0.77), and fatigue (34.37 ± 7.24), whereas vitality (3.01 ± 0.67) was higher in individuals who did not undergo any extraction recently. Participants who were not satisfied with appearance reported with higher scores for impaired sleep (2.50 ± 0.78), impaired awakening (2.59 ± 0.71), and fatigue (32.97 ± 7.3) whereas low score for vitality (3.11 ± 0.73). Individuals who experienced toothache the last week had the highest scores for impaired sleep (3.02 ± 0.70) and impaired awakening (3.10 ± 0.94). Individuals who had experienced toothache during the last year were reported with highest score for fatigue (38.66 ± 8.50), whereas the score for vitality (3.23 ± 0.79) was highest for individuals who experienced toothache during the last 3 months. Participants who perceived their gingival condition as normal presented highest score for impaired awakening (2.48 ± 0.72). Individuals who perceived their gingival condition as poor/very poor presented least score for vitality (2.78 ± 0.35) and higher score for impaired sleep (2.39 ± 1.00) whereas fatigue (3.47 ± 6.15) score was least in individuals who perceived their gingival condition as normal. Population who had bleeding gums was reported with higher score for impaired sleep (2.08 ± 0.52), impaired awakening (2.89 ± 0.73), and fatigue (34.95 ± 6.49), whereas score for vitality (3.01 ± 0.67) was higher in individuals with no bleeding gums.
Table 2: Comparison of sleep disturbance, vitality, fatigue, and sleep quality scales (mean±standard deviation) according to self-reported oral health status

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[Table 3] shows that participants having DMFT score between 1 and 3 show impaired sleep score as 2.3016 ± 0.6451, impaired awakening as 2.4426 ± 0.714, vitality as 3.1077 ± 0.6236, and fatigue as 34.0494 ± 6.41. DMFT score between 4 and 6 show impaired sleep score as 2.2988 ± 0.7097, impaired awakening as 2.3732 ± 0.774, vitality as 2.9054 ± 0.6654, and fatigue as 34.0625 ± 7.4193. DMFT score of >6 was observed when impaired sleep is 2.3778 ± 0.8136, impaired awakening 2.4444 ± 0.595, vitality 3.1429 ± 0.6144, and fatigue 33.2222 ± 4.3525.
Table 3: Comparison of sleep disturbance, vitality, and fatigue (mean±standard deviation) to recorded oral health status

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  Discussion Top


In this study, the association between disturbed sleep, fatigue, and vitality with dental caries was explored. A significant association was found between impaired sleep, impaired awakening, and vitality with nontreated caries (P < 0.05), which differs from the results of a similar study carried out by Dumitrescu et al., wherein no such significance was observed.[3] This might be because nonmedical individuals were selected in this study unlike the study by Dumitrescu et al., wherein the 1st-year dental students were selected who might be more conscious about the oral hygiene, and another reason can be that particular age group was not selected in our study.[3] A significant association between impaired sleep and perceived gingival condition was found which was in agreement with the results of a study conducted by Wiener, which might be because the individuals with disturbed sleep are less motivated for daily healthcare activities.[15] This reason might also hold true in cases where association between impaired sleep and dissatisfaction of individual with his own appearance of teeth was found positive. No significance was found between sleep disturbance, fatigue, and vitality with DMFT index of the individual which might be because the sample size of the present study was small. It was found that 8.6% of individuals with impaired sleep perceived their oral health poor because of variations in individual's perception of oral health. It was observed that individuals experiencing toothache and bleeding gums had significance with impaired sleep, impaired awakening, fatigue, and vitality (P < 0.05); this might be because the pain and discomfort experienced by the patient result in disturbed sleep which in turn results in fatigue and reduced vitality.

A significant association was observed between disturbed sleep and impaired awakening with current extraction this might be because of the complications arising from the extraction, tooth extracted, and reason for tooth extraction. No association was observed between perceived oral health with disturbed sleep, impaired awakening, and fatigue as observed in the study by Dumitrescu et al., wherein positive association was found between these entities which might be due to the difference in individual's perception.[3]

On comparing oral health behaviors, association between frequency of brushing, flossing, and last dental visit with impaired sleep was observed which might be because individuals with impaired sleep are less inclined toward self-care and day-to-day activities.

Limitations

The data collected were based on the information given by the individuals, and no medical tests were done because of which the reliability of the data obtained is questionable. Only dental caries was assessed and not overall oral health due to limited period and resources. Finally, DMFT index was used in our study which can be a biased index due to its various limitations.[21]


  Conclusion Top


Various significant associations were observed between oral health behaviors, self-reported oral health status with disturbed sleep, impaired awakening, vitality, and fatigue suggesting the need for improvement between interdisciplinary. An individual's lifestyle, health care habits, and behavior have an impact on overall well-being of the person, and therefore, lifestyle information should be included in clinical practice. At this point, it is essential for our education to impart message regarding significance of regular exercise and physical and mental health. Moreover, oral health education should be integrated into general public health awareness programs, camps, and workshops for welfare of the individual as a whole.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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