Psychosocial and Behavioral Aspects of Pain and Perception of Oral Health

Aims: To evaluate the contribution of the psychosocial and behavioral aspects of pain to the perception of oral health in a sample of Brazilian dental patients. Methods: This cross-sectional study involved 436 patients who sought dental care in the School of Dentistry of São Paulo State University and who reported some type of orofacial pain. The study group’s mean age (± standard deviation [SD]) was 39.9 ± 13.6 years, and the sample was 74.5% female. The Portuguese version of the Oral Health Impact Profile Short Form (OHIP-14) and the Multidimensional Pain Inventory (MPI) were used. The data were included in a structural equation model in which perception of oral health was considered the dependent variable. The evaluation of the contribution of psychosocial and behavioral aspects of pain to the perception of oral health was based on the statistical significance of causal paths (β) evaluated by z tests (α = 5%). Results: The fit of the models of OHIP-14 and MPI were adequate. Interference, self-control, negative mood, and punishing responses provided significant contributions to the perception of oral health. The structural model presented adequate fit to the data (explained variance = 28.0%). Conclusion: These findings provide evidence that psychosocial and behavioral aspects of pain such as interference of pain in activities, self-control, negative mood, and punishing responses contribute to the perception of oral health.

facial pain; oral health; pain; perception; psychosocial impact

1. Wan KY, McMillan AS, Wong MC. Orofacial pain symptoms and associated disability and psychosocial impact in community-dwelling and institutionalized elderly in Hong Kong. Community Dent Health 2012;29:110–116.

2. Mashoto KO, Astrøm AN, David J, Masalu JR. Dental pain, oral impacts and perceived need for dental treatment in Tanzanian school students: A cross-sectional study. Health Qual Life Outcomes 2009;7:73.

3. Fordyce WE. Behavioural science and chronic pain. Postgrad Med J 1984;60:865–868.

4. Magnusson JE, Becker WJ. Migraine frequency and intensity: Relationship with disability and psychological factors. Headache 2003;43:1049–1059.

5. da Silva JA, Ribeiro NP. Avaliação e Mensuração de Dor Pesquisa, Teoria e Prática. Ribeirão Preto, Brazil: Funpec, 2006.

6. Ulinski KG, do Nascimento MA, Lima AM, et al. Factors related to oral health-related quality of life of independent Brazilian elderly. Int J Dent 2013;2013:705047.

7. Yang SE, Park YG, Han K, Min JA, Kim SY. Dental pain related to quality of life and mental health in South Korean adults. Psychol Health Med 2016;21:981–992.

8. Turk DC, Okifuji A. Psychological factors in chronic pain: Evolution and revolution. J Consult Clin Psychol 2002;70: 678–690.

9. Alonso J, Vilagut G, Adroher ND, et al. Disability mediates the impact of common conditions on perceived health. PLoS One 2013;8:e65858.

10. de Waure C, Soffiani V, Virdis A, Poscia A, Di Pietro ML. Italian university students’ self-perceived health and satisfaction of life. Ann Ist Super Sanita 2015;51:121–125.

11. Locker D, Clarke M, Payne B. Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population. J Dent Res 2000;79:970–975.

12. Gaston-Johansson F, Johansson G, Felldin R, Sanne H. A comparative study of pain description, emotional discomfort and health perception in patients with chronic pain syndrome and rheumatoid arthritis. Scand J Rehabil Med 1985;17:109–119.

13. Kumar MS, Barnah D, Roy AS. Perceived health and hygiene practices of elderly living in a slum of Delhi: A preliminary survey. Ind J Gerontol 2015;29:100–108.

14. Iversen VC, Sam DL, Helvik AS. Psychological distress and perceived health in inmates in Norwegian prisons. Scand J PublicHealth 2014;45:171–176.

15. Slade GD, Spencer AJ. Development and evaluation of Oral Health Impact Profile. Community Dent Health 1994;11:3–11.

16. Zucoloto ML, Maroco J, Campos JA. Psychometric properties of the Oral Health Impact Profile and new methodological approach. J Dent Res 2014;93:645–650.

17. Slade GD. Derivation and validation of a short-form Oral Health Impact Profile. Community Dent Oral Epidemiol 1997;25: 284–290.

18. Daut RL, Cleeland CS, Flanery RC. Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain 1983;17:197–210.

19. Kerns RD, Turk DC, Rudy TE. The West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain 1985;23: 345–356.

20. Boggero IA, Carlson CR. Somatosensory and affective contributions to emotional, social, and daily functioning in chronic pain patients. Pain Med 2015;16:341–347.

21. Soler MD, Cruz-Almeida Y, Saurí J, Widerström-Noga EG. Psychometric evaluation of the Spanish version of the MPI-SCI. Spinal Cord 2013;51:538–552.

22. Zucoloto ML, Maroco J, Duarte Bonini Campos JA. Psychometric properties of the Multidimensional Pain Inventory appliedto Brazilian patients with orofacial pain. J Oral Facial Pain Headache 2015;29:363–369.

23. Lemos MMC, Zanin L, Jorge MLR, Florio FM. Oral health conditions and self-perception among edentulous individuals with different prosthetic status. Braz J Oral Sci 2013;12:5–10.

24. Montero J, Castillo-Oyagüe R, Lynch CD, Albadejo A, Castaño A. Self-perceived changes in oral health-related quality of life after receiving different types of conventional prosthetic treatments: A cohort follow-up study. J Dent 2013;41:493–503.

25. de Moura WVB, Costa ICC, de Andrade FB, et al. Oral health and self-perception in the elderly. Health 2014;6:3045–3053.

26. Nunes CI, Abegg C. Factors associated with oral health perception in older Brazilians. Gerodontology 2008;25:42–48.

27. Locker D. Concepts of oral health, disease and the quality of life. In: Slade GD (ed). Measuring Oral Health and Quality of Life. Chapel Hill, NC: University of North Carolina, 1997:11–24.

28. Maroco J. Análise de Equações Estruturais: Fundamentos Teóricos, Software & Aplicações, ed 2. Lisboa: ReportNumber, 2014.

29. Associação Brasileira de Empresas de Pesquisa. Critério de Classificação Econômica Brasil. Dados com base no Levantamento Sócio Econômico, 2008.

30. Oliveira BH, Nadanovsky P. Psychometric properties of the Brazilian version of the Oral Health Impact Profile—Short form. Community Dent Oral Epidemiol 2005;33:307–314.

31. Kaplan D. Structural Equation Modeling: Foundations and Extensions. Thousand Oaks, CA: Sage, 2000.

32. Moffitt TE, Arseneault L, Belsky D, et al. A gradient of childhood self-control predicts health, wealth, and public safety. Proc Natl Acad Sci U S A 2011;108:2693–2698.

33. Duckworth AL. The significance of self-control. Proc Natl Acad Sci U S A 2011;108:2639–2640.

34. Fredrickson BL, Cohn MA, Coffey KA, Pek J, Finkel SM. Open hearts build lives: Positive emotions, induced through loving-kindness meditation, build consequential personal resources. J Pers Soc Psychol 2008;95:1045–1062.

35. Uchôa E, Vidal JM. Antropologia médica: Elementos conceituais e metodológicos para uma Abordagem da saúde e doença. Cad Saúde Publica 1994;10:497–504.