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 Table of Contents  
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 593-600

Prevalence of dental caries and their relation to oral health impact profile (OHIP-14) among national contact sports athletes: a cross-sectional study

1 Centre for Restorative Dentistry Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Selangor, Malaysia
2 National Sports Medicine Centre, Institut Sukan Negara (ISN), Kuala Lumpur, Malaysia
3 Department of Orthopaedics and Traumatology, Hospital Sungai Buloh, Sungai Buloh, Selangor, Malaysia

Date of Submission07-Jul-2021
Date of Decision01-May-2021
Date of Acceptance27-Sep-2021
Date of Web Publication30-Nov-2021

Correspondence Address:
Dr. Aiemeeza Rajali
Centre for Restorative Dentistry Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), 47000 Sungai Buloh, Selangor.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JIOH.JIOH_162_21

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Aim: The prevalence of caries is a valuable index used for determining and monitoring the oral health status among the population and in general believed to be impactful towards the quality of life. The study aimed to determine decayed (D), missing (M), and filled (F) teeth index and its relation to the quality of life among national contact sports athletes. Materials and Methods: A total of 84 national athletes of age 18–36 years old were recruited by cluster sample method from rugby, silat, and hockey teams of the National Sports Institute of Malaysia. The intraoral examination was done for Decayed–Missing–Filled (DMFT) index using World Health Organization’s criteria and the Oral Health Impact Profile (OHIP-14) tool was distributed for oral health-related quality of life (OHRQoL). The collected data were analyzed using t-test, analysis of variance, and Pearson statistics. Results: From this study, 77.62% of athletes reported a prevalence of dental caries with a moderate mean DMFT index of 2.79 ± 2.87. On the basis of OHIP-14, most athletes (85.71%) reported a low impact level with mean 9.036 ± 7.635. The Pearson correlation showed that missing (M) (r = 0.324, P = 0.003) and total DMFT (r = 0.261, P = 0.017) had a significant positive relationship with the total OHIP-14. It affected the OHIP-14 domains of social disability, handicap, psychological discomfort, and psychological disability (P < 0.05). Conclusion: The prevalence of caries among contact sports athletes is ongoing toward remarkable improvement. However, missing (M) and total DMFT were found to be a significant impact on the OHRQoL of athletes. Hence, it is important to impart preventive measures for dental caries that will attribute to the quality of life.

Keywords: Athlete, Caries, DMFT Index, OHIP-14, Oral Health-related Quality of Life

How to cite this article:
Mohd Shaharuddin I, Rajali A, Nik Zulkifeli NR, Hussein KH, Wan Hamat NH, Abu Hassan MI. Prevalence of dental caries and their relation to oral health impact profile (OHIP-14) among national contact sports athletes: a cross-sectional study. J Int Oral Health 2021;13:593-600

How to cite this URL:
Mohd Shaharuddin I, Rajali A, Nik Zulkifeli NR, Hussein KH, Wan Hamat NH, Abu Hassan MI. Prevalence of dental caries and their relation to oral health impact profile (OHIP-14) among national contact sports athletes: a cross-sectional study. J Int Oral Health [serial online] 2021 [cited 2022 Aug 10];13:593-600. Available from:

  Introduction Top

Oral health is not only the absence of caries, gingival disease, tooth loss, or oral pain, but also potentially responsible for causing the inability of a person to function normally. Oral health-related quality of life (OHRQoL) impacts people’s comfort when eating, sleeping, and engaging in social interaction and their satisfaction with respect to their oral health.[1] Assessment is performed by studying how factors such as function and pain, as well as psychological and social aspects, affect the wellbeing of an individual. Therefore, a holistic approach in health care that is related to a patient’s quality of life should be implemented. Because of the significant impact of oral health on quality of life, it has been placed as the public health priorities including for athletes. One of the main factors affecting oral health is the prevalence of dental caries, which can be objectively, measured using the Decayed–Missing–Filled (DMFT) index. Moreover, this index has been used internationally used as a tool for determining oral health status and monitoring intervention programs for the community’s health.[1],[2]

Common dental caries presentations are pain, uncomfortable feeling, and severe disturbances caused by pulp-related pain, root caries, and abscess. Pain results from diseases or conditions such as caries, pericoronitis, and periodontal disease could lead to poor athletic achievements.[3] A study in Thailand found 85% of professional soccer players had caries with an average 10.8 DMFT score and affects the players during training.[4] The performance of athletes is crucial and oral health should not hinder it. Yapıcı et al.[5] confirmed that with increased DMFT scores, the physical performance of male athletes compromised because of the impact on the speed and physical agility, and yielded poor performances from the athletes. Studies conducted at Rio de Janeiro, which involved athletes who qualified for Olympic and Paralympic Games, documented that, based on oral examination and quality of life assessment, 43% of the athletes required dental care.[6] In a different study, Needleman et al. found that athletes were in a state of distress regarding their oral health, of which 28% claimed that it affects their wellbeing. Apart from that, 18% stated that their oral health disturbed their training and their performance.[7] Moreover, these studies had shown that impaired oral health does affect sporting performance.[4],[5],[6],[7]

The Oral Health Impact Profile (OHIP)-14 is the predominant tool used to quantify people’s perceptions of the social affects of dental diseases on their wellbeing.[8],[9] It also represents the consequences of oral diseases affected on the quality of life. The OHIP-14 reliability and validation were displayed in previous studies and translated into several languages, including Malay.[8],[9],[10] Although there were few local studies had been done among adults in Malaysia, none had conducted on dental caries experience and impacts among national athletes.[8],[10] Dental caries are preventable by an early diagnosis, risk assessment, education, and preventive care measures.[3],[5],[6],[7] Thus, recognizing that oral health problems along with the impact of OHRQol can be helpful in planning and targeting oral health programs for national athletes. With the continuous achievement of Malaysian national athletes and representation at the international level, hence focusing on the potential risk to their performance should be importantly addressed. In addition, this athlete’s group is an important population because they are influential people in the community.

The aim of this study was to investigate the oral health status using the DMFT index and relation with OHRQoL among national contact sports athletes.

  Materials and Methods Top

Setting and design

This study was a cross-sectional study conducted on national athletes in Malaysia who were involved in contact sports. Data collection was carried out via clinical examination and dissemination of the questionnaire at the Sports Medicine Centre, National Sports Institute of Malaysia (Institut Sukan Negara) from January 2020 to March 2021. The sample size was calculated based on the prevalence of national athletes involved with contact sports in Malaysia and the previous study.[4],[11] Sample calculation was performed using G power software version with α set to 0.05 and power set to 85% and 27 participants in each group were chosen after taking consideration of 5% dropout.[11] Via the cluster sampling method, a total of 84 national athletes were selected from rugby, hockey, and silat (martial arts) teams and consented to participate. The inclusion criteria for this study were must be 18 years or older athletes, competitive in contacts sports, and understand English or Malay. They were excluded if they have lesser than 20 teeth.

Dental caries experience

Teeth charting was conducted via intraoral examination by two qualified prosthodontists and DMFT index was recorded via an individualized examination and diagnosis form. Inter-examiner reliability was assessed by replicated examination of 10 athletes and found to be in perfect agreement with the Cohen kappa coefficient at the value of 0.997. Examination and calculation of the number of teeth decayed (D), missing (M), and filled (F) caused by caries was performed on 32 teeth for each athlete and the DMFT score was then calculated. The maximum score of the DMFT index is 32, where a higher score indicates an increased number of dental caries. The DMFT index was according to WHO classification into very low (0–1.1), low prevalence (1.2–2.6), moderate prevalence (2.7–4.4), high prevalence (4.5–6.5), and very high prevalence when the DMFT is greater than or equal to 6.6.[1],[2],[11]

Oral health impact profile

QHRQoL was then determined using the short version Oral Health Impact Profile (OHIP-14) tool. The questionnaire, printed in both English and Malay, was distributed to the athletes. A total 14-item questionnaire in OHIP-14 evaluated seven impact dimensions are as follows: functional limitation, physical pain, psychological discomfort, physical disability, social disability, and handicap.[8] A five-point Likert scale was used for responses, coded as follow: 0 = never; 1 = seldom; 2 = sometimes; 3 = quite often; and 4 = very often. The summation of all the values for the 14 questions was calculated, and the total values were ranged from 0 to 56, where higher scores denoted worse OHRQoL whereas lower scores denoted a better OHRQoL.[9] Scores were categorized according to impact level in this sample’s population into low (0–18.9), moderate (19–37.9), or high impact (38–56). Impact scores for individual domains were calculated using the mean score for each subject.

Statistical analysis

In this study, all data were organized and analyzed using MS Excel (Microsoft Office, Windows 2007, USA) and SPSS ver. 27 for Windows (SPSS Inc., Chicago, IL, USA). Differences were considered significant when the P value was less than 0.05. The collected data were described in frequency and mean with standard deviation. Using a t-test and ANOVA, the DMFT index and OHIP-14 items were compared at different levels of independence. The correlation between the variables was evaluated.

  Results Top

Athletes demographics

A total of 84 national athletes of age 18–36 years (mean = 22.98 ± 4.072 years) were recruited in this study, of whom 60.71% (n = 51) were male and 39.29% (n = 33) were female. In terms of contact sports activity, 36% of participants were rugby athletes, 21% were silat athletes and 43% were hockey athletes, as shown in [Figure 1].
Figure 1: Number of athletes by different type of contact sport

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DMFT index in relation to gender and contact sports

Overall, 72.62% (n = 61) reported a prevalence of dental caries with the DMFT range from 0 to 13. Of these, 46.43% (n = 39) had a DMFT score less than 2.0, 16.67% (n = 14) between 2.0 and 3.0 and 36.9% (n = 31) with score greater than 3.0. [Table 1] shows that, of the total athletes in this study, the mean DMFT score for male participants was higher than for female participants. Regarding the type of contact sports, the highest mean score for DMFT score is 3.22 ± 2.768 for hockey athletes, followed by rugby with a score of 2.47 ± 2.980 and silat athletes with a score of 2.44 ± 2.935. However, there was no significant difference found between the athlete categories (P > 0.05).
Table 1: Characteristic variables and Mean of decayed (D), missing (M), filled (F), and DMFT index

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OHIP-14 in relation to gender and contact sports

The reported range of the OHIP-14 impact was between 0 and 31 with an average total OHIP-14 of 9.036 ± 7.635. As shown in [Table 2], the mean total OHIP-14 score for males was lower than for female athletes. Of all the athletes, 85.71% (n = 72) had low OHIP-14 impact, 14.29% (n = 12) had moderate impact, and none had high impact. Rugby athletes had the highest total OHIP-14 score followed by hockey and silat athletes; however, this difference was not significant, as the (P > 0.05). [Table 3] shows the prevalence of the OHIPs-14’s reported domains and mean severity score.
Table 2: Characteristic variables and total OHIP-14 scores

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Table 3: Prevalence of impact and mean severity score for each OHIP-14 item (total N = 84)

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It is observed that domains of physical pain and psychological discomfort domains were most affected in the OHIP-14. The highest mean subscale score for male participants was 1.24 ± 0.951 for OHIP-14 question 5, whereas the highest mean for the female participants was recorded at 1.30 ± 0.918 for question number 4. The lowest mean score for male participants was 0.29 ± 0.610 and the lowest mean score for female participants was 0.27 ± 0.719 under question 13. There was a significant difference for question 6, which falls under the psychological discomfort domain (P < 0.05), as presented in [Table 4]. As shown in [Table 5], rugby athletes had the highest mean score for question 5 (1.50 ± 1.009), followed by silat athletes in question 4 (1.17 ± 1.098), and hockey athletes in question 5 (1.08 ± 0.906). However, there was no significant difference in OHIP-14 mean severity among the sports groups.
Table 4: Mean severity score of OHIP-14 questions according to gender

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Table 5: Mean severity score of OHIP-14 questions according to the type of contact sports

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DMFT index and relationship with total OHIP-14 on the study populations

Based on the data presented in [Table 6], a Pearson correlation revealed that the Missing (M) (r = 0.324, P = 0.003) and total DMFT (r = 0.261, P = 0.017) had a significant positive relationship with the total OHIP-14 score. These two parameters did affect the OHIP-14 domains of social disability, handicap, psychological discomfort, and psychological disability domains, as shown in [Table 7]. It was indicated that there was a positive moderate correlation between the occurrence of dental caries and OHRQoL of athletes in the study population.
Table 6: DMFT index in relation to total OHIP-14 score

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Table 7: Association between missing (M) and DMFT in relation to mean severity score for each OHIP-14 question

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  Discussion Top

The present study demonstrated the relationship between oral health and quality of life among Malaysian athletes. The differences in oral health status among athletes are different among countries or regions and may be indirectly influenced by the topographic area. A previous survey that was performed between 2002 and 2010, reported that the national mean DMFT in population of age of 15–19 was 2.24 in Thailand, 2.9 in Malaysia, 3.57 in South Korea, and 2.3 in Turkey.[12] The World Health Organization (WHO) indicated that the global goal of DMFT values is 3 or less for the whole population. In reference to the WHO classification, the severity of the DMFT index for both male and female athletes in this study was categorized as moderate prevalence, which is below 4.4.[1] According to the National Oral Health Plan for Malaysia, there has been a reduction in the mean DMFT index from 6.9 in 1990 to 4.4 in 2000 for the age group 20–24. The goal of the National Oral Health Plan for 2011–2020 is to ensure caries-free in 50% of 16 years old population and 0% edentulous among adults of age 35–44. On top of that, they are aiming to reduce the mean DMFT to 2.[12],[13] The results of the current study indicate that Malaysian athletes have achieved the WHO target, and overall that the country is progressing toward the Malaysian national target. This current trend of remarkable decline in prevalence, experience, and incidence of caries is also being borne out in several other countries.[2],[12]

Male athletes were found to have higher DMFT scores than female athletes. Similar to a cross-sectional study conducted on students in sports faculty in Chennai, the mean DMFT was recorded at 2.23 ± 3.01 for the male students and 1.87 ± 0.62 for female students.[14] Shaffer et al.[15] stipulated that this is due to women having better and appropriate dental care than men. During training, the consumption of sports drinks and foods during training sessions were found to be the factors contributing to the increased risk for caries formation and dental erosion due to their dietary habit.[14],[16] However, from this study, the OHIP scores were found to be higher in female athletes. This suggests that females have a higher tendency to be concerned about any issues inside their oral cavity and aware of any sort of discomfort that happens in their oral cavity.[17] This implies that women are more affected by the problems in the oral cavity than men.

Among the seven domains under OHIP, the domains of physical pain and psychological discomfort had the two highest mean impact scores among the study population. The pain experience is one of the fundamentals that suggest poor OHRQoL status.[18] In our opinion, this may be due to the issues related to the athlete’s experiences particularly in the number of caries, missing, as well as filled teeth. However, the total OHIP-14 score of the athletes in this study was below 18.9, which suggests the impact is mild and in agreement with previous studies.[8],[10],[19] Generally, young adults are considered to have good oral health and reported OHIP depends on their expectations. Hence, the athletes with poor oral health and low expectations may misinterpret, consequently report themselves as not having problems.[8],[19] Our study included three contact sports athletes and from the mean OHIP score, the highest is rugby athletes, second is hockey athletes and followed by silat athletes. These contact sports can result in traumatic dental injuries among athletes, which will ultimately result in an extensive impact on their OHRQoL.[20] Pain, discomfort, and tooth discoloration, especially affecting the anterior teeth, are the consequences of traumatic dental injuries. At times, these will result in an athlete’s lack of confidence in their image, affecting their communication with others because they will try not to smile, laugh or speak and show their teeth to others.[19]

On the basis of the correlation test conducted in between decayed (D), missing (M), and filled (F) teeth in relation to the OHIP score, a positive correlation between missing (M) teeth, DMFT with the quality of life were found. An earlier study found that the quality of life level will worsen as the number of teeth lost increases.[21] The result of another study supports this finding and further specify that those who lose a minimum of one tooth in the anterior segment experienced a greater impact on their quality of life than those who lose one tooth in the posterior segment.[21],[22] In addition, the number of missing teeth significantly impacts one’s quality of life, and poorer OHRQoL is denoted by a higher number of missing teeth.[21] However, only missing (M) teeth were found to be correlated with the impact level in the current study, perhaps because they are at advanced disease stages accompanied by tooth replacement, and that was a rare event among these healthy athletes.

As shown in the results, the domains affected by missing teeth are psychological discomfort, social disability, and handicap. This evidence is supported by Mack et al., who deduced that tooth loss is associated with a physical handicap and social disability especially if the tooth is in the upper anterior segment, as this affects their participation in social activities.[23] Nonetheless, functional limitations and psychological setbacks are among the consequences faced by people with missing teeth or partially edentulous due to their inability to chew properly, leading to dissatisfaction with their teeth or mouth.[21],[22],[23],[24]

Previously, there had been studies conducted among soccer and triathlon athletes respectively in Thailand and Germany using DMFT as standardized diagnosing tools and relation toward quality of life.[4],[25] However, both of these studies failed to find the relationship between oral health status and quality of life due to the small sample size.[4],[25] Differently, this present study shows the impact of missing teeth due to caries on the quality of life among national contact sports athletes. Missing teeth are sequelae end of dental caries and the risk factors towards the progression of the caries are preventable.[21],[22] Thus, to determine the prevention, the consequences of caries, and diagnosis and treatment, there is a need for early detection by specialized professionals.[7],[25] However, at this moment, to the best of our knowledge, no team dentist at the sports center to provide early prevention for these athletes. The practice of sports in high-performance athletes is shown affected by the needs of healthy individuals.[7],[25] Therefore, it is highly important to keep the athletes healthy thus they do not have issues during training and competition. Thus, this present study has a relevant strength as the finding had provided us with knowledge regarding the impact of caries on the athletes and the importance of early intervention to prevent loss of teeth.

As for limitations, the convenience sampling used in the present study may have caused unintended bias in the selection of participant since the survey was voluntary, which make the generalize difficulty and specific towards certain sports activities. However, information obtained from the present study is beneficial as a basis for understanding the impact of caries on the quality of life among contacts sports athletes. Other oral examination and records of the dietary habit of contacts sports athletes may be investigated in further studies as it may further cofounded influence quality of life among contact sports athletes.

  Conclusion Top

The mean DMFT score for male athletes was higher than the mean DMFT for female athletes. Apart from that, we can conclude there is a moderate positive correlation between the occurrences of DMFT with total OHIP-14 score among national contact sports athletes in Malaysia. Missing (M) teeth worsen the OHRQoL among national athletes and are dominant in psychological discomfort, social disability, and handicap. Therefore, we recommend that athletes must undergo routine dental check-ups or obtained necessary dental treatment to prevent the worsening of caries and improve their quality of life.


We express our sincere appreciation to the National Sports Medicine Centre’s staff for helping us with all the arrangements. We also greatly appreciate the participation of the 84 athletes for their cooperation and willingness to help with this project.

Financial support and sponsorship

The authors would like to express gratitude to the Ministry of Education Malaysia for the funding supported under National Grant FRGS-RACER (RACER/1/2019/SKK14/UITM/1).

Conflicts of interest

The authors declare that is no conflict of interest.

Authors’ contribution

IMS: the conception of the study, data collection, data acquisition and analysis, manuscript draft, and revision; AR: the conception of the study, data collection, data acquisition and analysis, revision, and final reviewing; NRNZ: data collection, data acquisition and revision, and final reviewing; KHH and NHWH: data collection and data acquisition; MIAH: Advisor, revision, and final reviewing. Finally, all authors approved the final version of the manuscript for publication.

Ethical policy and institutional review board statement

The protocol of this research was approved by the Research Ethics Committee of Universiti Teknologi MARA (UiTM) (REC/713/19) and the Human Ethics Committee of National Sports Institute of Malaysia (ISNM.600–4/1/26 (2)).

Patient declaration of consent

The authors certify that they have obtained all appropriate athletes’ consent forms. In the form, the athletes have given his/her consent for his/her other clinical information to be published. They understand that their names and initials will not be published to conceal their identity.

Data availability statement

Data can be obtained on written correspondence to the corresponding author on a valid request.

List of Abbreviations

ANOVA Analysis of Variance

DMFT Decayed (M), Missing (M), Filled (F) Teeth

OHRQoL Oral Health-Related Quality of Life

OHIP Oral Health Impact Profile

WHO World Health Organization

  References Top

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  [Figure 1]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]


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