AN ASSESSMENT OF THE IMPACT OF DENTAL CARIES AND ITS MANAGEMENT ON THE QUALITY OF LIFE AMONG ADOLESCENTS IN BENIN, NIGERIA

CHAPTER ONE INTRODUCTION 1.1 Background of the Study Adolescents represent a vital demographic within global public health, and addressing their health needs is key to achieving sustainable well-being outcomes. A quality of life (QoL) framework has become instrumental in enhancing the understanding of adolescent health and guiding the formulation of policies that support their overall development (Xavier et al., 2021). The dialogue surrounding the link between health and quality of life highlights it as a socially constructed concept, grounded in individual and group-based perceptions of well-being, happiness, and personal aspirations that align with the specific needs of a given population (Sanchez, 2020). Oral or dental health-related quality of life refers to the extent to which oral diseases affect an individual's daily functioning (Chen et al., 2019). Oral health, as a multifaceted concept, encompasses a range of physiological and psychological dimensions and is now widely recognized as an integral component of general health and well-being. It provides insights into patients’ subjective experiences with oral healthcare and plays a crucial role in identifying and addressing their care needs (Singh et al., 2021). The broader impact of poor oral health is reflected in the limitations it places on individuals' functional capacities and their ability to perform expected social and academic roles. In particular, oral conditions such as dental caries have been found to contribute to increased school absenteeism and decreased academic performance among children and adolescents (Matthew et al., 2020). Dental caries remains one of the most prevalent and persistent public health challenges globally, particularly among the youth population (Singh et al., 2021). According to Xian et al. (2017), the global prevalence of dental caries in permanent teeth among adolescents aged 12–19 years is approximately 34.1%. Adolescents are particularly vulnerable to this condition due to poor adherence to preventive behaviours, including irregular dental visits and suboptimal oral hygiene practices (Sebastian, 2019). The success of preventive strategies is further constrained by a lack of public awareness, sociocultural influences, and limited access to professional oral healthcare services (Singh et al., 2021). Basil (2020) asserts that gender differences play a substantial role in shaping adolescents' oral health behaviours, with female adolescents generally exhibiting more proactive preventive habits and greater concern for physical appearance than their male counterparts. This disparity is often reinforced by cultural norms that place higher emphasis on cleanliness and personal aesthetics for girls (Hammond et al., 2020), whereas boys tend to prioritise other aspects of physical health, leading to less engagement in oral hygiene practices (Singh et al., 2021). The incidence of dental caries in permanent dentition typically peaks during adolescence—a life stage marked by significant psychological and social vulnerability—which may result in long-term adverse consequences if left untreated (Singh et al., 2021). Adolescents suffering from poor oral health may experience pain, tooth loss, impaired oral function, facial disfigurement, missed school days, and, in severe cases, increased mortality risk from oral cancers. These issues collectively diminish their quality of life and adversely affect their future opportunities (Marshal, 2019). In Nigeria, the prevalence of periodontal diseases among adolescents aged 15 years and above ranges from 15% to 58%, with profound implications for their overall well-being (Adedigun & Emeka, 2022). Furthermore, recent data suggest that the prevalence of dental caries among Nigerian adolescents may be as high as 80%, a stark contrast to the approximate 35% prevalence observed in the United Kingdom (Abayomi et al., 2022). Dental caries, also known as tooth decay, is a chronic disease that presents serious public health challenges worldwide, particularly during adolescence. It not only affects physical health but also impacts mental and social well-being (Abayomi et al., 2022). In Benin City—the capital of Edo State in southern Nigeria—there is a large and growing adolescent population navigating a critical developmental stage. Here, the burden of dental caries remains significant, exacerbated by limited access to oral healthcare and insufficient public awareness regarding oral hygiene (Sanusi, 2023). Investigating the effects of dental caries and its treatment on adolescents' quality of life is essential for informing the design of targeted health policies and interventions. Hence, this study is both timely and necessary. 1.2 Statement of the Problem Despite advances in dental care and treatment methods, a considerable number of adolescents in Benin continue to suffer from untreated dental caries. This condition adversely affects various aspects of their daily lives, including persistent pain, difficulty eating, emotional distress, and reduced self-esteem—all of which can hinder academic performance and social development. There is a critical need to assess the full extent of these impacts and evaluate the adequacy of existing health interventions to improve adolescent oral health outcomes. One promising strategy is the integration of oral health into Nigeria's broader community health initiatives. Significant investments have already been made in training community health workers to enhance public health education and promote preventive care (Bode et al., 2019). Advocating for the inclusion of oral health within these efforts is essential—especially the reinforcement of proper oral hygiene practices, such as brushing twice daily (Amadi et al., 2021). Such campaigns could also aim to reduce frequent consumption of refined carbohydrates between meals and encourage adolescents to seek preventive dental care rather than waiting for dental problems to arise. Currently, the primary reason most adolescents seek dental services is to address existing issues, rather than to prevent them. This reflects a general lack of understanding regarding the benefits of preventive oral health care (Mba, 2021). Barriers to accessing dental services in Nigeria include high costs, inadequate infrastructure, and cultural attitudes that discourage preventive healthcare (Chima, 2019). A multifaceted strategy is essential to reducing the incidence of dental caries in a country where the oral healthcare system is limited, underutilized, and lacking in a preventive focus. Additionally, research shows that dental service utilisation among Nigerian adolescents remains low (Julius et al., 2023). The majority seek dental attention only when a problem arises, with limited awareness about preventive care options (Mba, 2021). Challenges such as high treatment costs, geographical barriers, and cultural resistance to preventive care continue to limit access and contribute to the persistence of dental caries (Ekpenyong et al., 2023). A comprehensive approach is therefore critical to reversing the rising trend of caries among adolescents in Nigeria—especially in areas where oral health education and resources are scarce. Moreover, given the increasing rates of poverty in Nigeria, it is not uncommon for families to resort to using fluoride-free toothpaste or to limit brushing to once a day. These practices significantly increase the risk of tooth decay among vulnerable adolescents (Silas & Iniubong, 2023). It is imperative that the dental health community initiate proactive campaigns advocating for the use of fluoride-containing toothpaste and the adoption of consistent brushing habits twice a day. This study was thus prompted by the urgent need to examine and address these pressing issues. 1.3 Objectives of the study The primary objective of this study is to critically analyse the Impact of Dental Caries and Its Management on the Quality of Life Among Adolescents in Benin, Nigeria. Specific objectives of this study are to: i.To assess the prevalence of dental caries among adolescents in Benin, Nigeria. ii.To explore the factors associated with dental caries among adolescents in Benin, Nigeria. iii.To investigate the impact of untreated dental caries on the oral health-related quality of life of adolescents in Benin, Nigeria iv.To identify barriers to accessing dental care and treatment among adolescents in Benin, Nigeria. v.To propose recommendations for improving dental health education and oral health promotion among adolescents in Benin, Nigeria 1.4 Research Questions The following research questions will be answered in this study: i.What is level of prevalence of dental caries among adolescents in Benin, Nigeria? ii.What are the factors associated with dental caries among adolescents in Benin, Nigeria? iii.What is the impact of untreated dental caries on the oral health-related quality of life of adolescents in Benin, Nigeria? iv.What are the barriers to accessing dental care and treatment among adolescents in Benin, Nigeria? v.What are the recommendations for improving dental health education and oral health promotion among adolescents in Benin, Nigeria? 1.5 Research Hypotheses The following research hypotheses are formulated to guide the study: Ho: There is no significant impact of untreated dental caries on the quality of life of adolescents in Benin, Nigeria. Ha: There is significant impact of untreated dental caries on the quality of life of adolescents in Benin, Nigeria. 1.6 Significance of the study This study is important since it focuses on the prevalent problem of dental caries among adolescents, emphasising its influence on their quality of life. The project seeks to enhance public health policies and dental care practices in Benin and similar contexts by comprehending the specific obstacles and assessing the efficacy of existing treatments. This will ultimately lead to improved health outcomes for adolescents. Moreover, the study's findings can provide policymakers with valuable guidance in creating focused oral health programmes and policies that give priority to the oral health of adolescents. This encompasses enhancing the availability of dental care services and incorporating oral health into wider healthcare programmes.  Furthermore, the study can enhance community involvement in oral health promotion initiatives by increasing awareness about the significance of oral health among adolescents and their carers. This can promote a nurturing atmosphere for long-term enhancements in oral health. The findings obtained from this study can provide valuable information for developing targeted preventive measures for adolescents in Benin. Encouraging good oral hygiene habits and scheduling frequent dental examinations can effectively prevent dental caries and the negative consequences it has on one's quality of life. In addition, improving the comprehension, convictions, and actions concerning oral health in secondary school pupils can lead to long-lasting health benefits. Optimal oral hygiene is linked to overall well-being, including improved nutrition, clear communication, and greater social interaction. Timely intervention in oral health issues might mitigate the economic burden associated with the management of intricate dental disorders. Finally, this research enhances the existing knowledge on oral hygiene habits among adolescents, specifically within the Nigerian setting. This research can provide a basis for future investigations into many elements of oral health education and behaviour among different age groups and populations. 1.7 Scope of the study Broadly, this study focus is to critically analyse the Impact of Dental Caries and Its Management on the Quality of Life Among Adolescents in Benin, Nigeria. Specifically, this study seeks assess the prevalence of dental caries among adolescents in Nigeria, explore the factors associated with dental caries among adolescents in Nigeria, investigate the impact of untreated dental caries on the oral health-related quality of life of adolescents in Nigeria, identify the barriers to accessing dental care and treatment among adolescents in Nigeria and it also offer recommendations for improving dental health education and oral health promotion among adolescents in Nigeria. The study is carried out in Benin, Edo state. The respondents of this study are adolescents within the age of 12 to 15 years old. 1.8 Limitations of the study As with any human endeavor, the researchers faced many minor constraints during the investigation. The main limitation was the lack of extensive literature on the subject, due to the limited availability of data regarding impact of dental caries and its treatment on the quality of life of adolescents in Benin, Nigeria. Hence, a significant allocation of time and exertion was necessary to ascertain the appropriate materials, books, or information and amass data.  Furthermore, this study is constrained by its small sample size and narrow geographical scope, focusing solely on Benin, Edo state. Therefore, the conclusions of this study cannot be extended to other situations, thus requiring further investigation.  Moreover, the researcher's restrictions were mostly due to financial constraints, as they are a student without any source of income to sustain themselves. The exorbitant transportation costs at the research location, exacerbated by the prevailing inflation in Nigeria, posed a significant challenge in meeting the expenses associated with transportation. Furthermore, the researcher faced a time constraint due to the need to do this research while still fulfilling the obligations of attending lectures and participating in other educational activities. 1.9 Definition of terms Oral disease: Oral diseases encompass a range of diseases and conditions that include dental caries, periodontal (gum) disease, tooth loss, oral cancer, oro-dental trauma, noma and birth defects such as cleft lip and palate. Oral health: Oral health is the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompasses psychosocial dimensions such as self-confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment. Dental caries: Dental caries, or dental decay, is an infectious condition that deteriorates the structure of teeth. The most common result of dental caries is a cavity—a hole or space in the teeth. Without proper treatment, dental caries can cause pain, tooth loss—and in rare cases when the infection spreads to the brain—even death.