Perception of oral health and oral health-related quality of life among aviators in the armed forces: A cross-sectional study

INTRODUCTION

Oral health is a unique determinant of an individual’s overall quality of life influencing significantly the daily functioning, comfort, and psychosocial wellness. Unlike other clinical disease indicator parameters, the subjective impact of oral conditions on normal routine physiologic functions such as mastication, phonetics, and social interactions is increasingly established through the concept of oral health-related quality of life (OHRQoL).^[1] The oral health impact profile (OHIP) is a well-recognized and widely used community oral health tool used to measure OHRQoL. Since the original version was lengthy and complex, the adapted, simpler, and concise version abbreviated 14-item version (OHIP-14) is nowadays more widely used due to greater feasibility retaining robust validity in occupation-based population study models.^[2,3]

Military aviators represent a distinct occupational cohort exposed to aviation-specific physiological stresses, circadian rhythms altered due to operational tasks, and high cognitive/motor demands. Even minor dental problems such as sensitivity/pain due to dental decay may impair in-flight performance or trigger temporary grounding, with consequent operational and safety implications. Military and aerospace medicine literature therefore emphasizes proactive dental readiness and periodic dental screening.

Despite this operational imperative, empirical data addressing aviators’ perceptions of their oral health and the resultant effect on OHRQoL remain scarce. Evaluating these among aviators can help identify gaps in oral health awareness, preventive behaviors, and the need for targeted dental interventions. Such assessments using validated instruments like the OHIP-14 can assist in formulating tailored preventive and educational programs, ensuring sustained oral health and mission efficiency. This study, therefore, aims to assess the perception of oral health and OHRQoL among military aviators using the OHIP-14 questionnaire and to explore associations with occupational and behavioral factors.

MATERIAL AND METHODS

A cross-sectional descriptive study was conducted to assess the OHRQoL using OHIP-14 questionnaire among the military aviators across geographic deployment between November 24 and December 24. The study included military aviators aged between 25 and 60 years across services, aircraft streams, and geographic deployment. Aviators who provided informed consent were included in the study. Individuals with a history of recent trauma or surgery, diagnosed with uncontrolled systemic illness, malignancy, and those unwilling to participate were excluded.

RESULTS

The distribution of the respondent subjects based on demographic variables, smoking, dental problem status, and dental treatment status is summarized in Figures 1-4, respectively.

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Figure 1: Distribution of respondents by demographic variables. RPA: Remotely piloted aircraft, UAV: Unmanned aerial vehicle.

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Figure 2: Distribution of respondents by smoking status.

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Figure 3: Distribution of respondents by dental problem status.

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Figure 4: Distribution of respondents by dental treatment status.

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Around 64.2% were non-smokers and among those who smoked, the duration of smoking varied considerably.

The domain-wise mean OHIP-14 scores are summarized in Table 1. Among the seven components analyzed, the functional limitation (4.10 ± 1.89) recorded the highest mean score. Psychological disability (mean = 0.53 ± 1.17) and psychological discomfort (mean = 0.32 ± 0.73) had comparatively low scores. Six sigma limits were applied as an exploratory quality assessment framework to identify domains exceeding acceptable variation thresholds. When compared (Lower: 1.34; Mean: 1.61; Upper: 1.89), it was observed that functional limitation and physical pain scores exceeded the upper limit. The remaining domains were within the defined limits [Figure 5].

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Figure 5: Six sigma-based comparative distribution of oral health impact profile-14 domains.

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The association between overall OHIP-14 scores and baseline characteristics is presented in Table 2. A statistically significant increase in overall OHIP-14 scores was observed with advancing age (F = 9.62, p < 0.001) and increasing duration of service (F = 8.17, p < 0.001). Smoking status was also significantly associated with higher OHIP-14 scores (t = 1.99, p = 0.047). No significant association was observed between aircraft stream and overall OHRQoL.

The relationship between baseline characteristics and individual OHIP-14 domains is detailed in Table 3. Age and years of service showed significant associations with the domains of physical pain, functional limitation, and physical disability (p < 0.001). Smoking status was significantly associated with the psychological disability domain (p = 0.009), while other domain-wise associations were not statistically significant.

Spearman’s correlation analysis demonstrated significant positive correlations among multiple OHIP-14 domains [Table 4]. Strong correlations were observed between physical pain and physical disability (p = 0.651), physical pain and functional limitation (p = 0.542), and between physical disability and handicap (p = 0.553), all of which were statistically significant (p < 0.001).

DISCUSSION

The present study evaluated the perception of oral health and its impact on OHRQoL among military aviators using the validated OHIP-14 instrument. The results revealed that functional limitation and physical pain were the most affected domains. This was similar to the study conducted by Singh and Talmale^[4] where functional limitation and physical pain recorded the highest mean score. Physical pain contributes largely toward low OHRQoL values. This was in agreement with the studies conducted by Acharya and Sangam,^[5] Batista et al.,^[6] Dahl et al.,^[7] Lu et al.,^[8] Montero-Martin et al.,^[9] and Papagiannopoulou et al.^[10] The results in the study showed a significant relationship between age and OHRQoL, implying that the oral health impact tends to increase with advancing age possibly due to cumulative dental wear, neglect, or systemic influences. This was similar to the study conducted by Li et al.^[11] and Pakkhesal et al.^[12]

In the present study, smokers exhibited a higher mean OHIP than the non-smokers indicating tobacco use may exacerbate oral health problems, leading to a greater perceived impact on OHRQoL. This was similar to the study conducted by Maida et al.,^[13] Astrom et al.,^[14] Mbawalla et al.,^[15] and Bakri et al.^[16] Among all the domains of OHIP, psychological disability recorded the highest when comparing with smokers and non-smokers. This was in contrast to the study conducted by Sagtani et al.^[17] where psychological discomfort recorded the highest mean value.

Correlation analysis demonstrated strong interrelationships among physical pain, functional limitation, physical disability, and handicap domains, highlighting the multidimensional nature of oral health impacts. The exploratory use of Six Sigma analysis identified domains with greater variability, offering an additional perspective on areas that may warrant focused preventive and clinical attention. Overall, these findings emphasize the value of comprehensive oral health strategies that address both physical symptoms and their functional implications in military aviators.

In the present study, approximately 15.8% of aviators reported habitual non-productive clenching or bruxism. Although this prevalence was lower than that reported by Kaushik et al.,^[18] who observed a prevalence of 51% among aviation personnel, the finding remains clinically relevant in the context of military aviation. Occupational stress, operational fatigue, altered sleep cycles, high cognitive workload, and anxiety associated with flying duties may contribute to parafunctional habits such as clenching and bruxism. These habits can further aggravate temporomandibular discomfort, tooth wear, muscle fatigue, and functional limitation, thereby negatively influencing oral health-related quality of life. The aviation environment therefore presents unique occupational stressors that may predispose aviators to stress-related oral manifestations compared to the general population.

CONCLUSION

Military aviators generally demonstrate good OHRQoL; however, functional limitation and physical pain remain key determinants influencing their perceived oral well-being. Advancing age, longer service duration, and smoking were significantly associated with poorer OHRQoL. Future research may benefit from longitudinal study designs to evaluate temporal changes in OHRQoL throughout different phases of military service and flying exposure. Incorporating OHRQoL assessments, preventive dental strategies, and targeted smoking cessation interventions into periodic medical evaluations can help detect early deterioration in oral health, ensuring sustained readiness, comfort, and mission capability among aviators.