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Geriatr Gerontol Int 2016; 16: 37–45
ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH
Geriatric oral health predicaments in New Delhi, India Abhinav Singh,1 Bharathi M Purohit2 and Nitin Masih3 1
Department of Dentistry, All India Institute of Medical Sciences (AIIMS) – Bhopal, Under Ministry of Health & Family Welfare – Government of India, 2Department of Public Health Dentistry, People’s College of Dental Sciences, Bhopal, and 3Department of Public Health Dentistry, ESIC Dental College & Hospital, Ministry of Labour & Employment, New Delhi, India
Objectives: The aim of the present study was to analyze geriatric oral health predicaments in India. Specifically, to assess the oral health status and treatment needs among the geriatric population attending health camps in New Delhi, Northern India. Methods: The sample size for the cross-sectional study comprised of 248 elderly participants aged 60 years having attended the health check-up camps organized in New Delhi, India. The community periodontal index was used for assessment of periodontal disease. The World Health Organization’s criterion was used for detection of dentition status and treatment needs. The χ2-test was used to compare between categorical variables. The Mann–Whitney U-test was used to compare between two groups for quantitative variables. Regression analysis was carried out to identify the factors associated with dental caries and periodontal disease status. Results: The mean number of affected sextants with the highest community periodontal index score of 4 was 3.54 ± 2.45. Mean decayed, missing and filled teeth score of 16.39 ± 8.97 was recorded among the elderly. Prosthetic need was noted among 206 (83.1%) participants. Age and literacy status contributed to 27% and 12% of the variance respectively in the decayed, missing and filled teeth model. (P < 0.001) Major contributory factors in the periodontal disease model for the 37%, 11% and 11% variance were age, sex and tobacco consumption (P < 0.001). Conclusion: Two striking features of the study were the high levels of unmet prosthetic needs and the extremely low utilization of dental care. There is an urgent necessity to resolve the high burden of unmet prosthetic need among the aged in India. Geriatr Gerontol Int 2016; 16: 37–45. Keywords: dental care for elderly, developing countries, geriatric dentistry, public health dentistry.
Introduction The aging phenomenon has transpired as a significant health issue of the 21st century. This rise in life expectancy is attributed primarily to the substantial reduction in mortality at different stages of life, which has been brought about by improved healthcare facilities, sanitation, environmental and public health reforms coupled with better hygiene and living conditions.1 It is now recognized that although both developed and developing countries are experiencing growing proportions of older adults, developing countries are currently aging faster than developed countries. Two-thirds of the
Accepted for publication 22 October 2014. Correspondence: Dr Abhinav Singh BDS MDS, Department of Dentistry, All India Institute of Medical Sciences (AIIMS) – Bhopal, Ministry of Health & Family Welfare – Government of India, Bhopal 462001, India. Email: [email protected]
© 2015 Japan Geriatrics Society
world’s elderly live in developing countries that are less prepared to deal with this aspect of population dynamics compared with the developed world.2 This is a huge population that must receive attention from policymakers across the world who are or will be challenged by the changing demands for social and health services including oral health services. India has attained the tag of an aging nation, with the elderly population in 2013 being over 8% (100 million), and is anticipated to increase to 20% (325 million) by 2050.3 India’s population is likely to increase by 60% between 2000 and 2050, but the number of older adults in the population who have reached 60 years-of-age will shoot up by 360%. One salient feature regarding the elderly population of India is that the rate of growth of the elderly population is a great deal more rapid than the growth of the total population.4 Poor oral health has been reflected as a risk factor for general health problems in the geriatric population.5 Oral diseases are complex, multifactorial and doi: 10.1111/ggi.12434
|
37
A Singh et al.
progressive in nature. Enhanced susceptibility to oral diseases is noted among the elderly population because of an increase in chronic medical conditions and the associated disabilities. The discussed predicaments amplify in size because of declining immunity in the elderly. Globally, poor oral health amongst older people has been particularly evident in high levels of tooth loss, dental caries experience and the prevalence rates of periodontal disease.2 Often these are the consequence of neglect in the early years of life. In terms of provision of care, old age forms a distinct target group. The associations between dental disease and specific medical conditions have become more established. Oral health is not only vital for appearance and a sense of well-being, but also for general health and quality of life in elderly individuals. Improving oral health will significantly enhance the physical, social and mental attributes of geriatric individuals. Oral disorders are snowballing across the lifespan to an extent that adverse outcomes of oral conditions are likely to be the greatest among people in the later stages of life.6–8 The present and future generation of dental practitioners will confront the challenge of providing dental care for a growing number of older adults. The government should start framing policies now, otherwise its consequences are likely to take it by surprise. Formulation and implementation of health policies rely on epidemiological data. To date, few studies regarding oral health conditions, prosthetic status and needs among the elderly population have been carried out in India. As a result, there is a need for epidemiological studies evaluating the geriatric oral health predicaments of older adults, and comparing these with other cross-cultural studies. Keeping this in mind, an oral health survey was carried out among the geriatric population in New Delhi. The specific aim of the present study was to assess the oral health status and treatment needs among the geriatric population attending health camps in New Delhi, Northern India
Methods Sample size and study design The target population for the present cross-sectional study comprised of older adults aged 60 years and above attending health check-up camps organized under a national social security scheme in New Delhi, India. A 1 day-camp was organized on the 10th of every month, which was attended by specialists from the dental and medical disciplines. A total of 248 older adults attended these camps from March 2012 to February 2013. All the elderly subjects attending the camps participated in the study. 38
|
Information on demographic characteristics of participants along with oral health behaviors, such as frequency of brushing, tobacco related habits and utilization of dental care, were collected by means of personal interviews administered by the examiners. Literacy levels were categorized for study participants. The four categories recorded were illiterate (no formal education), completed middle school (7th grade), completed high school (10th grade) and those with a graduation or higher degree. Similarly, income levels were recorded as nil income, earning between INR5000–10 000 (∼US$80–165) and those earning ≥ INR10 000 per month (∼US$165). The dental team comprised of two trained examiners assisted by a recording clerk.
Clinical examination Dental examinations were carried out according to the World Health Organization (WHO) recommendation.9 The examination was carried out in the specified areas within the camp settings. All the participants were examined under adequate illumination (type III), and clinical data were collected on periodontal status and dental caries. The community periodontal index (CPI) was used for assessment of periodontal disease. The dentition is divided into six sextants; each sextant is given a score. A tooth is probed to determine pocket depth, subgingival calculus and bleeding response. The WHO criterion was used for detection of dentition status and treatment needs.9 The caries experience was recorded in terms of decayed, missing and filled teeth (DMFT). The examination was carried out with a plane mouth mirror. A systematic approach was used for assessment of dentition status and treatment needs. The examination proceeded in an orderly manner from one tooth or tooth space to the adjacent tooth or tooth space. A tooth was considered present in the mouth when any part of it was visible. Two-day training sessions for standardization and calibration of data collection methods were organized for the various used indices. The kappa statistic was carried out, and a value of 0.86 for interexaminer agreement was obtained. Intra-examiner agreement was found to be in the range of 0.88–0.90 for the two examiners. The examination procedure was standardized for validity, reliability and reproducibility of the data before and during the survey. Ethical clearance was taken from the institutional ethics committee. Informed written consent was taken before carrying out the survey. Duplicate examinations were carried out systematically on approximately 10% (every 10 sample) of the participants by the two examiners throughout the survey, and the kappa statistic was in range of 0.86–0.88. © 2015 Japan Geriatrics Society
Geriatric oral health
Statistical analysis Data were collected, entered and analyzed using SPSS version 16.0 (SPSS, Chicago, IL, USA) for windows. Mean and standard deviations were used as basic descriptive statistics. The χ2-test was used to compare between categorical variables. The Mann–Whitney U-test was used for comparison between two groups for quantitative variables. Linear regression analysis was carried out to determine the factors associated with dental caries and periodontal disease status. Logistic regression analysis was carried out to determine the risk factors associated with the state of edentulousness. Dependent variables to be included in the logistic regression analysis were dichotomized. Odds ratio was calculated for all variables with 95% confidence intervals. Significance was assumed at ≤ 0.05.
tion. The majority of the men (53.7%) and women (79.5%) participants had no regular source of income. (Table 1)
Oral health behavioral characteristics Toothbrushes and toothpastes were used by 233 (93.9%) and 213 (85.8%) participants, respectively. A total of 40 (16.1%) participants brushed two or more times a day. Significant sex differences were noted for frequency of cleaning teeth, tobacco-related habits and utilization of dental care. Among the male participants, 84 (48%) consumed some form of tobacco. None of the female participants consumed any form of tobacco. (P ≤ 0.001) The majority of the participants (175 [70.6%]) had never visited a dentist. A sex difference was observed, adding to 129 men (73.7%) and 46 women (63%) having never visited a dentist. (P ≤ 0.05; Table 2)
Results Demographic characteristics
Oral health status and age distribution of oral diseases
A total of 248 participants comprised the sample. Of these, 175 participants (70.5%) were men and 73 (29.5%) participants were women. Significant sex differences were noted in the literacy levels among the geriatric study population. Of the men, 76 (43.4%) had a formal level of education of graduation or postgraduation, as compared with 27 women (37%), and 10 men (5.7%) were illiterate as compared with nine women (12.3%) who did not receive any form of formal educa-
Dental abrasion was observed among 189 (76.2%) participants, along with a noted significant sex difference (P ≤ 0.001). Bleeding/calculus and periodontal pockets were present among 18.8% and 81.5% participants, respectively. The mean number of affected sextants with the highest CPI score of 4 was 3.54 ± 2.45. Significant sex differences were noted for periodontal diseases and the mean number of affected sextants (P ≤ 0.001). Decayed teeth, missing teeth and filled teeth were noted
Table 1 Distribution of participants according to age, sex, literacy and income status
Age group (years) 60–70 71–80 81–90 Total Mean age (years) Literacy status Illiterate Completed middle school (7th grade) Completed high school (10th grade) Graduation and higher Total Income levels (INR)† 0 (No income) 5000–10 000 per month (∼US$80–165) ≥10 000 per month (∼US$165) Total †
Sex Male (%)
Female (%)
115 (65.7) 41 (23.4) 19 (10.9) 175 (100) 72.6 ± 13.12
37 (50.7) 26 (35.6) 10 (13.7) 73 (100) 68.3 ± 15.47
10 (5.7) 26 (14.9) 63 (36) 76 (43.4) 175 (100)
9 (12.3) 17 (23.3) 20 (27.4) 27 (37) 73 (100)
0.001
94 (53.7) 38 (21.7) 43 (24.5) 175 (100)
58 (79.5) 7 (9.5) 8 (11) 73 (100)
0.001
P-value
0.001
248 (100) 70.45 ± 14.30
US$1 = ∼INR61.60
© 2015 Japan Geriatrics Society
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39
A Singh et al.
Table 2 Oral health behavioral characteristics among participants Oral health related behavior variables
Male, n (%)
Female, n (%)
P-value
Total (%)
Mode of cleaning teeth
10 (5.7) 165(94.3) 151 (86.2) 24 (13.8) 147 (84) 28 (16) 91 (52) 84 (48) 129 (73.7) 46 (26.3)
5 (6.9) 68 (93.1) 57 (78.1) 16 (21.9) 66 (90.4) 7 (9.6) 73 (100) – (0) 46 (63) 27 (37)
0.71
15 (6.1) 233 (93.9) 208 (83.9) 40 (16.1) 213 (85.8) 35 (14.2) 164 (66.1) 84 (33.9) 175 (70.6) 73 (29.4)
Frequency of cleaning teeth Material used for cleaning teeth Tobacco related habits Utilization of dental care
Finger Toothbrush Once daily ≥2 times a day Toothpaste Toothpowder Absent Present Never visited Previously visited
0.05 0.37 0.001 0.05
Table 3 Oral health status among participants Clinical variables Dental abrasion Periodontal status (highest CPI score)
Mean no. sextants
Decayed teeth, n (%) Missing teeth, n (%) Filled teeth N (%) Mean DMFT Range DMFT, n (%)
Edentulous
Absent Present Healthy Bleeding Calculus Pockets 4–5 mm Pockets 6 + mm CPI = 0 CPI = 1 CPI = 2 CPI = 3 CPI = 4 Absent Present Absent Present Absent Present 0 1–9 ≥10
Male, n (%)
Female, n (%)
P-value
Total (%)
28 (16) 147 (84) – (0) 4 (2.3) 18 (10.3) 70 (40) 83 (47.4) 1.38 ± 1.26 1.41 ± 1.27 1.62 ± 1.31 4.29 ± 1.85 4.36 ± 2.31 38 (21.7) 137 (78.3) 12 (6.9) 163 (93.1) 157 (89.7) 18 (10.3) 18.31 ± 9.72 38 (21.7) 51 (29.2) 86 (49.1) 16 (9.1%)
31 (42.5) 42 (57.5) – (0) 9 (12.3) 15(20.5) 28 (38.4) 21(28.8) 1.09 ± 1.21 1.82 ± 1.59 1.49 ± 1.24 3.04 ± 1.63 2.73 ± 2.60 20 (27.4) 53 (72.6) 9 (12.3) 64 (87.7) 56 (76.7) 17 (23.3) 14.47 ± 8.23 20 (27.4) 16 (21.9) 37 (50.7) 6 (8.2%)
0.001
59 (23.8) 189 (76.2) – (0) 13 (5.2) 33 (13.3) 98 (39.6) 104 (41.9) 1.23 ± 1.23 1.61 ± 1.43 1.55 ± 1.27 3.67 ± 1.74 3.54 ± 2.45 58 (23.4) 190 (76.6) 21 (8.5) 227 (91.5) 213 (85.9) 35 (14.1) 16.39 ± 8.97 58 (23.4) 67 (27) 123 (49.6) 22 (8.9)
0.001
0.001
0.05 0.28 0.001 0.001 0.05
0.41
CPI, community periodontal index; DMFT, decayed, missing and filled teeth.
among 190 (76.6%), 227 (91.5%) and 35 (14.1%) participants, respectively. A mean DMFT score of 16.39 ± 8.97 was recorded among the participants. Significant sex differences were noted for decayed teeth (P ≤ 0.05), filled teeth (P ≤ 0.001) and mean DMFT scores (P ≤ 0.001). A total of 123 (49.6%) participants had more than 10 missing teeth, and 22 (8.9%) participants were edentulous. (Table 3) Significant sex differences were noted for the highest CPI score of 4 and mean DMFT scores between the 60–70 years, 71–80 40
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years and 81–90 years elderly groups (P ≤ 0.001; Table 4).
Prosthetic status and needs A total of 205 (82%) participants had no prosthesis. A total of 193 (77.8%) and 201 (81.1%) participants had no prosthesis in the upper arch and lower arch, respectively. Similarly, 148 men (84.5%) and 57 women (78%) had no prosthesis (P ≤ 0.001). Prosthetic need of one © 2015 Japan Geriatrics Society
Geriatric oral health
Table 4 Age distribution of periodontal disease and dental caries Age group (years)
Sex Male (%)
P-value Female (%)
Mean number of sextant with highest CPI score of 4 60–70 years 5.61 ± 3.02 3.97 ± 2.85 71–80 years 4.95 ± 2.11 2.86 ± 2.33 80–90 years 2.51 ± 2.03 1.36 ± 2.62 Total 4.36 ± 2.31 2.73 ± 2.60 Mean DMFT 60–70 years 14.47 ± 8.87 10.80 ± 6.70 71–80 years 16.34 ± 10.43 11.43 ± 9.37 80–90 years 24.10 ± 9.84 21.18 ± 8.62 Total 18.31 ± 9.72 14.47 ± 8.23
0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001
CPI, community periodontal index; DMFT, decayed, missing and filled teeth.
unit, combination and full prosthesis was noted among 206 (83.1%) participants. There was no prosthetic need among 42 (16.9%) participants – 23 men (13.1%) and 19 women (26%) (P ≤ 0.001).
Regression models Stepwise multiple linear regression analysis was carried out to analyze caries status (DMFT) and periodontal disease in relation to several independent variables, which included age, sex, literacy status, income, frequency of cleaning teeth, tobacco consumption and utilization of dental care. The linear regression table shows the percentage of variability that can be explained by the predictor variables. R is the regression coefficient of the regression analysis. The change in the R2 evaluates how much predictive power was added to the model by the addition of another variable. The variables in the model explained 69% of the variance in caries status and 75% of the variance in the periodontal disease. In the DMFT model, age and literacy status contributed to 27% and 12% of the variance, respectively (P ≤ 0.001). In the periodontal disease model, major contributory factors for the 37%, 11% and 11% variance were age, sex and tobacco consumption (P ≤ 0.001; Table 5). Logistic regression analysis was carried out with DMFT (DMFT = 0 vs DMFT ≥ 1), periodontal disease (CPI < 3 vs CPI ≥ 3), edentulous state (≥10 missing teeth missing vs
Geriatr Gerontol Int 2016; 16: 37–45
ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH
Geriatric oral health predicaments in New Delhi, India Abhinav Singh,1 Bharathi M Purohit2 and Nitin Masih3 1
Department of Dentistry, All India Institute of Medical Sciences (AIIMS) – Bhopal, Under Ministry of Health & Family Welfare – Government of India, 2Department of Public Health Dentistry, People’s College of Dental Sciences, Bhopal, and 3Department of Public Health Dentistry, ESIC Dental College & Hospital, Ministry of Labour & Employment, New Delhi, India
Objectives: The aim of the present study was to analyze geriatric oral health predicaments in India. Specifically, to assess the oral health status and treatment needs among the geriatric population attending health camps in New Delhi, Northern India. Methods: The sample size for the cross-sectional study comprised of 248 elderly participants aged 60 years having attended the health check-up camps organized in New Delhi, India. The community periodontal index was used for assessment of periodontal disease. The World Health Organization’s criterion was used for detection of dentition status and treatment needs. The χ2-test was used to compare between categorical variables. The Mann–Whitney U-test was used to compare between two groups for quantitative variables. Regression analysis was carried out to identify the factors associated with dental caries and periodontal disease status. Results: The mean number of affected sextants with the highest community periodontal index score of 4 was 3.54 ± 2.45. Mean decayed, missing and filled teeth score of 16.39 ± 8.97 was recorded among the elderly. Prosthetic need was noted among 206 (83.1%) participants. Age and literacy status contributed to 27% and 12% of the variance respectively in the decayed, missing and filled teeth model. (P < 0.001) Major contributory factors in the periodontal disease model for the 37%, 11% and 11% variance were age, sex and tobacco consumption (P < 0.001). Conclusion: Two striking features of the study were the high levels of unmet prosthetic needs and the extremely low utilization of dental care. There is an urgent necessity to resolve the high burden of unmet prosthetic need among the aged in India. Geriatr Gerontol Int 2016; 16: 37–45. Keywords: dental care for elderly, developing countries, geriatric dentistry, public health dentistry.
Introduction The aging phenomenon has transpired as a significant health issue of the 21st century. This rise in life expectancy is attributed primarily to the substantial reduction in mortality at different stages of life, which has been brought about by improved healthcare facilities, sanitation, environmental and public health reforms coupled with better hygiene and living conditions.1 It is now recognized that although both developed and developing countries are experiencing growing proportions of older adults, developing countries are currently aging faster than developed countries. Two-thirds of the
Accepted for publication 22 October 2014. Correspondence: Dr Abhinav Singh BDS MDS, Department of Dentistry, All India Institute of Medical Sciences (AIIMS) – Bhopal, Ministry of Health & Family Welfare – Government of India, Bhopal 462001, India. Email: [email protected]
© 2015 Japan Geriatrics Society
world’s elderly live in developing countries that are less prepared to deal with this aspect of population dynamics compared with the developed world.2 This is a huge population that must receive attention from policymakers across the world who are or will be challenged by the changing demands for social and health services including oral health services. India has attained the tag of an aging nation, with the elderly population in 2013 being over 8% (100 million), and is anticipated to increase to 20% (325 million) by 2050.3 India’s population is likely to increase by 60% between 2000 and 2050, but the number of older adults in the population who have reached 60 years-of-age will shoot up by 360%. One salient feature regarding the elderly population of India is that the rate of growth of the elderly population is a great deal more rapid than the growth of the total population.4 Poor oral health has been reflected as a risk factor for general health problems in the geriatric population.5 Oral diseases are complex, multifactorial and doi: 10.1111/ggi.12434
|
37
A Singh et al.
progressive in nature. Enhanced susceptibility to oral diseases is noted among the elderly population because of an increase in chronic medical conditions and the associated disabilities. The discussed predicaments amplify in size because of declining immunity in the elderly. Globally, poor oral health amongst older people has been particularly evident in high levels of tooth loss, dental caries experience and the prevalence rates of periodontal disease.2 Often these are the consequence of neglect in the early years of life. In terms of provision of care, old age forms a distinct target group. The associations between dental disease and specific medical conditions have become more established. Oral health is not only vital for appearance and a sense of well-being, but also for general health and quality of life in elderly individuals. Improving oral health will significantly enhance the physical, social and mental attributes of geriatric individuals. Oral disorders are snowballing across the lifespan to an extent that adverse outcomes of oral conditions are likely to be the greatest among people in the later stages of life.6–8 The present and future generation of dental practitioners will confront the challenge of providing dental care for a growing number of older adults. The government should start framing policies now, otherwise its consequences are likely to take it by surprise. Formulation and implementation of health policies rely on epidemiological data. To date, few studies regarding oral health conditions, prosthetic status and needs among the elderly population have been carried out in India. As a result, there is a need for epidemiological studies evaluating the geriatric oral health predicaments of older adults, and comparing these with other cross-cultural studies. Keeping this in mind, an oral health survey was carried out among the geriatric population in New Delhi. The specific aim of the present study was to assess the oral health status and treatment needs among the geriatric population attending health camps in New Delhi, Northern India
Methods Sample size and study design The target population for the present cross-sectional study comprised of older adults aged 60 years and above attending health check-up camps organized under a national social security scheme in New Delhi, India. A 1 day-camp was organized on the 10th of every month, which was attended by specialists from the dental and medical disciplines. A total of 248 older adults attended these camps from March 2012 to February 2013. All the elderly subjects attending the camps participated in the study. 38
|
Information on demographic characteristics of participants along with oral health behaviors, such as frequency of brushing, tobacco related habits and utilization of dental care, were collected by means of personal interviews administered by the examiners. Literacy levels were categorized for study participants. The four categories recorded were illiterate (no formal education), completed middle school (7th grade), completed high school (10th grade) and those with a graduation or higher degree. Similarly, income levels were recorded as nil income, earning between INR5000–10 000 (∼US$80–165) and those earning ≥ INR10 000 per month (∼US$165). The dental team comprised of two trained examiners assisted by a recording clerk.
Clinical examination Dental examinations were carried out according to the World Health Organization (WHO) recommendation.9 The examination was carried out in the specified areas within the camp settings. All the participants were examined under adequate illumination (type III), and clinical data were collected on periodontal status and dental caries. The community periodontal index (CPI) was used for assessment of periodontal disease. The dentition is divided into six sextants; each sextant is given a score. A tooth is probed to determine pocket depth, subgingival calculus and bleeding response. The WHO criterion was used for detection of dentition status and treatment needs.9 The caries experience was recorded in terms of decayed, missing and filled teeth (DMFT). The examination was carried out with a plane mouth mirror. A systematic approach was used for assessment of dentition status and treatment needs. The examination proceeded in an orderly manner from one tooth or tooth space to the adjacent tooth or tooth space. A tooth was considered present in the mouth when any part of it was visible. Two-day training sessions for standardization and calibration of data collection methods were organized for the various used indices. The kappa statistic was carried out, and a value of 0.86 for interexaminer agreement was obtained. Intra-examiner agreement was found to be in the range of 0.88–0.90 for the two examiners. The examination procedure was standardized for validity, reliability and reproducibility of the data before and during the survey. Ethical clearance was taken from the institutional ethics committee. Informed written consent was taken before carrying out the survey. Duplicate examinations were carried out systematically on approximately 10% (every 10 sample) of the participants by the two examiners throughout the survey, and the kappa statistic was in range of 0.86–0.88. © 2015 Japan Geriatrics Society
Geriatric oral health
Statistical analysis Data were collected, entered and analyzed using SPSS version 16.0 (SPSS, Chicago, IL, USA) for windows. Mean and standard deviations were used as basic descriptive statistics. The χ2-test was used to compare between categorical variables. The Mann–Whitney U-test was used for comparison between two groups for quantitative variables. Linear regression analysis was carried out to determine the factors associated with dental caries and periodontal disease status. Logistic regression analysis was carried out to determine the risk factors associated with the state of edentulousness. Dependent variables to be included in the logistic regression analysis were dichotomized. Odds ratio was calculated for all variables with 95% confidence intervals. Significance was assumed at ≤ 0.05.
tion. The majority of the men (53.7%) and women (79.5%) participants had no regular source of income. (Table 1)
Oral health behavioral characteristics Toothbrushes and toothpastes were used by 233 (93.9%) and 213 (85.8%) participants, respectively. A total of 40 (16.1%) participants brushed two or more times a day. Significant sex differences were noted for frequency of cleaning teeth, tobacco-related habits and utilization of dental care. Among the male participants, 84 (48%) consumed some form of tobacco. None of the female participants consumed any form of tobacco. (P ≤ 0.001) The majority of the participants (175 [70.6%]) had never visited a dentist. A sex difference was observed, adding to 129 men (73.7%) and 46 women (63%) having never visited a dentist. (P ≤ 0.05; Table 2)
Results Demographic characteristics
Oral health status and age distribution of oral diseases
A total of 248 participants comprised the sample. Of these, 175 participants (70.5%) were men and 73 (29.5%) participants were women. Significant sex differences were noted in the literacy levels among the geriatric study population. Of the men, 76 (43.4%) had a formal level of education of graduation or postgraduation, as compared with 27 women (37%), and 10 men (5.7%) were illiterate as compared with nine women (12.3%) who did not receive any form of formal educa-
Dental abrasion was observed among 189 (76.2%) participants, along with a noted significant sex difference (P ≤ 0.001). Bleeding/calculus and periodontal pockets were present among 18.8% and 81.5% participants, respectively. The mean number of affected sextants with the highest CPI score of 4 was 3.54 ± 2.45. Significant sex differences were noted for periodontal diseases and the mean number of affected sextants (P ≤ 0.001). Decayed teeth, missing teeth and filled teeth were noted
Table 1 Distribution of participants according to age, sex, literacy and income status
Age group (years) 60–70 71–80 81–90 Total Mean age (years) Literacy status Illiterate Completed middle school (7th grade) Completed high school (10th grade) Graduation and higher Total Income levels (INR)† 0 (No income) 5000–10 000 per month (∼US$80–165) ≥10 000 per month (∼US$165) Total †
Sex Male (%)
Female (%)
115 (65.7) 41 (23.4) 19 (10.9) 175 (100) 72.6 ± 13.12
37 (50.7) 26 (35.6) 10 (13.7) 73 (100) 68.3 ± 15.47
10 (5.7) 26 (14.9) 63 (36) 76 (43.4) 175 (100)
9 (12.3) 17 (23.3) 20 (27.4) 27 (37) 73 (100)
0.001
94 (53.7) 38 (21.7) 43 (24.5) 175 (100)
58 (79.5) 7 (9.5) 8 (11) 73 (100)
0.001
P-value
0.001
248 (100) 70.45 ± 14.30
US$1 = ∼INR61.60
© 2015 Japan Geriatrics Society
|
39
A Singh et al.
Table 2 Oral health behavioral characteristics among participants Oral health related behavior variables
Male, n (%)
Female, n (%)
P-value
Total (%)
Mode of cleaning teeth
10 (5.7) 165(94.3) 151 (86.2) 24 (13.8) 147 (84) 28 (16) 91 (52) 84 (48) 129 (73.7) 46 (26.3)
5 (6.9) 68 (93.1) 57 (78.1) 16 (21.9) 66 (90.4) 7 (9.6) 73 (100) – (0) 46 (63) 27 (37)
0.71
15 (6.1) 233 (93.9) 208 (83.9) 40 (16.1) 213 (85.8) 35 (14.2) 164 (66.1) 84 (33.9) 175 (70.6) 73 (29.4)
Frequency of cleaning teeth Material used for cleaning teeth Tobacco related habits Utilization of dental care
Finger Toothbrush Once daily ≥2 times a day Toothpaste Toothpowder Absent Present Never visited Previously visited
0.05 0.37 0.001 0.05
Table 3 Oral health status among participants Clinical variables Dental abrasion Periodontal status (highest CPI score)
Mean no. sextants
Decayed teeth, n (%) Missing teeth, n (%) Filled teeth N (%) Mean DMFT Range DMFT, n (%)
Edentulous
Absent Present Healthy Bleeding Calculus Pockets 4–5 mm Pockets 6 + mm CPI = 0 CPI = 1 CPI = 2 CPI = 3 CPI = 4 Absent Present Absent Present Absent Present 0 1–9 ≥10
Male, n (%)
Female, n (%)
P-value
Total (%)
28 (16) 147 (84) – (0) 4 (2.3) 18 (10.3) 70 (40) 83 (47.4) 1.38 ± 1.26 1.41 ± 1.27 1.62 ± 1.31 4.29 ± 1.85 4.36 ± 2.31 38 (21.7) 137 (78.3) 12 (6.9) 163 (93.1) 157 (89.7) 18 (10.3) 18.31 ± 9.72 38 (21.7) 51 (29.2) 86 (49.1) 16 (9.1%)
31 (42.5) 42 (57.5) – (0) 9 (12.3) 15(20.5) 28 (38.4) 21(28.8) 1.09 ± 1.21 1.82 ± 1.59 1.49 ± 1.24 3.04 ± 1.63 2.73 ± 2.60 20 (27.4) 53 (72.6) 9 (12.3) 64 (87.7) 56 (76.7) 17 (23.3) 14.47 ± 8.23 20 (27.4) 16 (21.9) 37 (50.7) 6 (8.2%)
0.001
59 (23.8) 189 (76.2) – (0) 13 (5.2) 33 (13.3) 98 (39.6) 104 (41.9) 1.23 ± 1.23 1.61 ± 1.43 1.55 ± 1.27 3.67 ± 1.74 3.54 ± 2.45 58 (23.4) 190 (76.6) 21 (8.5) 227 (91.5) 213 (85.9) 35 (14.1) 16.39 ± 8.97 58 (23.4) 67 (27) 123 (49.6) 22 (8.9)
0.001
0.001
0.05 0.28 0.001 0.001 0.05
0.41
CPI, community periodontal index; DMFT, decayed, missing and filled teeth.
among 190 (76.6%), 227 (91.5%) and 35 (14.1%) participants, respectively. A mean DMFT score of 16.39 ± 8.97 was recorded among the participants. Significant sex differences were noted for decayed teeth (P ≤ 0.05), filled teeth (P ≤ 0.001) and mean DMFT scores (P ≤ 0.001). A total of 123 (49.6%) participants had more than 10 missing teeth, and 22 (8.9%) participants were edentulous. (Table 3) Significant sex differences were noted for the highest CPI score of 4 and mean DMFT scores between the 60–70 years, 71–80 40
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years and 81–90 years elderly groups (P ≤ 0.001; Table 4).
Prosthetic status and needs A total of 205 (82%) participants had no prosthesis. A total of 193 (77.8%) and 201 (81.1%) participants had no prosthesis in the upper arch and lower arch, respectively. Similarly, 148 men (84.5%) and 57 women (78%) had no prosthesis (P ≤ 0.001). Prosthetic need of one © 2015 Japan Geriatrics Society
Geriatric oral health
Table 4 Age distribution of periodontal disease and dental caries Age group (years)
Sex Male (%)
P-value Female (%)
Mean number of sextant with highest CPI score of 4 60–70 years 5.61 ± 3.02 3.97 ± 2.85 71–80 years 4.95 ± 2.11 2.86 ± 2.33 80–90 years 2.51 ± 2.03 1.36 ± 2.62 Total 4.36 ± 2.31 2.73 ± 2.60 Mean DMFT 60–70 years 14.47 ± 8.87 10.80 ± 6.70 71–80 years 16.34 ± 10.43 11.43 ± 9.37 80–90 years 24.10 ± 9.84 21.18 ± 8.62 Total 18.31 ± 9.72 14.47 ± 8.23
0.001 0.001 0.001 0.001 0.001 0.001 0.001 0.001
CPI, community periodontal index; DMFT, decayed, missing and filled teeth.
unit, combination and full prosthesis was noted among 206 (83.1%) participants. There was no prosthetic need among 42 (16.9%) participants – 23 men (13.1%) and 19 women (26%) (P ≤ 0.001).
Regression models Stepwise multiple linear regression analysis was carried out to analyze caries status (DMFT) and periodontal disease in relation to several independent variables, which included age, sex, literacy status, income, frequency of cleaning teeth, tobacco consumption and utilization of dental care. The linear regression table shows the percentage of variability that can be explained by the predictor variables. R is the regression coefficient of the regression analysis. The change in the R2 evaluates how much predictive power was added to the model by the addition of another variable. The variables in the model explained 69% of the variance in caries status and 75% of the variance in the periodontal disease. In the DMFT model, age and literacy status contributed to 27% and 12% of the variance, respectively (P ≤ 0.001). In the periodontal disease model, major contributory factors for the 37%, 11% and 11% variance were age, sex and tobacco consumption (P ≤ 0.001; Table 5). Logistic regression analysis was carried out with DMFT (DMFT = 0 vs DMFT ≥ 1), periodontal disease (CPI < 3 vs CPI ≥ 3), edentulous state (≥10 missing teeth missing vs
