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ORIGINAL RESEARCH Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 2  |  Page : 244-247
Assessment of oral health status and treatment needs of elders associated with elders' homes of Ambala division, Haryana, India


Department of Preventive and Community Dentistry, M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana, India

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Date of Submission18-Jul-2009
Date of Decision29-Sep-2009
Date of Acceptance04-Mar-2010
Date of Web Publication22-Jul-2010
 

   Abstract 

Objective: To determine the oral health status and treatment needs of subjects aged 60 years and above.
Background: The average life span in most parts of the world continues to increase. In the coming decades, dental practitioners will face the challenge of providing dental care for a growing number of elders who retain more natural teeth.
Materials and Methods: The study was conducted in 10 elders' homes of Ambala division on subjects 60 years or older. Modified WHO format (1997) was used. All the subjects present in the elders' home on the day of examination were included. One hundred and fifty-two subjects were examined.
Results: Around half (47.4 %) of the subjects had no functional teeth. Among the rest of the subjects, 26.9% subjects did not use any oral hygiene measure. 19.1% subjects reported wearing a denture. 36.8% subjects had not visited a dentist ever in their life. 28.7% subjects were suffering from pain. The mean number of decayed teeth per subject was 3.66. Maximum subjects had a Community Periodontal Index score of 2.
Conclusion: Education regarding maintenance of oral hygiene and regular dental check up should be stressed for the elders. Dental care, especially prosthetic care, should be focused upon.

Keywords: Elder home, edentulous, oral health

How to cite this article:
Bansal V, Sogi G M, Veeresha K L. Assessment of oral health status and treatment needs of elders associated with elders' homes of Ambala division, Haryana, India. Indian J Dent Res 2010;21:244-7

How to cite this URL:
Bansal V, Sogi G M, Veeresha K L. Assessment of oral health status and treatment needs of elders associated with elders' homes of Ambala division, Haryana, India. Indian J Dent Res [serial online] 2010 [cited 2019 Aug 20];21:244-7. Available from: http://www.ijdr.in/text.asp?2010/21/2/244/66647
Aging is an universal process and a normal inevitable biologic phenomenon. Man, from time immemorial, has tried to increase the life span and enhance health from various scientific innovations. With discoveries in medical science and improving social conditions, the average life span in most parts of the world continues to increase, and it becomes the mission of the health professionals to work not merely to increase the life span but also, and perhaps more importantly, make later years of life more productive and enjoyable. [1]

Oral disorders are cumulative across the life span so that unfavourable outcomes of oral conditions are likely to be greatest among people in the later stages of life. [2] In the coming decades, dental practitioners will face the challenge of providing dental care for a growing number of elderly who retain more natural teeth. [3]

The state of Haryana consists of 7% of the elderly population. The life expectancy of a common man in Haryana is 65.0 years for males and 65.6 years for females with an expected increase to 70.9 years for males and 73.7 years for females by the year 2021-'25. [4] Some countries have already accumulated enough information on the specific needs of this part of the population, while some countries or states are yet to proceed. [3]

As of today, there are no records available regarding oral health care programs provided in the state of Haryana for the elderly population. Hence, this study was taken up to assess the oral health status and treatment needs of the elders associated with elders' homes of Ambala division (districts Ambala, Yamunanagar, Panchkula, Kaithal and Kurukshetra) of Haryana state.


   Materials and Methods Top


All the 10 elders' homes of the Ambala division [5] were taken up for the study. The inclusion criteria were being 60 years or more in age and association as a resident or as a day visitor to the elders' home. All the subjects present in the elders' home on the day of examination and meeting the above-mentioned inclusion criteria were included in the study.

After obtaining ethical clearance from the Institutional ethical committee, the examiner (VB) was calibrated and a pilot study was conducted among 20 elders who attended the outpatient department in the M.M. College of Dental Sciences and Research (MMCDSR). The demographic details and oral health status with treatment needs were recorded on a modified WHO format (1997). [6] Informed consent was obtained from the subjects. The subjects were made to sit on a stool/chair available and type III examination [7] was performed and a total of 152 subjects were examined. The data were analyzed using SPSS package version 13.0. Chi square analysis was used to find the significance of the cross-tabulation of counts of two or more variables. Student's t-test (Unpaired) and analysis of variance (ANOVA) were used to find the significance of the cross-tabulation of a variable with the mean of another variable. P value was stated to be statistically significant when equal to or lower than 0.05 and statistically highly significant when equal to or lower than 0.01. Each study camp was followed by a health education and a free dental treatment camp for the elderly.


   Results Top


Maximum age reported was 97 years and the mean age of the sample was 70.49 years (SD = 9.15). Males constituted 70.4% of the subjects. 41.4% of the subjects had not undergone any formal education while 14.5% were graduates. Among the medical conditions, hyper/hypotension was the most commonly reported condition, with one-fourth of the overall sample affected by it. It was followed by endocrinal disorders (majority of which were diabetic), with 13% of the population affected by it. 23.7% of the subjects were used to smoking since a mean duration of 35.47 years. 3.3% subjects chewed tobacco and 8.6% subjects were used to taking alcohol. Overall, 108 subjects had at least one tooth in their oral cavity. Of these, 26.9% subjects did not use any oral hygiene measure while 9.3% were not in a regular habit.

Among the subjects wearing a denture, 58.6% were found wearing complete denture [Table 1].

51.7% of the subjects removed and cleaned their dentures twice or more daily while 34.5% subjects removed and cleaned their dentures only before going to bed. 13.8% of the subjects reported that they do not remove their dentures at all and hence are also not cleaning it.

No attempt was made to evaluate the quality of the dentures. Also, it was believed that those subjects who possessed a denture did not need any treatment regarding their denture or pertaining thereto.

Of all the subjects, 36.8% had never visited a dental surgeon ever in their life time. Among those who had visited a dentist, only 3.13% were in the habit of visiting the dentist regularly, i.e. every year.

66.45% of the subjects had a complaint regarding their oral health and among them, 28.7% complained of pain, 22.8% for replacement of missing teeth and 9.9% of them had multiple complaints.

Among the overall study sample, 7.23% of the subjects were diagnosed with leukoplakia. 6.57% of the subjects had leukoplakia on the buccal mucosa while the other 0.66% had it on the floor of the mouth.

Regarding the status of edentulousness, 19.1% had no teeth, while a considerable number of subjects had all the remaining teeth indicated for extraction. Thus, subjects without any functional teeth were found to be 47.37%.

Among the remaining (dentate) subjects, the mean number of teeth present was 22.86 and the mean number of decayed teeth was 3.66, with three decayed crowns and 0.66 decayed roots per person. 46.8% of the subjects had at least one decayed tooth.

Around three-fourth of the subjects (77.22%) had 20 or more teeth in their oral cavity. On an average, each subject had three teeth to be extracted and another three teeth in need of a filling.

10.53% of the subjects had complete dentures while 37.5% of the subjects needed complete dentures in both the arches.

Even among the dentate subjects, the maximum number of subjects needed a combination of one and/or multiunit prosthesis, both in maxillary (20.4%) and mandibular (19.1%) arches [Table 2].

Of the total sample, 47.37% of the subjects could not be considered for recording of the Community Periodontal Index (CPI) as the teeth present in all the six sextants were <2. In the rest of the sample, 51.3% had a maximum CPI score of 2 followed by 26.3% with a maximum score of 3. Only 11.3% of the subjects had a healthy periodontium.


   Discussion Top


Various authors described the ratio of men to women to be tilted toward women, [2],[3],[8],[9],[10] which does not match with our study. This difference in sex ratio of the study group depicts higher association of males with the elders' homes as residents and/or as day visitors.

The educational level of the subjects can be stated to be high when compared to the study by Mersel, [11] as 29% of the subjects had more than 12 years of schooling, with graduates constituting a major portion of it. Goel et al, [1] reported that 3/4 th of the overall sample was illiterate.

Mersel [11] reported that 20% of the subjects visited a dentist once every year whereas only 3% of the subjects in our study used to visit the dentist regularly. Similarly, the number of subjects who had never visited a dentist in their life time was around three times that reported by Mersel. [11]

Arthritis in this study was quite uncommon, with 4.6% subjects against Mersel, [11] with 53% subjects reporting to be suffering with Arthritis. Difficulty with walking and pain in joints usually accompany growing age. When considering medical condition, people usually do not consider joint pain or dysfunction, stating only conditions like hyper/hypotension, diabetes, cardiovascular disease, etc.; hence, a low prevalence of arthritis.

Approximately one-fourth of the study sample was habitual of smoking tobacco in this study. Mersel [11] and Goel [1] found a similar figure, which was quite high when compared to that reported by Aleksejuniene. [2] Chewing tobacco was uncommon, which is similar to that observed by Goel et al. [1]

A high number of subjects were not in the regular habit of using oral hygiene measures, and this was similar to that reported by Aleksejuniene. [2] It was found that most of those subjects who followed regular oral hygiene habits used toothbrush and toothpaste while most of those who were irregular in their oral hygiene habits used tree stick.

The mean number of teeth present per dentate subject was quite high when compared to Carter et al. [9] and Peltoal et al. [10]

The prevalence of edentulousness was similar to Tramini et al., [8] while it was quite low with respect to that reported by Peltoal et al. [10] and Carter et al. [9] and higher than that reported by Murray et al., [12] Aleksejuniene [2] and Mack et al. [3]

The use of partial and/or complete dentures was quite low while the need for a prosthesis was quite high when compared to other studies. [8],[9],[11],[12] This lesser use of dentures in our study is in accordance with the already stated lesser utilization of dental services. The elderly subjects usually become dependent on others due to their impaired physical or mental condition. Being in elders' home gives further impetus to their being dependent, and is in accordance to their higher unmet prosthetic needs.

Females were less likely to be edentulous than males in all ages. This was against what was reported by Tramini et al. [8] Use of complete dentures decreased, while its need increased with increasing age. This is in accordance with various studies. [3],[8]

Around half of the subjects could not be considered for periodontal assessment due to insufficient teeth. Subjects with healthy periodontium were half of that reported by Goel et al. [1] Presence of calculus was the most common finding.

Although extended results have been achieved, yet the small sample size hinders the generalizability of the results to the general population. Hence, further studies are needed at a larger scale to collect the baseline oral health data and to plan restorative and prosthetic services for the elders.

To conclude, the oral health status, especially the periodontal status and the prosthetic status of the subjects, is poor. Most of the elderly subjects do not maintain their oral hygiene and have poor utilization rates for dental services. Steps need to be taken for an improvement in this direction by the government as well as the dental fraternity.

 
   References Top

1.Goel P, Singh K, Kaur A, Verma M. Oral health care for elderly: Identifying the needs and feasible strategies for service provision. Indian J Dent Res 2006;17:11-21.  Back to cited text no. 1  [PUBMED]  Medknow Journal  
2.Aleksejuniene J, Holst D, Eriksen HM. Patterns of dental caries and treatment experience in elderly Lithuanians. Gerodontology 2000;17:77-86.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Mack F, Mojon P, Budtz-Jψrgensen E, Kocher T, Splieth C, Schwahn C, et al. Caries and periodontal disease of the elderly in Pomerania, Germany: Results of the study of health in Pomerania. Gerodontology 2004;21:27-36.  Back to cited text no. 3      
4.Central Bureau of Health Intelligence. National Health Profile 2006; Directorate General of Health Services: Ministry of Health and Family Welfare; 2006. p. 2-14.  Back to cited text no. 4      
5.Directorate of Social Justice and empowerment, Government of Haryana. Available from: http://www.socialjusticehry.nic.in/others.htm#aw . [last accessed on 2008 May 20].  Back to cited text no. 5      
6.World Health Organization. Oral Health Surveys. 4 th ed. Basic Methods, Geneva: WHO; 1997.  Back to cited text no. 6      
7.Dunning JM. Principles of Dental Public Health. 4 th ed. Cambridge: Harvard University Press; 1986. p. 338-9.  Back to cited text no. 7      
8.Tramini P, Montal S, Valcarcel J. Tooth loss and associated factors in long-term institutionalized elderly patients. Gerodontology 2007;24:196-203.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  
9.Carter G, Lee M, McKelvey V, Sourial A, Halliwell R, Livingston M. Oral health status and oral treatment needs of dependent elderly people in Christchurch. N Z Med J 2004;117:1-10.  Back to cited text no. 9      
10.Peltola P, Vehkalahti MM, Wuolijoki-Saaristo K. Oral health and treatment needs of the long-term hospitalized elderly. Gerodontology 2004;21:93-9.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]  
11.Mersel A. Oral health status and dental needs in a Geriatric institutionalized population in Paris. Gerodontology 1989;8:47-51.  Back to cited text no. 11  [PUBMED]    
12.Murray PE, Ede-Nichols D, Garcia-Godoy F. Oral health in Florida nursing homes. Int J Dent Hyg 2006;4:198-203.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]  

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Correspondence Address:
Vikram Bansal
Department of Preventive and Community Dentistry, M.M. College of Dental Sciences and Research, Mullana, Ambala, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.66647

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    Tables

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