| Abstract|| |
Aim: The aim of the present study is to assess the prevalence of Kennedy's classification, status of existing prosthodontic appliances if any, awareness of the subjects regarding various treatment options, and treatment needs in a group of elderly institutionalized residents.
Materials and Methods: The subjects were selected from various old age homes present in Mangalore city, with ages ranging from 60 to 80 years. The subjects were interviewed and examined by a single trained examiner and findings were recorded on a clinical case history report sheet.
Results: Kennedy's class I was most prevalent and class IV the least. Among the subjects examined, only 12.4% were wearing prosthesis. Based on the Nevalainen's index and Karslon's index, most of the prosthodontic appliances were found to be in poor condition. 86% of the subjects were in need of prosthodontic treatment. 75% of the subjects interviewed were unaware of the treatment options available.
Conclusion: The elderly patients living in institutions do not achieve a deserving and satisfactory oral health care. The oral care assistance in institutionalized elderly patients has been an unfulfilled service.
Keywords: Denture treatment needs for elderly, geriatric dentistry, institutionalized patients, prosthetic needs
|How to cite this article:|
Eachempati P, Shenoy VK, Jain N, Singh S. Prosthodontic status and needs of elderly institutionalized residents in Mangalore: A prospective study. Indian J Dent Res 2013;24:284-8
The increasing proportion of the elderly among the populations of almost all countries is presenting them and their societies with specific challenges. This rise in aged population would create new problems and challenges, requiring changes in the organization of our society, making it likely that more and more older people will have to depend upon old age homes. For these people, oral health promotion and protection is very essential to improve the quality of life, both physically and mentally.  It is predicted that the elderly population of India shall be the highest in the world by 2025. Their contribution to the demographic profile is increasing every day. 
|How to cite this URL:|
Eachempati P, Shenoy VK, Jain N, Singh S. Prosthodontic status and needs of elderly institutionalized residents in Mangalore: A prospective study. Indian J Dent Res [serial online] 2013 [cited 2020 Feb 16];24:284-8. Available from: http://www.ijdr.in/text.asp?2013/24/3/284/117987
Loss of teeth could be a disturbing emotional experience for many people. ,, Some people associate the loss of teeth with growing old, which may be emotionally disturbing. Just like the fact that decline in activities of daily living  is a final common pathway for a broad range of decrements in general health, tooth loss constitutes a final common pathway for most dental diseases and conditions. This tooth loss can lead to substantial impacts on quality of life.  In order to prevent or improve the oral health-related quality of life, dentists frequently recommend replacement of teeth with either a fixed or removable prosthesis.
There is abundant data on dental prosthetic needs of elderly institutionalized and non-institutionalized population, but most of these studies are from developed countries. Though there are a few studies ,,, that have assessed prosthetic status and treatment needs in institutionalized elderly in India, there is a continuous need to assess the same in different population groups. Hence, the present study was conducted, with the aim of assessing the prosthodontic status and needs of the institutionalized elderly in Mangalore, India.
| Objectives|| |
To aid in the study protocol, certain objectives were put forward:
- To record the number of completely edentulous patients
- To record the number of partially edentulous patients
- To assess the prevalence of Kennedy's classification
- To know about the general awareness of the subjects regarding replacement of teeth
- Functional evaluation and status of existing prosthesis, if any
- Assessing treatment needs for all the subjects.
| Materials and Methods|| |
The study was conducted among the institutionalized elderly, aged 60 years and above, residing in Mangalore.
Based on available information, five old age homes with a total of 300 residents were identified. Subjects aged 60 years and above were selected for the study irrespective of gender.
A total of 171 subjects were identified and selected for the interview and examination. The subjects were made to sign the informed consent form after which a single trained examiner recorded the data using standardized instruments.
The findings were recorded on a clinical case history report sheet and the observations were made [Table 1]. To aid in the evaluation of the existing prosthesis, the Nevalainen's index  for removable prosthesis [Table 2] and the Karlson's index  for fixed partial dentures were used [Table 3]. The treatment needs were categorized from 0 to 4 and assessed as suggested by Vigild  [Table 4].
| Results|| |
One hundred and seventy-one subjects with a mean age of 67.65 years took part in the study. The male to female ratio suggested that 84% of the subjects were females.
A total of 169 (99%) subjects were found to be edentulous in one arch or the other.
Forty-nine subjects (29%) were completely edentulous in both the arches, whereas eight subjects (5%) were completely edentulous in one of the arches. One hundred and twelve subjects (66%) were partially edentulous in one or both arches [Figure 1].
Prevalence of Kennedy's classification and teeth distribution
Out of 177 partially edentulous arches, 69 class I situations (39%), 65 class II situations (37%), and 41 class III situations (23%) were found. Class IV situations were the least in number, with only two subjects (1%) presenting with the same [Figure 2].
The most persistent teeth in both jaws were canines. Mean values for the missing teeth were the highest for the lower molars (80% reported with absence of at least one lower molar).
Subjects wearing prosthesis
Among the 169 edentulous subjects, only 21 (12.4%) were wearing a prosthesis. Thirteen subjects (62%) were wearing both maxillary and mandibular complete denture; 5 (24%) were wearing a single complete denture, among which four were maxillary and one was mandibular.
Two subjects (9.5%) were wearing a removable partial denture, one maxillary and one mandibular. Only one subject (5%) was found with a three-unit posterior mandibular fixed partial denture [Figure 3].
Status of the existing prosthesis
Based on the Nevalainen's index, 10 maxillary and 9 mandibular complete dentures were graded to be poor. Three each of the maxillary and mandibular dentures were satisfactory. Four maxillary and two mandibular dentures were found to be in good condition. Using the same criteria for evaluation, the maxillary removable partial denture was found to be poor, whereas the mandibular removable partial denture was satisfactory.
Only one fixed partial denture was noted, but was graded to be of poor quality according to Karlson's index [Figure 4].
One hundred and one (59%) of the subjects were under category 1, 41 (24%) were categorized as category 2, and 24 (14%) of the subjects were under category 0. Three and two subjects were under categories 3 and 4, respectively (2% and 1%) [Figure 5].
Patient awareness and reason for not wearing prosthesis
One hundred and twenty-six subjects were unaware of the prosthetic treatment option and 43 subjects (25%) had various other reasons for not wearing the prosthesis [Figure 6].
| Discussion|| |
In the present study, the prevalence of edentulousness, either partial or complete, was found to be 99%. Angellilo et al.  and Ong et al.  in their study found the prevalence to be 59.8% and 51.2%, respectively.
The prevalence of edentulism can be regarded as a rough but instructive indicator of the oral health of elderly population. In the present study, 49 subjects (29%) were completely edentulous in both arches. This is in accordance with previous studies conducted by Miyazaki  and Loh et al.,  who found it to be 30% and 27.3%, respectively. Edward,  Thakare,  and Rao  also found similar results in their study. Prasad  reported lower prevalence (11.83%) of edentulousness in home dwelling elderly. However, in the present study, the subjects were institutionalized elderly.
The male to female ratio suggested a predominance of female subjects. This observation is in accordance with the previous findings. Vigild et al.  suggested that the higher rate of edentulousness among women may be explained by different treatment patterns of the two sexes. In general, the women make more use of health services than the men do. This includes the use of dental service, and more frequently women have their few remaining teeth extracted and replaced by dentures for cosmetic reasons.
Prevalence of Kennedy's classification suggested a dominance of class I situations (39%) followed by class II, III, and IV, respectively.
The most commonly missing teeth were the lower molars and this finding is similar to that found in other studies.  This finding indicates the importance the subjects place to esthetics in comparison to function. This explains the fewer incidences of Kennedy's class IV situation over class I and II situations.
The present study suggested a very low percentage of subjects wearing prosthesis. The reasons attributed varied, with unawareness being the most common reason. This suggests that although some institutions offer free dental care, the need for prosthodontic treatment is far from being met. It would represent a major improvement if the elderly received an oral check up and had their oral and dental problems solved at the time of admission. Education and motivation regarding the existing status of oral health and maintenance of the same is needed to improve the overall awareness among the institutionalized elderly.
The status of the existing prosthesis suggested that 10 maxillary and 9 mandibular dentures were unsatisfactory. The maxillary removable partial dentures were found to be poor, whereas the mandibular removable partial dentures were satisfactory. This finding is in contrast to the results of other studies where majority of the mandibular dentures were of poor retention and stability. Only one fixed partial denture was noted and was graded to be of poor quality. The extremely low incidence of fixed partial denture indicates that economic constraints play a vital role in seeking fixed prosthetic treatment.
Results regarding the treatment needs showed that more than 50% subjects needed treatment and were willing to receive the same. Need for prosthesis was similar to those reported by Stuck et al.,  Mersel et al.,  Smith et al.,  Frenkel et al.,  Thakare et al.,  and Chaware et al.  These authors felt that the probable reason for lower percentage of fulfilled prosthetic needs in their studies may be the unfounded belief by families and health care practitioners that tooth loss is inevitable during aging, lack of awareness on the importance of oral health, poor access to services, and higher costs of dental care.
Also, 24% who needed treatment were not willing to receive the treatment for various reasons. Such a group of population should be targeted to improve the awareness regarding the importance of teeth replacement.
| Conclusion|| |
The elderly patients living in institutions do not achieve a deserved and satisfactory oral health care. The oral care assistance in institutionalized elderly patients has been an unfulfilled service. There is a wide gap between the prosthetic needs and prosthetic status. There is an urgent need for a proper strategic planning by the institutional authorities, dental professionals, and the government to address the problem.
Hence, our focus should be to increase the awareness regarding oral health needs of older individuals. This should be aimed at providing best quality care at the lowest possible cost, maximizing treatment effectiveness, and reaching those in greatest need of our service.
| References|| |
|1.||Rao A, Sequeira P, Peter S, Rajeev A. Oral Health status of institutionalised elderly in Mangalore, India. Indian J Dent Res 1999;10:55-61. |
|2.||Shenoy RP, Hegde V. Dental prosthetic status and prosthetic need of the institutionalized elderly living in geriatric homes in Mangalore: A pilot study. ISRN Dent 2011;2011:987126. |
|3.||Dodge CA. Prevention of complete denture problems by use of "overdentures". J Prosthet Dent 1973;30:403-11. |
|4.||DeFranco RL. Overdentures. Dent Clin North Am 1977;21:379-94. |
|5.||Renner RP, Foerth D, Levey M. Preventive prosthodontics-overdenture service. A case report. N Y State Dent J 1977;43:17-21. |
|6.||Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The Index of Adl: A standardized measure of biological and psychosocial function. JAMA 1963;185:914-9. |
|7.||Locker D, Miller Y. Evaluation of subjective oral health status indicators. J Public Health Dent 1994;54:167-76. |
|8.||Shigli K, Hebbal M, Angadi GS. Prosthetic status and treatment needs among patients attending the prosthodontic department in a dental institute in India. Eur J Prosthodont Restor Dent 2009;17:85-9. |
|9.||Bhat M. Oral health status and treatment needs of a rural Indian fishing community. West Indian Med J 2008;57:414-7. |
|10.||Nadgere JB, Doshi AG, Kishore S. An evaluation of prosthetic status and prosthetic need amongst people living in and around Panvel, Navi. Mumbai. A Survey. Int J Prosthest Dent 2010;1:6-9. |
|11.||Nevalainen MJ, Rantanen T, Narhi T, Ainamo A. Complete dentures in Prosthetic rehabilitation of elderly persons: Five different criteria to evaluate the need for replacement. J Oral Rehabil 1997;24:251-8. |
|12.||Karlson S. A clinical evaluation of fixed bridges, 10 years following insertion. J Oral Rehabil 1986;13:423-32. |
|13.||Vigilid M. Denture status and need for Prosthodontic treatment among institutionalized elderly in Denmark. Community Dent Oral Epidemiol 1987;15:128-33. |
|14.||Angelillo IF, Segliocco G, Hendricks SJ, Villari P. Tooth loss and dental caries in institutionalized elderly in Italy. Community Dent Oral Epidemiol 2009;18:216-8. |
|15.||Ong G, Soh G, Chong YH. Periodontal status of institutionalized elderly in Singapore. Community Dent Oral Epidemiol 1992;20:382-3. |
|16.||Miyazaki H, Ohtani I, Abe N, Ansai T, Katoh Y, Sakao S, et al. Periodonal conditions in older age cohorts aged 65 years and older in Japan, measured by CPITN and loss of attatchment. Community Dent Health 1995;12:216-20. |
|17.||Loh T, Ow RK, Neo J. Tooth loss and coronal caries experience of elderly residence in Singapore. Community Dent Oral Epidemiol 1996;24:300-1. |
|18.||LoEC, Yan L, Dyson JE. Oral health status of institutionalized elderly in Hongkong. Community Dent Oral Epidemiol 2004;21:224-6. |
|19.||Thakare V, Ajith Krishnan CG. Periodontal status, prosthetic status and prosthetic needs among institutionalized geriatric individuals in Vadodara city, Gujarat. A descriptive study. Indian J Public Health 2010;15:153-7. |
|20.||Prasad KV, Thanveer K, Javali SB. Denture status and needs of prosthetic treatments in elderly population of Dharwad district, Karnataka State. J Indian Dent Assoc 2001;72:204-6. |
|21.||Catovic A, Jerolimov V, Catic A. Tooth loss and the condition of Prosthodontic appliances in a group of elderly home residents. J Oral Rehabil 2000;27:199-204. |
|22.||Stuck AE, Chaappius C, Flury H, Lang NP. Dental treatment needs in an elderly population referred to geriatric hospital in Switzerland. Community Dent Oral Epidemiol 1989;17:267-72. |
|23.||Mersel A, Anaise JZ, Tov AS. Prosthetic needs and demands for services of a group of elderly people in Israel. Community Dent Oral Epidemiol 1984;12:315-8. |
|24.||Smith JM, Sheiham A. Dental treatment needs and demands of an elderly population in England. Community Dent Oral Epidemiol 1980;8:360-6. |
|25.||Frenkel H, Harvey I, Newcombe RJ. Oral health care among nursing home residents in Avon. Gerodontology 2000;17:35-8. |
|26.||Chaware S, Ghodpage SL, Sinha M, Chauhan V, Thakare V. Prosthetic status and prosthetic needs among institutionalized geriatric individuals in Nashik city, Maharashtra: A descriptive study. J Contemp Dent Pract 2011;12:192-5. |
Department of Prosthodontics, Manipal College of Dental Sciences, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
[Table 1], [Table 2], [Table 3], [Table 4]