| Abstract|| |
Context: Oral health means more than only good teeth. It is a state-of-being-free from mouth and facial pain, oral and throat cancer, oral infections, periodontal diseases, tooth decay or loss, and other diseases/disorders. The age distribution of the world's population is changing. With advances in medicine, the proportion of older people continues to increase worldwide. Aims, Setting, Materials and Methods: A cross-sectional study was carried out among 158 elderly (>60 years) residing in a slum of Kolkata during the period from April 2017 to June 2017 to assess the impact of oral health on general health. Data were collected using a pretested predesigned schedule containing Geriatric Oral Health Assessment Index. Data analysis was performed in R software. Poisson regression was used to find the associates of the impact of oral health. Results: Mean (standard deviation) age was 68.54 (5.9) years. A total of 104 (65.8%) participants reported; foul breath as a problem and 88 (55.7%) reported gum bleeding as a problem. All participants used to clean their teeth daily but only 36.1% used to clean their teeth at least twice daily. More than half the participants reported that they have limited the kind of food they eat due to dental/gum condition and trouble chewing. Conclusion: There is a need to provide sensitive oral health services that are accessible, affordable, appropriate, and acceptable. Knowledge regarding oral health and hygiene should be provided to all elderly, especially diabetics. Further research with the broader conceptual framework, in different age groups and in different settings are warranted.
Keywords: Elderly, Geriatric Oral Health Assessment Index, Poisson regression, slum
|How to cite this article:|
Garg S, Dasgupta A, Maharana SP, Mallick N, Pal B. A study on impact of oral health on general health among the elderly residing in a slum of Kolkata: A cross-sectional study. Indian J Dent Res 2019;30:164-9
|How to cite this URL:|
Garg S, Dasgupta A, Maharana SP, Mallick N, Pal B. A study on impact of oral health on general health among the elderly residing in a slum of Kolkata: A cross-sectional study. Indian J Dent Res [serial online] 2019 [cited 2019 Jul 18];30:164-9. Available from: http://www.ijdr.in/text.asp?2019/30/2/164/259228
| Introduction|| |
Oral health means more than only good teeth. It is a state of being free from mouth and facial pain, oral and throat cancer, oral infections, periodontal diseases, tooth decay or loss, and other diseases/disorders that limit an individual's capacity in biting, chewing, smiling, speaking, and psychosocial well-being. Oral health is indispensable for a good quality of life. Poor oral health affects growth negatively in all aspects of human development.
Despite great success in improving the oral health of population globally, problems remain in many communities worldwide, particularly among the underprivileged groups in developing countries. Worldwide, 60%–90% of school children and nearly 100% of adults have dental cavities. Dental diseases are easily preventable to a large extent. However, information and awareness about the preventive aspects of oral and dental health are usually not applied in practice and therefore, dental disease, particularly caries and periodontal disease, continue to be rampant in the population. India has a high prevalence of oro-dental diseases, and it is well established that oral diseases are a public health problem.
The age distribution of the world's population is changing. With advances in medicine, the proportion of older people continues to rise worldwide. By 2051, there will be 2 billion people over the age of 60 with 80% of them living in developing countries. Globally, about 30% of people aged 65–74 have no natural teeth. The elderly population in India has tripled in the last 51 years and will relentlessly increase in the near future. In 2001, the proportion of older people was 7.7% which increased to 8.94% in 2016. This growth is staggering, posing tremendous challenges in caring for the aging population.
The interrelationship between oral health and general health is particularly pronounced among older people. Poor oral health can increase the risks to general health and with compromised chewing and eating abilities, can affect nutritional intake. The high prevalence of multi-medication therapies in this age group may further complicate the impact on oral health. Other relevant issues include diet with high sugar content, inadequate oral hygiene due to poor dexterity, alcohol/tobacco use that is detrimental to oral health.
Severe periodontal disease, for example, is associated with diabetes. The strong correlation between several oral diseases and noncommunicable chronic diseases is primarily a result of the common risk factors. The consequences of these diseases and conditions are significant, leading to disabilities, and reduced quality of life. Oral diseases are usually progressive and cumulative.
The situation is worsened in developing countries where least importance is given to oral health services. Given that some older people may experience financial hardships following retirement, the cost or perceived cost of dental treatment, together with negative attitudes to oral health and impaired mobility, may deter them from visiting a dentist.,
With this background, this study was conducted to assess the impact of oral health on general health among the elderly.
| Materials and Methods|| |
This was an observational study done within a period of 3 months from April 2017 to June 2017. The study participants were elderly individuals (age >60 years) residing in the service area of Urban Health Unit and Training Center (UHUTC), Chetla. UHUTC, Chetla is the urban field practice area of All India Institute of Hygiene and Public Health, Kolkata. It has 4 units with 8 sectors [Figure 1].
|Figure 1: The service area of Urban Health Unit and Training Center, Chetla|
Click here to view
As no other study on this issue was found until date, a pilot study was conducted in one of the 8 sectors to assess the impact of oral health on general health using Geriatric Oral Health Assessment Index (GOHAI). Those individuals with GOHAI score less than the median were categorized as with higher impact of oral health on general health. It was found that 52.5% had a higher impact. After taking this as prevalence, with absolute precision of 10%, Type-I error as 5% and nonresponse rate as 5%, minimum sample size came to be 158. Individuals with age >60 years were included in the present study while those who were critically ill at the time of the survey were excluded. Out of the remaining 7 sectors, one sector was selected randomly. Line listing of all the elderly in that sector was done, and 158 individuals were selected randomly.
Data were collected with a predesigned pretested schedule which had 6 parts:
- Sociodemographic and behavioral characteristics
- History of diabetes
- Perception of general health and oral health
- Oral health-related knowledge
- Oral Hygiene
Examination for a number of teeth, the presence of caries/plaques, stomatitis/cheilosis, and gum bleeding was also done after completion of the face-to-face interview.
Three questions were asked to report the perception of general health, oral health, and chewing capacity; each on 3-point Likert scale ranging from good to bad. Two questions were asked to report perception of foul smelling breath and the problem of gum bleeding; both on the dichotomous scale as yes/no.
Eight questions were asked to assess the oral health-related knowledge; response for each was reported on the dichotomous scale as yes/no. Yes, response was given score as one. Five questions were asked to assess the oral health-related hygienic practices; optimum response for each was given score as one. A higher score represents better knowledge and oral hygiene.
Details about the impact of oral health on general health during the past 3 months were collected using the GOHAI after translation into vernacular and pretesting on 30 individuals. The GOHAI consists of 12 questions that reflect those aspects considered to have an impact on the quality of life of the older population. A higher score indicates less impact.
The study was done with the due permission of Institutional Review Board and after taking written informed consent. All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000.
All analyses were conducted with R: a language and environment for statistical computing. Cronbach's alpha was used to assess the internal consistency of GOHAI. Zero-truncated count (Poisson) regression models were used to find the determinants of impact of oral health on general health. Results were considered statistically significant at conventional P < 0.05 level.
| Results|| |
Mean (standard deviation [SD]) age of the participants was 68.54 ± 5.9 years. Mean (SD) years of completed schooling were 7.6 ± 4.9 years. One hundred and three (66.5%) were females. Ninety (57%) were living with the spouse at the time of the survey. One hundred and five (66.5%) belonged to the joint family. Eighty-seven (55.1%) were economically dependent on their families. Mean (SD) per capita income (PCI) was 2900 ± 2800 Indian Rupees with a median of 2000 rupees.
Fifty-six (35.4%) were diabetic. Eighty-one (51.3%) participants reported that they had a practice of using a toothbrush for cleaning the teeth. Forty-five (28.5%) were a smoker, 51 (31.6%) had a habit of chewing tobacco, and 56 (35.4%) were betel-nut chewers.
One hundred and four (65.8%) participants reported; foul breath as a problem and 88 (55.7%) reported gum bleeding as a problem. Fifty-seven (36.1%), 36 (22.8%), and 62 (39.2%) of them reported general health, oral health, and chewing capacity as good. Mean (SD) number of teeth was 19.4 ± 6.7. On oral examination 26 (16.5%), 106 (67.1%), and 16 (10.1%) of the participants were found to have glossitis/stomatitis, dental caries, and gum bleeding, respectively.
Out of 158 participants, 145 (91.8%) had the correct knowledge about the frequency of brushing teeth, but only 21.5% knew about the frequency and need of dental check-up at a dentist [Table 1].
|Table 1: Knowledge regarding oral health among study participants (n=158)|
Click here to view
All participants used to clean their teeth daily but only 36.1% used to clean their teeth at least twice daily. Only 12% were reported that they used mouthwash regularly [Table 2].
More than half participants reported that they have limited the kind of food due to dental/gum condition and trouble chewing. Similarly, about half were unable to swallow comfortably. More than 90% had sensitivity to hot/cold/sweets [Table 3].
|Table 3: Impact of oral health on general health among the study participants (n=158)|
Click here to view
GOHAI score had a mean of 33.9 with a median of 32.5. Cronbach's alpha was 0.79. GOHAI score ranged from 14 to 55. GOHAI scale had a significant correlation with the perceived general health and oral health [Table 4].
|Table 4: Association between perceived general health and oral Geriatric Oral Health Assessment Index Score (n=158)|
Click here to view
On truncated Poisson regression, increasing age (incident rate ratio [IRR] = 0.98) was found to have a detrimental effect on oral health and hence greater impact on general health. Individuals who belonged to joint family (IRR = 1.07), high-income family, i.e., PCI >₹2000 (IRR = 1.1), who had a habit of using a toothbrush (IRR = 1.12) and who were not diabetics (IRR = 1.18) had a higher score and hence less impact. Similarly, more number of teeth (IRR = 1.01), higher knowledge score (IRR = 1.03), and higher hygiene score (IRR = 1.12) were significantly increasing the GOHAI score and hence decreasing the impact. The model was fit as shown in [Figure 2]. As there was acceptable dispersion on truncated Poisson regression, further analysis with other statistics was not considered [Table 5].
|Table 5: Determinants of impact of oral health on general health: Left truncated poisson regression (n=158)|
Click here to view
| Discussion|| |
Overall this cross-sectional study found 55.1% of the study participants facing the higher impact of poor oral health on general health as given by higher GOHAI scores. Increasing age, joint family, high family income, i.e., PCI >2000), the habit of using a toothbrush and those with no diabetes (IRR = 1.18) were significantly associated with the GOHAI score, i.e., they had less impact on general health. Similarly, more number of teeth (IRR = 1.01), higher knowledge score (IRR = 1.03) and higher oral hygiene score (IRR = 1.12) were significantly associated with less impact. Perceived oral health was found to be significantly associated with general health.
Nearly more than half of the study participants in various studies by Dasgupta et al., Jain et al. in India and Murariu et al., Rodakowska et al. outside India,,,, had reported oral health problems such as functional disabilities, sensitivity, and the use of medication to relieve pain; which is similar to the findings of our study. These concurrent findings unveil the existing pandemic of poor oral health worldwide. Although, study done by Atchison and Dolan reported the low proportion of the participants with oral health complaints than ours which may be attributed to the developed socioeconomic status of the participants in the former.
Lack of knowledge regarding the oral health was found to be significantly associated with poor oral health which is similar to the study done by Dasgupta et al. This emphasizes the need of increasing awareness and implementing the knowledge domain in current oral health services and the elderly health programs. A significant association was observed between the oral health and perceived general health; which is similar to the finding of various studies inside and outside India.,,, These findings further solidify the known fact that oral health has its impact on the overall well-being of the individual.
Age and education were found to be significant determinants of GOHAI score which is similar to the findings of Kundapur et al. in rural India. This similarity emphasizes the role of education and age on oral health. Female gender was found to be associated with GOHAI score in studies, in Kerala, and rural India, which is not similar to our study and the reason might be the higher number of females in the above studies. As both studies have found females with poorer oral health, this issue should be addressed. In the present study, diabetics had significantly lower GOHAI score which is in concurrence with the study done by Grossi and Genco suggesting a need of inclusion of oral health aspect into the present policies for the diabetes management. Less number of teeth were found to be associated with the higher impact of oral health which is similar to studies done by Batista et al. and Sanadhya et al., Individuals who belonged to higher socioeconomic status had a higher GOHAI score which is similar to the result of the study done by Jain et al. in Maharashtra. These findings may be attributed to the better availability of resources such as mouth-wash, availability of health services, and affordability for dental check-up.
| Conclusion|| |
This study provided a useful focus on the impact of oral health problems on the psychosocial and functional aspects of the elderly and also found factors associated with poor oral health. The study is also limited by certain aspects such as not all the known factors of poor oral health such as sugar and alcohol use were investigated in the present study,, all the data recorded in our study were self-reported, and hence, there may be a possibility of recall bias. Cross-sectional nature of the study cannot ascertain the temporality.
There is a need to provide sensitive oral health services that are accessible, affordable, appropriate, and acceptable. Knowledge regarding oral health and hygiene should be provided to all the elderly, especially the ones with diabetes. Further research with the broader conceptual framework, in different age groups and in different settings are warranted.
We would like to thank the Officer-in-charge of UHUTC, Chetla and Medical Officers for their help and cooperation in conducting the study. We would also like to thank the health workers and study participants for helping us during our field visits.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Report 1998 – Life in the 21st
Century: A Vision for All. The World Health Report. World Health Organization; 1998. Available from: http://www.who.int/whr/1998/en/
. [Last accessed on 2017 Mar 27].
Shay K, Berkey D, Beck J. The first international conference on rural ageing: A global challenge. Proceedings of the Oral Health Component. Charleston, West Virginia, USA, 2000. Int Dent J 2001;51:177-264.
Grossi SG, Genco RJ. Periodontal disease and diabetes mellitus: A two-way relationship. Ann Periodontol 1998;3:51-61.
Walls AW, Steele JG. Geriatric oral health issues in the United Kingdom. Int Dent J 2001;51:183-7.
World Health Organization. The Implications for Training of Embracing a Life Course Approach to Health. Geneva: World Health Organization; 2000. Available from: http://www.apps.who.int/iris/handle/10665/69400
. [Last accessed on 2017 Mar 27].
Atchison KA, Dolan TA. Development of the geriatric oral health assessment index. J Dent Educ 1990;54:680-7.
Dasgupta A, Majumdar S, Das S, Mukhopadhyay M. Impact of oral health on the elderly – Are they aware enough? – A cross sectional study in a slum of Kolkata. Int J Med Sci Public Health 2014;3:1300-4.
Jain R, Dupare R, Chitguppi R, Basavaraj P. Assessment of validity and reliability of Hindi version of geriatric oral health assessment index (GOHAI) in Indian population. Indian J Public Health 2015;59:272-8.
] [Full text]
Murariu A, Hanganu C, Bobu L. Evaluation of the reliability of the geriatric oral health assessment index (GOHAI) in institutionalised elderly in Romania: A pilot study. Oral Health Dent Manag Black Sea Ctries 2010;9:11-5.
Rodakowska E, Mierzyńska K, Bagińska J, Jamiołkowski J. Quality of life measured by OHIP-14 and GOHAI in elderly people from Bialystok, North-East Poland. BMC Oral Health 2014;14:106.
Kundapur V, Hegde R, Shetty M, Mankar S, Hilal M, Prasad AH, et al.
Effect of loss of teeth and its association with general quality of life using geriatric oral health assessment index (Gohai) among older individuals residing in rural areas. Int J Biomed Sci 2017;13:6-12.
Sanadhya S, Aapaliya P, Jain S, Sharma N, Choudhary G, Dobaria N, et al.
Assessment and comparison of clinical dental status and its impact on oral health-related quality of life among rural and urban adults of Udaipur, India: A cross-sectional study. J Basic Clin Pharm 2015;6:50-8.
Shekhawat KS, Chauhan A, Koshy AA, Rekha P, Kumar H. Reliability of Malayalam version of geriatric oral health assessment index among institutionalized elderly in Alleppey, Kerala (India): A pilot study. Contemp Clin Dent 2016;7:153-7.
] [Full text]
Batista MJ, Lawrence HP, de Sousa Mda L. Impact of tooth loss related to number and position on oral health quality of life among adults. Health Qual Life Outcomes 2014;12:165.
Dr. Swanya Prabha Maharana
Room No. 204, All India Institute of Hygiene and Public Health, 110 C. R. Avenue, Kolkata - 700 073, West Bengal
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]