|Year : 2020 | Volume
| Issue : 1 | Page : 22-25
|Knowledge, Attitude and practice survey on the perspective of oral lesions and dental health in geriatric patients residing in old age homes
Sinduja Palati, Pratibha Ramani, Herald J Shrelin, Gheena Sukumaran, Abilasha Ramasubramanian, KR Don, Gifrina Jayaraj, Archana Santhanam
Department of Oral and Maxillofacial Pathology, Saveetha Dental College, Saveetha University, Chennai, Tamil Nadu, India
Click here for correspondence address and email
|Date of Submission||08-Mar-2018|
|Date of Decision||20-Jan-2019|
|Date of Acceptance||18-Sep-2019|
|Date of Web Publication||02-Apr-2020|
| Abstract|| |
Aim: The aim of the study is to analyse the knowledge about oral lesions, the symptoms of such lesions and their attitude towards the treatment of these problems faced by institutionalised geriatric individuals. Methods and Materials: This questionnaire-based survey was conducted among 103 institutionalised elders residing at various institutions. The questionnaire consisted of questions that addressed the medical and dental issues faced by the institutionalised elders and assessed their knowledge and attitude towards dental health. All the received responses were tabulated and the results were represented graphically. Results: The results of the study showed that 44.66% of the elders underwent medical check-up once yearly and 72.82% of them visited the dentist. Of all 103 elders, none of them used dentures in spite of being edentulous and only 29.13% had any knowledge about oral lesions while the rest had no knowledge of the oral lesion and considered these lesions to be normal changes with increasing age. Conclusions: The findings of the present study demonstrate the need to improve access to oral healthcare and dental health education for the institutionalised elder population. In spite of the limitations of the study, we were able to record the obvious lack of dental hygiene practises, neglect and lack of motivation for proper dental care.
Keywords: Dental hygiene, geriatric dentistry, institutionalised elderly, oral health
|How to cite this article:|
Palati S, Ramani P, Shrelin HJ, Sukumaran G, Ramasubramanian A, Don K R, Jayaraj G, Santhanam A. Knowledge, Attitude and practice survey on the perspective of oral lesions and dental health in geriatric patients residing in old age homes. Indian J Dent Res 2020;31:22-5
|How to cite this URL:|
Palati S, Ramani P, Shrelin HJ, Sukumaran G, Ramasubramanian A, Don K R, Jayaraj G, Santhanam A. Knowledge, Attitude and practice survey on the perspective of oral lesions and dental health in geriatric patients residing in old age homes. Indian J Dent Res [serial online] 2020 [cited 2021 May 11];31:22-5. Available from: https://www.ijdr.in/text.asp?2020/31/1/22/281801
| Introduction|| |
The elders often have a number of oral and dental diseases but their subjective need for treatment is reported to be small especially the ones who spend the rest of their time at the old age home. There may be several reasons for this including financial ones but it may also relate to the observation that the pain threshold rises with ageing and the sensation of pain are an alarm. The amount of importance given to systemic health is far more than oral health. Oral health is neglected partly because care-dependent elders need care for their daily activities such as food intake, drug intake, getting dressed, bathing, general healthcare and physiotherapy. As a result, less time is reserved for activities that are commonly considered as less important by elders including oral care.
There is a gradual reduction in growth and repair of the epithelium, the resistance of the oral mucosa and its susceptibility to mechanical, chemical and microbial irritations which may increase. It may, however, be difficult to determine if a certain disorder is due to ageing itself, or abnormal oral habits, pathogenic microorganisms, drug treatment or some other irritating factors. Many older people have oral cavities that harbour a complicated mix of conditions that are physiological, pathological and microbiological, that is a challenge to keep in good condition. Oral dryness and increasing functional limitations make the older person more susceptible to oral diseases. The previous studies have identified many barriers to providing proper oral care to such patients. Dominant barriers and facilitators are relatively well understood such as (a) residents resisting oral care; (b) care provider's lack of knowledge, education or training in providing oral care; (c) care provider's attitudes towards oral care; (d) staffing and time issues and (e) quality of communication/collaboration among care providers and with residents.
This study aims to analyse the major problems faced by institutionalised geriatric individuals and their knowledge about oral lesions, the symptoms of such lesions and their attitude towards the treatment of these problems.
| Subjects and Methods|| |
This study was conducted with 103 institutionalised elders residing at various institutions; these samples were selected based on the inclusion and exclusion criteria. Inclusion criteria included elders of age above 60 years, residing in the aged-care homes in Chennai. The exclusion criteria were elders who were not willing to participate in the survey, physically or mentally challenged patients and elders with terminal diseases and systemic co-morbidities.
Nearly 200 questionnaires were sent and 103 responses were received. The questionnaire consisting of 14 questions was created by two oral pathologists and was reviewed by another author and validated and circulated across old age homes in Chennai. The questionnaire consisted of questions addressed to the medical and dental issues faced by the institutionalised elders and assessed their knowledge and attitude towards dental health. Around 103 responses were received. All the received responses were tabulated and the results were represented graphically.
| Results|| |
Of the 103 institutionalised elders who participated in the present study, 73.79% suffered from hypertension and 49.51% suffered from diabetes mellitus. [Figure 1] shows the duration between visits for medical and dental purposes, it can be seen that 44.66% of the elders undertook medical check-up yearly once and 72.82% of them visited the dentist only when needed and 85.44% of them took medications on a daily basis.
|Figure 1: The chart shows the time lapse between two visits. It can be seen that dental health is given less importance and many prefer a check-up only when necessary|
Click here to view
[Figure 2] shows the brushing habits of the participants, 57.28% of the participants use their finger instead of brushing their teeth and only 0.97% of them brush their teeth twice daily. It has been found that 38.83% of the participants, predominantly women, chew betel nut during their leisure hours while most of them did not know about the harmful effects and it has been proven that tobacco and its related products were the strongest risk factor, followed by the use of faulty dentures for lesions in elders.
|Figure 2: The chart shows the brushing habits followed, it is evident that not many use brush and none brush their teeth twice daily as recommended|
Click here to view
Of all 103 elders, none of them used dentures in spite of being edentulous and thus resulted in an increased difficulty in eating hard foods, thereby increasing the risk of malnutrition.
Of all the 103 participants, 38.83% of them complained of bad breath followed by 33.01% of them complaining of pain [Figure 3].
|Figure 3: The following chart shows the most common dental problems faced by institutionalised elders|
Click here to view
Certain older adults do have oral lesions but the lesions did not interfere with their daily life, so they did not seek medical attention. It was seen that the institutionalised elders had very less knowledge about the oral lesions. Only 29.13% had any knowledge about oral lesions while the rest had no knowledge about oral lesions and considered these lesions to be normal changes with increasing age. [Figure 4] shows that only 14.56% of the participants think they need to be treated for the lesions. This shows the level of knowledge and attitude towards the dental health of the institutionalised elders.
|Figure 4: This chart shows the treatment needs by the elders, this shows that only 14.56% of the individuals assume need treatment for their lesions, while the rest consider it to be normal changes or unnecessary complications in daily life|
Click here to view
| Discussion|| |
The prevalence of oral lesions is said to be increased in elder individuals compared to younger counterparts. The oral epithelium has to become thinner with advancing age. The underlying connective tissue shows reduced collagen synthesis with fibrotic and degenerative changes in collagen, as well as a loss of elastin. In addition, reduced immunological reactivity, impaired DNA repair capacity and impaired carcinogen metabolism render oral mucosa more permeable to noxious substances and more vulnerable to external carcinogens. However, age by itself is not the only contributing factor. Other factors such as trauma, systemic diseases, medications, poor nutritional status, oral hygiene and denture status might also influence the development of oral lesions. Oral hygiene levels were found to be poor and seemed to be influenced by age, care dependency and place of residence. In general, the worst oral hygiene and health was observed in the oldest age group (>89). This indicates that, within the high-risk group of frail older people 65 years of age or more, the oldest ones are at the highest risk for developing oral diseases.
Since several pathological oral conditions occur more frequently in the elders and since many conditions often give no pain symptoms, careful oral examination of the elders should be carried out at regular intervals. In spite of the fact that there is mushrooming of dental schools in India producing thousands of dentists per year, there is an unequal distribution of the dental professionals, thus it would be very valuable if physicians and nurses could make these examinations.
According to different studies, it is a common finding to observe oral pluripathology in the elders, due to the ageing process, systemic complexity involvement in these patients, metabolic changes, nutritional factors, prosthetic use, medications, psychobiological habits and alcohol or tobacco habits. Therefore, several conditions are to be encountered in this particular age group which includes neoplasms, infections, immunological, haematological and systemic disorders, leading to oral pain and discomfort in the older patient. The various causes leading to changes in the oral mucosa due to ageing are bacterial, fungal, viral, parasitic infections, infections caused by other agents, physical and thermal alterations, immune system changes, systemic diseases, tumours, trauma and other factors.
In the study by Pieternella et al. on the opinions of dentists on the barriers in providing oral healthcare to community-dwelling frail older people, they had found that 42% of the respondents were not willing to visit homebound frail older people for a periodic oral examination. This unwillingness of participants to visit homebound, older patients were linked to a lack of dental equipment. Furthermore, it has already been shown by Lamy et al. that poor prosthetic oral health among nursing home residents in Liege (Wallonia, Belgium) has led to difficulty in eating hard foods and an increase in the consumption of mashed foods, thus leading to decreased eating pleasure and higher risk for malnutrition.
Othman et al. investigated the willingness and barriers in providing domiciliary care for older people among dentists in the Malaysian government. It appeared that many dentists felt unprepared to visit homebound frail older people because of the lack of knowledge, time and skills required for the treatment of patients with complex medical conditions.
The other major finding in this study is that the importance given to general medical health is exponential compared to dental health. Therefore, oral healthcare should be better integrated into medical care, especially because there is a strong correlation between overall health and oral health. The unattended and sick elders and those living in remote areas do not have access to medical facilities despite having oral lesions. Homebound individuals are highly impaired functionally and have multiple co-morbidities. Self-rated oral health, especially in older age, has been found to have an effect on current and future self-rated health and ratings of self-esteem and life satisfaction. The high prevalence of poor oral health and hygiene practises, coupled with high rates of interest in accessing dental care in this neglected population raises important implications for all healthcare providers working with this vulnerable population. Katherine et al. in their study suggested that home-based primary care medical providers should be aware of this and consider oral health needs in their management of various medical conditions and geriatric syndromes including chronic pain, depression, social anxiety or withdrawal, malnutrition or failure to thrive, dysphagia and medication non-adherence.
Partnerships between dental programs and medical providers working with homebound older adults will become easier as dental technology becomes increasingly portable. Furthermore, it may be cost-effective to train allied dental professionals such as dental hygienists, non-dental medical professionals (nurse practitioners, registered nurses, physician assistants) or even trained non-clinical providers to administer oral health assessments and education on general oral health and hygiene, possibly with dental consultation through video conference, as has been done with other medical specialties including geriatric medicine in cases of remote regions where the distribution of dentists is sparse.,
As emphasised in the World Oral Health report 2003, WHO sees oral health as integral to general health and as a determinant for quality of life. The interrelationship between oral health and general health is particularly pronounced among older people primarily because several oral diseases have risk factors that are common with chronic diseases. Tobacco use and time since last dental visit were associated with an increased risk of mucosal surface lesions. Only age was related significantly to the risk of soft tissue enlargements. In a similar study done in Telangana, India, the authors have shown that the oral mucosal lesions are increased, the periodontal status was poor and the prevalence of denture wearing was low despite the high prevalence of edentulousness in their study group. This study gives us an overview of the knowledge and attitude of the institutionalised elder individuals towards their dental health and hygiene. Moreover, the results were found to be consistent with the study done by Sabiha et al.
| Conclusion|| |
The findings of the present study point to a need to improve access to oral healthcare and dental health education for the institutionalised elderly population. In spite of the limitations of the study, we were able to record the obvious lack of dental hygiene practises, neglect and lack of motivation for proper dental care. The increasing number of elders in such institutions under such conditions is a wake-up call to the upcoming dental practitioners. It is beyond all doubt that oral healthcare should start with good daily oral hygiene, the cornerstone of preventive oral healthcare.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ekelund R. Oral mucosal disorders in institutionalized elderly people. Age Ageing 1988;17:193-8.
Hoeksema AR, Peters LL, Raghoebar GM, Meijer HJA, Vissink A, Visser A. Oral health status and need for oral care of care-dependent indwelling elderly: From admission to death. Clin Oral Investig 2017;21:2189-96.
Hoben M, Hu H, Xiong T, Kent A, Kobagi N, Yoon MN. Barriers and facilitators in providing oral health care to nursing home residents, from the perspective of care aides—A systematic review protocol. Syst Rev 2016;5:53.
Patil S, Doni B, Maheshwari S. Prevalence and distribution of oral mucosal lesions in a geriatric Indian population. Can Geriatr J 2015;18:11-4.
Visschere LD, Janssens B, Reu GD, Duyck J, Vanobbergen J. An oral health survey of vulnerable older people in Belgium. Clin Oral Investig 2016;20:1903-12.
Bots-VantSpijker PC, Bruers JJM, Bots CP, Vanobbergen JNO, De Visschere LMJ, de Baat C, et al
. Opinions of dentists on the barriers in providing oral health care to community-dwelling frail older people: A questionnaire survey. Gerodontology 2016;33:268-74.
Lamy M, Mojon P, Kalykakis G, Legrand R, Butz-Jorgensen E. Oral status and nutrition in the institutionalized elderly. J Dent 1999;27:443-8.
Othman AA, Yusof Z, Saub R. Malaysian government dentists' experience, willingness and barriers in providing domiciliary care for elderly people. Gerodontology 2014;31:136-44.
Griffin SO, Jones JA, Brunson D, Griffin PM, Bailey WD. Burden of oral disease among older adults and implications for public health priorities. Am J Public Health 2012;102:411-8.
Benyamini Y, Leventhal H, Leventhal EA. Self-rated oral health as an independent predictor of self-rated general health, self-esteem and life satisfaction. Soc Sci Med 2004;59:1109-16.
Ornstein KA, DeCherrie L, Gluzman R, Scott ES, Kansal J, Shah T, et al
. Significant unmet oral health needs among the homebound elderly. J Am Geriatr Soc 2015;63:151-7.
Brignell M, Wootton R, Gray L. The application of telemedicine to geriatric medicine. Age Ageing 2007;36:369-74.
Shah MN, Gillespie SM, Wood N, Wasserman EB, Nelson DL, Dozier A, McConnochie KM. High-Intensity Telemedicine-Enhanced Acute Care for Older Adults: An Innovative Healthcare Delivery Model. Journal of the American Geriatrics Society. 2013;61:2000-7.
Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st
century-The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31:3-24.
Petersen PE, Yamamoto T. Improving the oral health of older people: The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2005;33:81-92.
Hand JS, Whitehill JM. The prevalence of oral mucosal lesions in an elderly population. J Am Dent Assoc 1986;112:73-6.
Shaheen SS, Kulkarni S, Doshi D, Reddy S, Reddy P. Oral health status and treatment need among institutionalized elderly in India. Indian J Dent Res 2015;26:493.
] [Full text]
No. 13/6, Puddu Palli Street, Mylapore, Chennai - 600 004, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
| Article Access Statistics|
| Viewed||2650 |
| Printed||36 |
| Emailed||0 |
| PDF Downloaded||160 |
| Comments ||[Add] |