Oral complaints and utilization of dental services in relation to general health factors in a 88-year-old Swedish population*

The aim of this study was to describe dental state, oral health problems, self-assessed ability to perform oral hygiene and utilization of oral health services in a sample of 88-year-old people (n=374) and to relate these variables to functional ability, subjective health and drug consumption. The intention was also to Identify barriers to utilization of dental care in non-institutionalized elderly people. The results of interviews showed that 46% of the subjects were dentate. Oral complaints were reported by 24% of the home living individuals. Poor health, medication and feelings of loneliness were factors associated with oral discomfort. Difficulties in performing oral hygiene activities were reported by 10% of the subjects and were correlated with functional impairments and feelings of loneliness. Utilization of dental services was correlated with dental state; 72% of the dentate and 8% of the edentulous subjects made regular dental visits. The main reason for not visiting a dentist was “no perceived need”. Independent of dental state, some factors were significantly correlated to low demand for dental services; these included feelings of loneliness, functional impairments and low school education.     

Analysis of socio-demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly

doi: 10.1111/j.1741‐2358.2010.00446.x
Analysis of socio‐demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly Objective: To investigate the association of socio‐demographic and systemic health factors according to the normative conditions of oral health care (dental caries, edentulism, periodontal disease and oral mucosal lesion) in elderly individuals. Material and methods: A cross‐sectional study was carried out in a group of elderly with access to community health care (n = 200). The normative conditions of oral health were then investigated according to the WHO and the SB Brazil criteria. Bivariate analyses were evaluated by the chi‐square test and Fisher’s exact test. An estimation of prevalence for the covariates was performed using Poisson’s regression models. Results: The prevalence of edentulism and oral mucosal lesions was detected in 58% and 21.5% of elderly patients, respectively. In the dentate subjects, the prevalence of dental caries and periodontal disease was 51.2% and 20.8%, respectively. Older men and individuals from lower‐income groups exhibited a higher prevalence of dental caries. Elderly women, illiterate individuals, and individuals over the age of 65 years exhibited a higher prevalence of edentulism. Elderly 60–64 years old and those who are employed had a significant association with periodontal disease. Conclusion: Socio‐demographic factors were associated with some notable oral diseases in the elderly.     

Dental and general health in a population of wild ring-tailed lemurs: a life history approach

Data are presented on dental and general health for seven groups of wild ring-tailed lemurs, Lemur catta, from the Beza Mahafaly Reserve, in southern Madagascar. As part of a study of population demography, adults were captured, collared, and tagged, and biometric measurements, dental casts, and analyses of dental and general health were made. Results indicate that patterns of dental health vary by individual, age, sex, and habitat. Prime adults show more dental attrition than young adults. Prime males living in more marginal habitats show greater mean attrition than those living in richer habitats. Dental damage, specifically to the toothcomb, indicates that mechanical stresses to this region may include the initial harvesting of foods, in addition to grooming. Males exhibit more evidence of past trauma, including scars and chipped teeth. These results indicate that environmental as well as social factors, such as female dominance, may lead to sex differences in health patterns among lemurs.     

A study of the prosthodontic and oral health needs of an ageing psychiatric population

Background: Life expectancy has increased worldwide, with India (having 8% who are senior citizens), falling into the “Greying Country” category. This ageing population constitutes a high‐risk oral health group, vis‐à‐vis impaired manual dexterity, cognitive deterioration and unmet treatment needs, which could be compounded by psychiatric morbidity. Objective: To assess oral health status and prosthodontic need of ageing psychiatric patients. Materials and method: One hundred and twenty‐five patients, aged 50 years or above, admitted to the Department of Geriatric Mental Health, King George’s Medical University, Lucknow, Uttar Pradesh, India, were examined for prosthodontic, oral health status and need, the study population being divided into groups on the basis of Bristol Activities Scale of Daily Living. Results: Depressive symptoms (which increased with age) and psychiatric morbidity were found to be more in females. About 98% of the population showed probing depths of more than 3 mm, with mean number of decayed/missing teeth and inability to maintain oral/denture hygiene (p < 0.001) increasing in higher disability levels. While 91.3% of the population wearing a prosthesis required new dentures, 33.3% of the study population had unfulfilled partial denture need and 28.4% had unfulfilled upper/lower complete denture need. Conclusion: Ageing psychiatric subjects require dental education and treatment to meet their needs.     

Self-reported dry mouth in Swedish population samples aged 50, 65 and 75 years

doi: 10.1111/j.1741‐2358.2010.00420.x Self‐reported dry mouth in Swedish population samples aged 50, 65 and 75 years Background: Reduced salivary flow may have a negative impact on general well‐being, quality of life and oral health. Objectives: To examine xerostomia in 50‐, 65‐ and 75‐year‐olds, background factors and effect on Oral Impacts on Daily Performances (OIDP). Methods: In 1992, a questionnaire was sent to all 50‐year‐old persons (n = 8888) in two Swedish counties. In 2007, the same questionnaire was sent to all 65‐year‐olds (n = 8313) in the two counties and to all 75‐year‐olds (n = 5195). Response rate was for the 50, 65 and 75 year olds 71.4, 73.1 and 71.9%, respectively. Results: Xerostomia was higher in women than in men in all age groups. There was higher prevalence of xerostomia with increasing age in both sexes and it was more frequent at night than during daytime. ‘Often mouth dryness’ was 2.6–3.4 times more prevalent in those who reported an impact from OIDP. The highest odd ratios were for daytime xerostomia and for the variables burning mouth (17.1), not feeling healthy (4.5), daily smoking (4.4), and medication (4.1). Conclusions: The dramatic increase of xerostomia between age 50 and 75, especially amongst women, needs to be considered in the management of this age group.     

Relationship between general health status and the change in chewing ability: a longitudinal study of the frail elderly in Japan over a 3-year period

Objectives: The aim of the present study was to identify the onset predictors of a change in chewing ability over a 3‐year period in the frail elderly. Methods: The subjects were frail elderly people living in southern Japan. Data were collected at baseline (n = 92) and 3 years later (n = 60). The dependent variable was a change in self‐rated chewing ability. The independent variables were age, gender, number of present teeth, dentition, maximum bite force (evaluated using a pressure‐sensitive foil), basic activities of daily living, self‐rated general health status, higher level of competence (evaluated using Tokyo Metropolitan Institute of Gerontology index), cognitive status (evaluated by revised Hasegawa Dementia Rating scale), and quality of life (evaluated using Philadelphia Geriatric Center morale scale) at baseline. To identify the most reliable predictors, bivariate analysis and multiple logistic regression analysis were performed, with the change of chewing ability as the dependent variable. Results: Bivariate analysis showed the change in chewing ability was significantly associated with general health status (p < 0.01), number of present teeth (p < 0.05) and maximum bite force (p < 0.01). Backward logistic regression analysis revealed that the most reliable predictor of a change in chewing ability at 3 years was general health status (odds ratio = 6.35, 95% CI = 1.69–23.88). Conclusion: The present findings suggest that general health status at baseline produces a change in chewing ability.     

Edentulousness and associated risk factors in a south Brazilian elderly population

Aim: To examine the relationship between edentulousness and the socioeconomic and behavioural variables collected in a cross‐sectional study of an elderly population. Methods: The study was conducted on 277 elderly (60 years or older) in the municipality of Biguaçu, Southern Brazil. The oral examinations and questionnaires were conducted by two calibrated dentists. The criteria used followed the WHO and FDI standards. Results: Prevalence of edentulousness reached 48.4%. A significant association was found in bivariate analysis for gender, satisfaction with appearance, time since last dental visit, the type of dental service sought in the last 5 years, educational level of the elderly and their children, and age of the elderly. In the multivariate analysis, gender, time since last dental visit and level of education of the elderly were significantly associated with edentulousness. Conclusions: Female sex and low educational level were the main risk factors for edentulousness in this population. Although various Brazilian studies suggest a decline in edentulousness in the country, methodologically robust research into edentulousness in Brazil is still limited, demanding further studies into this highly prevalent yet preventable health problem amongst the elderly.     

Dental anxiety among middle-aged and elderly women in Sweden. A study of oral state,utilisation of dental services and concomitant factors

The aim of this project was to investigate dental anxiety and its expression in utilisation of dental services, oral health and oral symptoms. In a cross-sectional study of women's health in Göteborg (population 432,000), Sweden, 1016 women aged 38 to 84 years participated. This randomly selected population took part in a series of investigative procedures including medical and dental clinical examinations, interviews and questionnaires. Levels of dental anxiety were measured on the Corah Dental Anxiety Scale (DAS). The average DAS score obtained was 7.2. The study showed that older women were significantly less anxious than younger ones. Severe dental anxiety (DAS 15) was experienced by 3.9% of the participants. This frequency corresponds well with findings by Hällström and Halling in their analysis of data from the first Göteborg study of women's health 24 years ago. High levels of dental anxiety were correlated with longer intervals between dental visits, poorer oral function and aesthetics and a higher frequency of oral symptoms. Headaches were more prevalent in the younger age groups and a correlation with dental anxiety was revealed. Our previous studies have shown that symptoms such as tension headaches are prevalent among dental phobic patients and that they are reported to be reduced by therapy for dental fear. The clinical and radiographical examinations revealed a generally poorer oral status, with a statistically significant higher number of decayed teeth among women with high dental anxiety.     

General health, dental status and perceived dental treatment needs of an elderly population in Istanbul

doi: 10.1111/j.1741‐2358.2010.00363.x
General health, dental status and perceived dental treatment needs of an elderly population in Istanbul Background: Comprehensive data on the oral health status and dental treatment needs of the elderly population in Turkey are deficient. Objectives: This pilot study determined the general and dental health status, perceived medical and dental treatment needs of an elderly population dwelling in residential homes in Istanbul. Method: Subjects at three different residential homes, namely one belonging to the state and two supported by foundations in Istanbul (N=121, female: 63 and male: 58) were involved in this study. A detailed questionnaire was prepared and dental examinations were conducted. Information was collected related to age, education levels, financial status, current physical functional status, general health, mental health, previous dental history, current dental status, oral hygiene practices and denture hygiene of these elderly people. The prevalence of edentulism, the presence and type of dental prostheses, dental and denture status and denture cleanliness were further evaluated. Results: The three most prevalent reported general health problems were associated with genito‐urinary problems (24%) followed by cardiovascular (18%) and respiratory problems (14%) varying significantly between genders, with males suffering more from cardiovascular problems than females (p < 0.05). Females showed significantly higher gastrointestinal and orthopaedic problems than males (p < 0.05). Females were more frequently edentulous than males but denture hygiene was significantly better in females than in males (p < 0.05). Brushing frequency did not significantly increase denture hygiene (p = 0.6). More than one‐third of the subjects had not been to the dentist within the previous 5–10 years, mainly due to lack of demand, followed by the cost of the dental care and fear. More than two‐thirds of denture‐wearing subjects wore their dentures only during eating. Conclusions: There was significant perceived dental treatment and care need for the sample population of elderly studied.     

Age and medication are significant risk factors for xerostomia in an English population, attending general dental practice

Objective: To study the prevalence of xerostomia in an English population, attending general dental practice and relate it to age. medication and gender. Design Study: Cross‐sectional. Setting: Five General Dental Practices in Merseyside, North of England. Subjects: 1,103 adult patients attending for routine dental care. Intervention : Questionnaire administered by dentists. Main Outcome Measures: Age, gender, systemic medication, reported oral dryness. Results: 1,103 patients (654 females) were recruited, of whom 427 (39%) were aged 60 years or older, 26% of patients reported taking medication. The overall prevalence of xerostomia was 12.7% (males‐10.3%, females 14.4%). Age. medication and female gender were found to be significant risk factors for xerostomia, using logistic regression analysis. Conclusions: The prevalence of xerostomia (12.7%) in an English population was lower than reported in previous North American and Swedish studies. Medication was a significant risk factor for xerostomia and a better predictor of risk status, than either age or gender.     

Oral health of institutionalised elderly: a qualitative study of health caregivers’ perceptions in Brazil

doi: 10.1111/j.1741‐2358.2010.00366.x
Oral health of institutionalised elderly: a qualitative study of health caregivers’ perceptions in Brazil Objective: The aim of this study was to qualitatively explore caregivers’ perceptions of oral health care and factors influencing their work in a public long‐term care institution for the elderly in Goiania, Brazil. Method: Data were collected from a sample of 10 caregivers using personal in‐depth interviews and observation. Results: Caregivers were mainly nurses’ aides without training in oral health care. Oral health was associated with access to dental treatment, oral hygiene and use of dentures. Edentulousness, use of inappropriate dentures and appetite loss were perceived as negative images. Procedures used for oral hygiene were toothbrushing, mouth cleaning with a gauze and using a mouthwash. Conflicting priorities in routine care, lack of caregivers’ knowledge and the co‐operation of the elderly were the main obstacles to satisfactory oral care. Conclusion: Oral health care of the elderly was perceived as a burden by caregivers, and did not follow a standard protocol. Caregivers’ knowledge and perceptions reinforce the need for education and training in oral health issues.     

Validity and reliability of a visual scoring method for masticatory ability using test gummy jelly

Background: For quantitative evaluation of masticatory ability of the elderly patients, there should be a simple and reliable method without special techniques and instruments. Objective: The purpose of this study was to examine the validity and reliability of a visual scoring method for assessing masticatory performance. Materials and Methods: A 10‐stage scale for visually scoring was rated based on the range of the glucose concentration dissolved from comminuted jelly. Photographic images of comminuted jellies were produced as a standard material for each score. Fifty subjects were recruited as raters who graded the visual score for 50 photographic images of comminuted jellies on the screen of a lap‐top three times in random order. Results: There were strong correlations (rs = 0.911– 0.981, Spearman’s rank coefficient) between the actual scores determined from the glucose concentration and the visual scores graded by subjects in all three measurements. The intraclass correlation coefficients (ICCs) of the inter‐rater reliability and the ICCs of the intra‐rater reliability of the visual scoring ranged from 0.946 to 0.947 and from 0.860 to 0.987 in three measurements, respectively. Conclusions: These results indicated that the visual scoring method was valid and reliable for evaluation of masticatory performance.     

A study of some masticatory functions in 90-year old subjects

A group of 35 90-year old subjects, randomly selected from the gerontologic population study in Göteborg (H-70), were examined with respect to function and dysfunction of the masticatory system. The methods included a questionnaire, clinical examination and recording of bite force endurance and maximal bite force, measured in the central incisor region. Forty percent were edentulous, 29% were partially edentulous and wore a removable denture, while the others were dentate without removable prostheses. Signs and symptoms of temporomandibular disorders were mostly mild and infrequent, except TMJ crepitation which was recorded in 69% of the subjects. Maximal bite force was in general low (mean 94 N) but showed a great individual variation (range 10 to 410 N). Bite force endurance was also very variable (mean 72 s, range 10 to 205 s). None of the 35 subjects reported poor masticatory ability, but 2 said they could not chew all kinds of food. In spite of a reduced bite force this group of 90-year olds considered their masticatory ability as good and most of them had no severe signs and symptoms of temporomandibular disorders.     

Factors associated with negative self-perception of oral health among elderly people in a Brazilian community

Objective: Self‐perception of oral health is an important measurement for assessing the health and quality of life of elderly people. The aim of this study was to analyse associations between negative self‐perception of oral health and poor oral state, socio‐demographic variables, depression and use of medications. Method: In this cross‐sectional study, elderly people aged 60 to 74 years living in the urban zone of a city in southern Brazil were interviewed and examined. Functionally dependent individuals were excluded. Self‐perception was measured using the General Oral Health Assessment Index, and scores of 30 points or less were considered to represent negative perception. The physical, social and worry dimensions of this indicator were also analysed. Results: Two hundred and sixty‐seven elderly people (mean age 66.5 years, 59.9% female) were included in the study. Most of them had had little schooling. Negative self‐perception was identified in 18.7%, although none of the poor oral state was associated with this variable. In multivariate analysis, negative self‐perception was associated with female gender and depression. The women presented significantly lower means in the three dimensions analysed and individuals with depression, in the physical and social dimensions. Poor oral health (edentulism and absence of posterior occlusion) were associated with the physical dimension. Conclusion: Negative self‐perception of oral health was associated with gender and depression, but not with poor oral health. Therefore, gender and the presence of depression are factors to be taken into account in assessments involving this age group.     

Attitudes to the importance of retaining natural teeth in an adult Swedish population

Objectives . To evaluate the attitudes to retaining natural teeth in an adult Swedish population, and to correlate the attitude to retaining natural teeth with some presumed influencing background factors. Design : Cross-sectional study using a newly developed questionnaire. Subjects : From the national census register of four municipalities in the southern part of the province of Halland, Sweden, with a total population of 126,878 adult (≥20 years) inhabitants, 4,200 persons were selected at random. The sample was randomised by age and sex, and 300 men and 300 women from the age groups 20, 30, 40, 50, 60, 70, and 80 years were included. Intervention and main outcome measures : The questionnaire aimed to evaluate the number of remaining natural teeth, the dental care habits, the self-estimated quality of natural teeth, and the attitude t o retaining natural teeth In the studied population, and also to evaluate the possible correlation between those factors, in particular, the attitude to retaining natural teeth versus the other factors. Results : It was found that the attitude to the importance of retaining natural teeth was strongly correlated with the number of remaining natural teeth, the dental care habits, and the self-estimated quality of natural teeth. Also sex had an influence on this attitude but not age. Conclusions : The attitude to the importance of retaining natural teeth in an adult Swedish population is correlated with the number of remaining natural teeth, the dental care habits, the self-estimated quality of natural teeth, and sex, but not with age.     

Correlates of dental visits among community‐residing Latino elders: a public health alert

doi:10.1111/j.1741‐2358.2009.00335.x
Correlates of dental visits among community‐residing Latino elders: a public health alert Objectives: To examine oral service utilisation in a probability sample of community‐residing Latino elders. Background: Older Latinos are at a potential increased risk of oral diseases, given their higher prevalence of co‐morbidities and lower rate of dental service utilisation. Methods: A prevalence survey was conducted among a random sample of Latino (largely Puerto Rican) elders (n = 205; mean age = 75.8; SD ± 5.3) in New York City during 2001–2002. A systematic random sample was drawn from the Centers for Medicare and Medicaid Services Beneficiary tape files. Current use of oral health services and self‐reported health conditions was obtained. Functional and cognitive impairment were assessed. Results: Less than half of the sample reported a dental visit in the previous year. The average time since the last dental visit was 54 months (SD ± 84.5). Last year dental visit compliers were more likely to be unmarried, living alone, with higher levels of education, fewer health conditions and less impairment with activities of daily living. In multivariate analyses, problem‐oriented behaviour, Medicaid beneficiary, education, living alone, chronic health conditions and mobility impairment explained 14% of the ‘time since last dental visit’ variance. Conclusions: Given that socio‐demographic and level of functioning determinants appear to influence the frequency of dental visits, a multilevel approach to oral health promotion is imperative.