Archives of Gerontology and Geriatrics 53 (2011) 252–257
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The association between socioeconomic status, oral hygiene practice, denture stomatitis and oral status in elderly people living different residential homes Buket Akalin Evren a, Altay Uludamar b, Ufuk Is¸eri c, Yasemin Kulak Ozkan a,* a
Marmara University, Faculty of Dentistry, Department of Prosthodontics, Bu¨yu¨kc¸iftlik Sok. No. 6, 34350 Nis¸antas¸ı, Istanbul, Turkey Dental Surgeon, Bu¨klu¨m Sok. No. 53 Kat: 4, 06660 Kavaklıdere, Ankara, Turkey c Yeditepe University, Faculty of Dentistry, Department of Prosthodontics, Bag˘dat Cad. No. 238, 81006 Go¨ztepe, Istanbul, Turkey b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 11 September 2010 Received in revised form 14 December 2010 Accepted 16 December 2010 Available online 26 January 2011
Oral hygiene practices and denture status of elderly people living in residential homes are different depending on the type of residential homes. In this study the elderly people living in three different residential homes were investigated for this purpose. A total of 269 subjects, 119 males (mean age 73.9 8.8) and 150 females (mean age 78.5 7.2) were involved in this study. All subjects were interviewed and clinically examined. Age, sex, educational status, financial status, general health, dental visiting, overnight denture wearing, brushing habits and frequency were recorded using a structured questionnaire. The prevalence of edentulism, the presence and type of dental prostheses, denture cleanliness and the presence of denture stomatitis were evaluated. Forty-one percent of subjects were non-educated. Fifty-one percent of subjects had low income. The majority of people (66.6%) were edentulous. Among the edentulous subjects 32% had full denture and 16% had no denture. Forty three percent of the subjects reported cleaning their dentures with water and 40% with a toothbrush only. Denture hygiene was good for 14% of the subjects. Denture stomatitis was observed in 44% of the subjects wearing dentures. There was statistically significant difference between residential homes and educational status, level of income, dental visiting, denture status, brushing methods and brushing frequency (p < 0.001). A positive relationship was observed between poor denture hygiene habits and the presence of denture-related stomatitis. The most important need within the residents of the residential home was the enhancement of oral care social insurance. ß 2010 Elsevier Ireland Ltd. All rights reserved.
Keywords: Elderly people Denture status Denture stomatitis Residential homes
1. Introduction Oral health status of older people has been gaining more importance in developing and developed countries in the last decades as the proportion of this group among the population slowly but continuously increases because of the increase in life expectancy. The general trend is for a reduction in edentulism and an increase in the retention of natural teeth until later life (Fiske et al., 2000). The dental disease pattern and oral status are changing in Turkey as well as in the world. In order to solve this similar problem, most of the developed countries have investigated dental and general health status of their elderly (Vigild, 1993; Petersen and Yamamoto, 2005). Turkey also has the same issue in its agenda. The elderly population in Turkey is 3,858,949 from the year 2000 census, which is 5.7% of the total population, with an increase of 33% since 1990. In Turkey, the population of 65 years of age and older is expected to constitute 7.5 million (12.5%) of the total Turkish population by the year 2010 (SIS, 2003). Although the
* Corresponding author. Tel.: +90 212 2319120; fax: +90 212 2465247. E-mail address:
[email protected] (Y.K. Ozkan). 0167-4943/$ – see front matter ß 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.archger.2010.12.016
majority of the elderly live independently in the community in Turkey, a growing number of older people live in different kinds of institutions. A total of 11.885 elderly live in 94 public and 5457 in 105 private nursing or residential homes (SIS, 2003). Most surveys indicate that the elderly who live in residential care have the worst oral health condition. Elderly people living in residential and nursing homes have even poorer dental health than those residing at home and experience high levels of clinically measured oral disease (Frenkel et al., 2000; Saub and Evans, 2001; Chalmers et al., 2002). Although interest in geriatric dentistry has increased in the dental profession worldwide (Norheim, 1979; Hunt et al., 1985; Weintraub, 1985; Ainamo and Osterberg, 1992; Ettinger, 1992; Pietrokovski et al., 1995; Marcus et al., 1996; Gift et al., 1997), comprehensive data on the oral health status and dental treatment needs of elderly population living in different residential homes in Turkey is deficient (Saydam et al., 1990; Kulak-Ozkan et al., 2002; Nalcaci et al., 2007). As a result, there is a need for epidemiological studies evaluating the oral health status of older adults and comparing it with other cross-cultural studies. In Turkey, residential homes are covered by law, impose obligations upon people running the homes to ensure adequate and reasonable provisions in certain areas. These include accommodation,
B.A. Evren et al. / Archives of Gerontology and Geriatrics 53 (2011) 252–257
recreational facilities, catering safety, laundry services, heating, lighting, and personal hygiene, but not oral health or access to a dentist (Akar and Ergu¨l, 2008). Residential homes in Turkey have been structured and run in a different manner compared to many other countries. These residential homes can be diversified in four different categories: (1) residential homes fully financed by the state and provide service to old age pensioners with no income. (2) Residential homes supported by the state and provide service to old age pensioners with limited income. (3) Residential homes subsidized by the state and provide service to old age pensioners with good income. (4) Private residential homes. Recently, there has been an increase in these types of private residential homes but studies carried out in such places do not always exhibit the reality among the population that struggle for financing their basic needs. Applying the results of studies conducted in certain category of residential homes where the economical, social and cultural levels are similar, may be misleading in representing the oral hygiene habits of entire old age pensioners in one country. Studies taking into account this diversity among the subjects are rare. Therefore, there is a need for evaluating the subjects in their own category. Effectiveness and deficiencies of the state policies concerning oral health of old age pensioners and defining effective oral health programs can only be determined in the light of such studies. Detriments of economical, social and physical capacity result in unfavorable oral hygiene leading to dental decay, periodontal problems and eventually losses in dentition. Many studies revealed the poor oral hygiene of subjects living in residential homes. Unfortunately, there is a lack of studies on the oral health of old age pensioners living in different residential homes in Turkey. Despite the fact that there is dental care services in some private and state residential homes, subjects are still complaining about their oral health. Oral health care is still not a priority in residential homes. The aim of this study therefore was to investigate oral hygiene and denture status of elderly people living in different residential homes in Istanbul. 2. Subjects and methods This epidemiological study was carried out in three residential home in Istanbul, Turkey. Group 1: Residential homes fully financed by the state and providing service to old age pensioners with no income (96 people, 50 females, 46 males). Group 2: Residential homes supported by the state and providing service to old age pensioners with limited income (80 people, 46 females, 34 males). Group 3: Residential homes subsidized by the state and providing service to old age pensioners with good income, two belonging to the state and one supported by private foundations (93 people, 54 females, 39 males). A total of 269 subjects, 119 males (mean age 73.9 8.8) and 150 females (mean age 78.5 7.2) were involved in this study. Only subjects of 65 years of age or older and having communicable condition were included in the study. Informed consent was obtained from all the residents who accepted to participate in the study. The subjects were interviewed using a detailed questionnaire and were clinically examined. Questionnaires were used to collect socio-demographic data, age, sex, level of education, level of income, general health, dental visiting, brushing methods, brushing frequency and denture wearing habits. After questionnaires, the calibrated dentists performed clinical and oral examinations. In the clinical examination, denture cleanliness, dentures stomatitis, denture status and related treatment needs were assessed. Denture cleanliness was examined using a plaque disclosing medium (proflavine monosulphate in 0.3% aqueous solution) to detect the plaque on the fitting surfaces of the maxillary dentures. Based on the quantity of plaque on the
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denture base, a previously described index was used for classification of denture cleanliness. Excellent: None or only few spots of plaque, Fair: More extended plaque, less than half of the denture base covered by plaque, Poor: More than half of denture base covered by plaque (Budtz-Jorgensen et al., 1975). Denture stomatitis was identified as previously described (Arikan et al., 1995; Kulak-Ozkan et al., 2002). 2.1. Statistical analysis The data were analyzed by using SPSS 11.0 statistical package program and reported with univariate and contingency tables; analysis of variance and chi-square test were performed to evaluate the statistical significance between the variables. The level of significance was chosen as 0.05. 3. Results 3.1. Demographic data and results of comprehensive interview Socio-demographic characteristics and self-reported answers of questionnaire of subjects are shown in Table 1. Among 269 subjects, 67 (24.9%) were 80 years of age and over (of those, 89.1% were in Group 1 and Group 2). There were statistically significant differences between groups and age (p = 0.001). One hundred and eleven subjects were non-educated (of those, all were in Group 1 and Group 2), and only 11.9% of all the subjects were university graduates (of those, 31% were in Group 1 and Group 2 and 69% were in Group 3). Approximately half of (47.2%) the study group had an annual individual income of less than 1.000 $ (of those, all were in Group 1 and Group 2), and were receiving income supplements including a shelter allowance. Only 20.5% had annual income of more than 5.000 $ (of those, all were in Group 3). There were statistically significant differences between groups and educational status and annual income (p = 0.001 and p = 0.001, respectively). The majority of the surveyed subjects (66.2%) rated their general health as either excellent or good for their age, and the rest were either not or only a little concerned about their health. Overall, 76% of the subjects were found to have some type of systemic disease; the three most prevalent reported ones were hypertension, followed by genitourinary problems, cardiovascular and respiratory problems. Only 38.3% of the subjects reported a dental visit within the previous year (of those, 60.2% were in Group 3) and 36.1% of the study group reported a dental visit within the last 5 to 10 years (of those, 90.7% were in Group 1 and Group 2). There were statistically significant differences between groups and dental visiting (p = 0.001). Why care was not sought more frequently, was principally due to the lack of perceived needs, cost of dental care, fear or anxiety about dental treatment. Forty percent of the subjects reported cleaning their dentures with toothbrush, compared to less than 9% each who reported using sodium bicarbonate, sodium hypochlorite, or ordinary soap (of those, 71% were in Group 3). One hundred and fifteen (42.8%) of subjects reported cleaning their dentures only with water (of those, 71% were in Group 1 and Group 2). There were statistically significant differences between groups and brushing habits (p = 0.001). Thirty five percent of subjects reported no brushing teeth or dentures (of those, 72% were in Group 1 and Group 2), compared to less than 12% each who reported that they brushed teeth/dentures twice a day (of those, 57% were in Group 3). There were statistically significant differences between groups and brushing frequency (p = 0.001). Only 31.9% of subjects removed their dentures overnight. There was no statistically significant difference between groups and overnight denture wearing (p = 0.001).
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Table 1 Distribution of some socio-demographic and personal characteristics of groups, n (%). Parameters
Group 1
Group 2
Group 3
Total
Number Gender Female Male Age, years 60–70 70–80 >80 Education Non-educated Primary school High school University Income, $/year No, less than 1000 1000–5000 5000–10,000 Self-reported general health Good Moderate Bad Visiting dentist in 1 year 1–5 years 5–10 years Brushing habits Tootbrush Tootbrush + paste Chemical Water Brushing frequency Very seldom Once a day Twice a day never Overnight wearing Yes No
96
80
93
269
50 (52.1) 46(47.9)
46 (57.5) 34 (42.5)
54 (58.1) 39 (41.9)
150 (55.8) 119 (44.2)
0.66
17(17.7) 43(44.8) 36(37.5)
39(48.8) 24(30) 17(21.3)
45(48.4) 34(36.6) 14(15.1)
101 (37.5) 101 (37.5) 67(24.9)
0.001
61(63.5) 32 (33.4) 3(3.1) –
50(62.5) 17(21.3) 3(3.8) 10(12.5)
– 23(24.8) 48(51.6) 22(23.7)
111(41.3) 72(26.8) 54(20.1) 32(11.9)
0.001
70(72.9) 26(27.1) 0
57(71.3) 19(23.8) 4(5)
– 42(45.2) 51(54.9)
127(47.2) 87(32.3) 55(20.5)
0.001
48(50) 23(24) 25(26)
61(76.3) 14(17.5) 5(6.3)
69(74.3) 17(18.3) 7(7.5)
178(66.2) 54(20.1) 37(13.8)
0.001
27(28.1) 42(43.8) 27(28.1)
14(17.5) 5(6.3) 61(76.3)
62(60.2) 22(23.7) 9(9.7)
103(38.3) 69(25.7) 97(36.1)
0.001
41(42.7) 2(2.1) – 53(55.2)
44(55) – 7(8.8) 28(35)
23(24.7) 16(17.2) 17(18.3) 34(36.6)
108(40.1) 18(6.7) 24(8.9) 115(42.8)
0.001
58(60.4) 12(12.5) 3(3.1) 23(24)
18(22.5) 6(7.5) 11(13.8) 45(56.3)
27(29) 21(22.6) 18(19.4) 27(29)
103(38.3) 39(14.5) 32(11.9) 95(35.3)
0.001
25(69.4) 11(30.5)
29(67.4) 14(32.6)
55(67.9) 26(32.1)
109(68.1) 51(31.9)
0.397
3.2. Results of clinical examinations Table 2 shows the distribution of groups by dental status, denture hygiene and denture stomatitis. While 67.2% of the examined subjects were edentulous, 30.5% were partially and 1.9% were fully dentate. Among 182 edentate subjects 43 (23.6%) had no
Table 2 Distribution of groups by dental status, denture hygiene and denture stomatitis, n (%). Parameters
Group 1
Group 2
Group 3
Total
Number Dental/denture status C/C ND C/R/R NPD D Denture hygiene Good Moderate Poor Stomatitis LDS GDS NS
96
80
93
269
14 (14.6) 27(28.1) 12 (12.5) 32(33.3) 10(10.4) 1 (1.0)
23(28.8) 15(18.8) 17(21.3) 19(23.8) 3(3.8) 3(3.8)
50(53.8) 1(1.1) 23 (24.7) 10(10.8) 8(8.6) 1(1.1)
87(32.3) 43(15.6) 52(19.3) 61 (22.7) 21(7.8) 5(1.9)
0.001
6(16.6) 13(33.3) 17 (47.2)
7(16.2) 12(27.9) 20(24.6)
10(12.3) 24(55.8) 51(62.9)
23(14.3) 45(28.1) 92(57.5)
0.385
10(52.6) 23(57.5) 20(25)
6(21.3) 10(25) 23(28.8)
3(15.7) 7(17.5) 37(46.2)
19(13.6) 40(28.7) 80(57.5)
0.03
p
