Dissertation committee:
Αναστασία Κοσιώνη, Αναπληρώτρια Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Γρηγόριος Πολυζώης, Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Ηρακλής Καρκαζής, Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Στέφανος Κούρτης, Αναπληρωτής Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Μιχάλης Σωτηρίου, Αναπληρωτής Καθηγητής, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Ίλεια Ρούσσου, Επίκουρη Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Ιόλη Αρτοπούλου, Επίκουρη Καθηγήτρια, Τμήμα Οδοντιατρικής, Σχολή Επιστημών Υγείας, ΕΚΠΑ
Summary:
Τhe older population is significantly increasing worldwide facing multiple socio-medical and dental needs. Despite progress in oral health prevention, oral disease is still common in older people due to multiple barriers and risk factors. Epidemiological data on oral health in older population in Greece, and especially in the older old, are limited making it difficult to develop and implement appropriate oral health policies.
The purpose of this Doctoral Thesis was to record oral health status, subjective oral complaints and oral care habits in a sample of urban population aged over 65 years in Attica and associate the findings with various demographic, medical, dental and behavioral factors.
METHODOLOGY
The investigation was conducted at the Open Care Centers For Older People in the Athens Region in areas of different socio-economic stratification. A total of 352 subjects over 65 years of age with a mean age of 73.9±6.9 years were recorded. The study included interviews using structured questionnaires and a clinical examination. The questionnaire included parameters related to demographic, socio-medical and dental characteristics.
The ICD-10 classification of diseases was used to record the medical history and the ATC classification for drugs intake. To assess the presence of depressive symptoms, the 15-item Geriatric Depression Scale (GDS-15) was used. Dental history taking recorded current oral symptoms, oral hygiene habits, the use and daily care of removable prostheses, the use of dental services, as well as the subjective assessment of the need and demand for dental care.
Subjective xerostomia was evaluated using reference questions and the 11-item Xerostomia Inventory, after translation and validation in Greek. The Geriatric Oral Health Assessment Index (GOHAI) was used to assess the effect of oral health on the quality of life of the participants, after translation into Greek and validation in the target population. The clinical examination recorded the oral health status using validated indices (ie. ICDAS II, DMFT, RCI, CPITN, OHI-S, salivary flow and pH tests, etc).
Statistical analysis included descriptive statistics, bivariate and multivariate analyses as well as validation analyses for XI-11 and GOHAI in Greek. The level of statistical significance was set at P≤0.05.
RESULTS
The most common medical condition was hypertension (62.8%) followed by diabetes type II (24.2%) and heart disease (23%). Medication use was very frequent and polypharmacy (over 3 medications per day) was recorded in 31% of the sample increasing to 44% for those aged over 85 years. Antihypertensives (64.2%) and anti-lipidemics (41.9%) were the most frequently consumed medications.
Regarding subjective oral health indicators, no statistically significant correlation was found related to gender and age. Only 33.8% of the participants stated that they generally had good oral health, while 62.5% mentioned that they had a current oral problem. Xerostomia, occasionally or continuously, was mentioned by 42% of the participants, burning mouth by 2.3%, dysgeusia by 6.5%, chewing difficulties by 28.1% and poor or moderate oral aesthetics by 42.1%.
A total of 43.5% people stated that they had visited the dentist in the past 12 months and 18.2% that they had visited the dentist more than 5 years ago. Despite that 58.2% believed that they needed dental care, only 27.6% intended to visit a dentist.
Only 31% of the dentate persons brushed their teeth more often than once a day, while 90.6% did not use any interdental cleaning device. Of those who used removable prostheses, 66.7% said that they cleaned them immediately after meals and 29.2% once a day; 40.5% of the denture wearers wore them 7/24h, while 25% used denture fixatives.
The clinical examination showed that 15.6% of the participants were completely edentulous, while 43.8% had more than 20 teeth; 47.7% used removable prostheses and 14.8% used a pair of complete dentures.
The mean number of teeth in the total population was 15.4 ± 9.7, while the mean number of teeth in the dentate people was 18.2 ± 7.7. Based on multifactorial analysis, the presence of more than 20 teeth was associated with younger age, dental visits within the past 12 months, and a lower body mass index. Many dentate people (59.6%) had at least one active decay, and 27.6% one active root decay. The DMFT index in the dentate sample was 22.3 ± 6.9 with an average percentage of 14.5 ± 24.8 carious teeth in the mouth. Multiple logistic regression analysis revealed a statistically significant correlation of dental decay with the saliva's bubbly quality, the lower number of remaining natural teeth and poor oral hygiene. The RCI value was 0,2±0,3 and the mean percentage of carious roots was 8.1±19.4. Multifactorial analysis demonstrated statistically significant correlations between increased root caries prevalence and smoking, saliva bubbly quality, lower saliva pH and the smaller number of remaining natural teeth.
Only 39.9% of the participants had good oral hygiene. A healthy periodontium was recorded in 3.4% of the dentate people, medium pockets (4-5mm) in 35.5% and deep pockets (≥6mm) in 47.0% of the dentate sample. Severe periodontitis was related to hypothyroidism, tooth decay, poor oral hygiene and the use of dentures.
Mucosal lesions were recorded in 18.2% of the population. The presence of oral lesions was mainly associated with the use of removable prostheses; 27% of the denture users had mucosal lesions compared to 5.8% of those who did not use dentures.
The mean GOHAI score in the total sample was 48.5 ± 8.5 (range: 16-60) indicating that the participants were generally satisfied with the quality of life associated with their oral health. The GOHAI score showed significant correlations with many medical, demographic and dental factors such as depression, number of teeth, subjective chewing ability, oral pain, aesthetic problems, using dentures, edentulousness, DMFT index, CPITN index, xerostomia index, decayed teeth and root caries index.
CONCLUSIONS
Based on the findings of the present study, oral disease was increased in the older population examined, while dental visitations were limited. Compared to the findings of the 2005 national oral health survey in a sample aged 65-74 years, the same age group in the present study presented a significant reduction in complete edentulousness and an increase in retaining more than 20 teeth, but at the same time an increase in caries prevalence and severe periodontal disease. Oral health status further deteriorated in the older age groups over 75 years of age.
The main study limitation was that the sample was urban with high degrees of social activity and functional capacity, precluding the generalisation of the findings to a national level.
The development of a national strategy for improving oral health in older people is imperative, as longer lives preserving more natural teeth but at the same time experiencing functional impairment and low access to dental care, will negatively affect the oral health status of the future older population.
