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Cent Eur J Public Health 2012; 20 (3): 233–236
SUMMARY
Objective: The aim of the research was to assess the oral hygiene habits in the elderly group of study population of Southern Poland.
Methods: The study was conducted in dental services in two selected cities in Southern Poland. The group of subjects consisted of 664 respond-
ents (272 men, 392 women) aged 65 to 81 years. Oral hygiene was measured with the author’s anonymous questionnaire consisting of twenty
questions. Questions related to information on personal history and general health, comorbidities, dietary habits, alcohol consumption, smoking,
taking drugs and the state of oral hygiene practices as frequency of visits to the dentist and the number of own teeth.
Results: The majority of the subjects had higher n = 240 (36.1%) and secondary n = 219 (33%) education and were predominantly n = 590
(89%) professionally inactive (retirees or pensioners). No signicant differences were found between the groups: women and men. But there were
differences in technologies used, the examined men signicantly often used computer in comparison with the women’s group. In total, 19.6% had
own natural teeth only, 45.0% own teeth and dentures, 30.0% dentures only, and 5.4% neither teeth nor dentures. Majority of subjects brush their
teeth or dentures only 1–2 times a day (80%) and visit the dentist less than once in 2 years or once a year (75%). Women signicantly more often
stated use of a toothbrush and taking care of oral hygiene and compared to men, they declared higher number of own teeth.
Conclusion: People aged over 65 neglect hygiene and oral care. Women pay more attention to oral hygiene and they have more own teeth than
men. The most frequent cause of oral hygiene neglect in the elderly could be gender, the socio-economic conditions, behaviour habits and lack of
sufcient health education. The dentist may need to consult with the patient’s GP the development of the appropriate personalised treatment plan
for the elderly. Young dentists need to be educated in order to provide appropriate dental care to the elderly.
Key words: oral hygiene, elderly people, author’s questionnaire, health education
Address for correspondence: Małgorzata Muc-Wierzgoń, Department of Internal Medicine, Medical University of Silesia, 7 Żeromskiego, 41-902
Bytom, Poland. E-mail: mwierzgon@sum.edu.pl
ASSESSMENT OF ORAL HYGIENE IN ADULTS
Wojciech Skorupka
1
, Karolina Żurek
2
, Teresa Kokot
3
, Ewa Nowakowska-Zajdel
3
, Edyta Fatyga
3
,
Elżbieta Niedworok
4
, Małgorzata Muc-Wierzgoń
3
1
Private Health Care Centre, Family Dental Service-Multident, Mikołów, Poland
2
Private Dental Service, Katowice, Poland
3
Department of Internal Medicine, Medical University of Silesia, Katowice, Poland
4
Department of Human Nutrition, Medical University of Silesia, Katowice, Poland
INTRODUCTION
Oral epidemiological research indicates that most of the elderly
in Poland as well as in other European countries and the United
States do not have adequate oral hygiene habits (1–3). The oral
cavity is an important part of the body, and it plays a crucial role
in chewing, swallowing, speaking, and in forming facial expres-
sions as well as maintaining nutritional status, systemic health,
and self-esteem. Oral hygiene is directly linked to systemic in-
fections, autoimmune disorders, chronic cardiovascular disease,
glucose control in diabetes, nutritional intake and other diseases
(4–7). These chronic diseases can affect a person’s quality of life,
especially the ability to eat, speak, taste, and swallow; in addition,
they can cause the psychological instability and significant pain.
Age-related lesions and dental problems stem from the occur-
rence of certain factors including the following: alveolar process
atrophy, dental caries, reduced daily salivation and xerostomia,
tooth loss, oral cancer, denture acceptance difficulties resulting
from advanced oral mucosal diseases, lesions in the denture bear-
ing areas (alveolar and osseous) and local and systemic diseases
(8). Many of these are the sequelae of neglect throughout the early
years of life (i.e.cariogenic diet, lack of prevention awareness and
habits like smoking and/or tobacco, pan, and betel nut chewing)
(9). Vellappally-Sajith et al. (10) describe different forms of
tobacco usage and its direct relationship with the prevalence of
dental diseases. Older adults are likely to take medications that
can impact oral health and affect dental treatment. Hundreds of
common medications, including antihistamines, diuretics, pain
killers, high blood pressure medications and antidepressants,
can cause side effects such as dry mouth, soft tissue changes,
taste changes, and gingival overgrowth (11, 12). Women who
are menopausal or post-menopausal may experience changes
in their mouths. Recent studies suggest that estrogen deficiency
can place post-menopausal women at higher risk for severe peri-
odontal disease and tooth loss. In addition, hormonal changes in
older women may result in oral discomfort including dry mouth,
pain and burning sensations in the gingiva and altered taste (13).
Many analytical studies in public health have examined so-
ciodemographic characteristics such as age, race, sex, and socio-
economic status; relatively few have investigated the influence of
behaviour and lifestyle characteristics on the oral health of older
populations (2, 14–16).
234
The aim of the research was to assess the state of dentition
and hygiene habits in the elderly group of study population of
Southern Poland.
MATERIALS AND METHODS
Subjects
Research was conducted in Dental Services in two selected
cities in Southern Poland (Katowice and Mikołów). The group
of subjects consisted of 664 people (272 men, 392 women) aged
65 and older with a maximum age of 81. The mean age of the
subjects was 72.2 ± 8.6. The patients were included into the study
group if older than 65 years and agreed to participate after giv-
ing informed consent. The study group profiles in demographic
and socio-economic aspects are presented in Table 1. The data
included gender, age, marital status, education and use of technol-
ogy. The respondents were divided into 3 groups: aged 65
–
69,
n = 273 (41.1%); 70
–
74, n = 206 (31%); and ≥75, n = 185 (27.9%).
Questionnaire
Anonymous questionnaire designed for the purpose of this
study consisted of twenty questions. Questions related to infor-
mation on personal history and general health, comorbidities,
dietary habits, alcohol consumption, smoking, taking drugs and
the state of oral hygiene practices, frequency of visits to the
dentist, and the number of own teeth. Some of the questions
were open questions and in the rest of them patients were asked
to mark ‘yes’ or ‘no’.
The questionnaires were filled in during the patient’s visit to
the Dental Services by the dentists from January to December
2010. They underwent dental examination as well. All patients
gave their consent to participate in an anonymous questionnaire.
The oral cavity conditions and results of oral health examina-
tion were not analysed in this paper.
Statistical Analysis
Much of the collected material was descriptive in nature.
Statistical analysis of the results included descriptive analyses,
the test of independence χ
2
(assessed the relationship between the
study groups, gender, socio-economic status, concomitant disease,
dietary habits and oral hygiene habits of seniors). The level of
significance was p < 0.05.
RESULTS
The majority of the subjects had higher (n = 240, 36.1%) and
secondary (n = 219, 33%) education and were predominantly
(n = 590, 89%) professionally inactive (retirees or pensioners).
No significant differences were found between female and men.
The only differences found concerned the use of technology.
Examined group of men used computer significantly more often
than the female group (p < 0.001).
Diseases most commonly reported by the subjects were the
following: arterial hypertension (88%), osteoarthritis (82%),
obesity (62%), coronary heart disease (55%), respiratory disorders
(43%), diseases of peripheral vessels (34%), type 2 diabetes (33%)
and mental illness (2%). There were no significant differences
between examined groups.
Out of 664 patients, 221 (33.3%) had never smoked, 224
(33.7%) smoked in the past and 219 (33%) patients were smok-
ers who continued to smoke after examination. Majority of study
group members drink coffee every day. Only 73 patients (69 men
and 4 women) (11%) declared that they abused alcohol in the past.
All examined people stated that they were not dieting (insufficient
vegetables and fruits intake per day, too much fat and callories).
Additionally, all the patients were divided into 3 age groups,
but the statistically significant differences were observed only
between genders: female (n = 392, 59%) and men (n = 272, 41%)
(Tables 2, 3).
Not all respondents (n = 113, 17%) reported that they clean their
teeth or dentures using a toothbrush or denture brush. They did
Patients Male Female p
N 664 100.0% 272 41.0% 392 59.0% <0.001
Age
65–69 273 41.1% 116 42.6% 157 40.1%
<0.0570–74 206 31.0% 95 35.0% 111 28.3%
≥75 185 27.9% 61 22.4% 124 31.6%
Marital status
Single/widowed/divorced 425 64.0% 149 54.8% 285 72.7%
<0.001
Married 239 36.0% 123 45.2% 107 27.3%
Education level
Higher 240 36.1% 128 47.1% 112 28.6%
NS
Secondary 219 33.0% 73 26.8% 146 37.2%
Vocational 132 19.9% 52 19.1% 80 20.4%
Primary 73 11.0% 19 7.0% 54 13.8%
Use of technology
Automated teller machine only 132 20.0% 57 20.9% 75 19.1%
<0.001
Computer only 120 18.0% 71 26.1% 49 12.5%
Both 259 39.0% 118 43.4% 141 36.0%
Neither 153 23.0% 26 9.6% 127 32.4%
Table 1. Demographic and socio-economic characteristics of the study group
235
it mostly 1 or 2 times a day (n = 531, 80%). Women significantly
more often stated the use of toothbrush and taking greater care
of oral hygiene (p < 0.001) (Table 2).
Almost 30% of the study participants changed their toothbrush
more frequently than every 3 months. Approximately 28% of the
seniors were not sure how often they changed their toothbrushes.
The others change it once a year. All respondents did not go to
the dentist too often. The vast majority of the patients (n = 478,
72%) visited the dentist once a year. No significant differences
were found between the groups.
The reason for the last visit of the dentist were toothache
n = 352 (53%) and need for change of the dentures (n = 133,
20%) (Table 2). The women took greater care of oral cavity and
visit dental offices more often than men did. In total, 19.6% had
own natural teeth only, 45.0% own teeth and dentures, 30.0%
dentures only, and 5.4% neither teeth nor dentures. The number
of the natural teeth in the study patients were presented in Table 3.
DISCUSSION
Old age generally exacerbates specific health problems. Age-
related dental symptoms, the tooth loss, weakened immune system
and side effects of medicine have a long-term impact on general
health and the state of the oral cavity. Therefore, the elderly,
who are frequently chronically ill, constitute a high-risk group
that requires special care regarding the health of the oral cavity.
Bearing in mind how important dentition is for general health, it
is necessary to take preventive measures and successfully promote
Patients Male Female p
Practice of oral
hygiene
Yes 365 55.0% 103 42.6% 262 66.8%
<0.001
No 299 45.0% 169 57.4% 130 33.2%
Use a toothbrush
Yes 551 83.0% 192 70.6% 360 91.8%
<0.001
No 113 17.0% 80 29.4% 33 8.4%
Received health edu-
cation of oral hygiene
Yes 451 68.0% 175 64.3% 276 70.4%
NS
No 212 32.0% 97 35.7% 116 29.6%
Regular tooth brushing
after meals
Yes 27 4.0% 12 4.4% 15 3.8%
NS
No 637 96.0% 260 95.6% 377 96.2%
Frequency of oral
hygiene per day
Never 133 20.0% 87 32.0% 46 11.7%
<0.001Once 511 77.0% 178 65.4% 333 85.0%
Two times or more 20 3.0% 7 2.6% 13 3.3%
Frequency of visit to
the Dentist Service
More than once every 6 months 20 3.0% 9 3.3% 11 2.8%
NS
Once every 6 months 33 5.0% 15 5.5% 18 4.6%
Once every 6–11 months 113 17.0% 51 18.8% 62 15.8%
Once a year 478 72.0% 190 69.8% 288 73.5%
Once every two years 20 3.0% 7 2.6% 13 3.3%
Reason for the last
visit to the dentist
Toothache 352 53.0% 178 65.4% 174 44.4%
<0.001
Routine exam 53 8.0% 20 7.4% 33 8.4%
Dental extraction 126 19.0% 37 13.6% 89 22.7%
Need for change of the prosthesis 133 20.0% 37 13.6% 96 24.5%
Table 2. Oral hygiene practices of the elderly patients
and implement prophylaxis (17, 18). Among the over 65 examined
population, approximately 80% suffered from at least one chronic
disease, hearing loss, vision impairment or taste disorders. Elderly
people usually take five or more medications per day.
The research showed that the elderly people do brush their
teeth; however, the majority (80%) does it only once or twice per
day. Moreover, they did not go often to the dentist. As many as
72% of the subjects visit the dentist once a year. The barriers to
proper oral hygiene in elderly people including visit to the dentist
are: low socio-economic status (income), lack of fund, chronic
system disease, age, and fear of pain.
The respondents aged over 65 used both upper and lower
dentures, and only a fraction of them still have their own teeth
(239, i.e. 39% stated ‘0 own teeth’).
In other research, the reasons for tooth loss were as follows:
caries, parodontopathy, and trauma (18, 19). While the National
Institute of Dental and Craniofacial Research (NIDCR) reported
that the prevalence of both partial and total tooth loss in seniors
has decreased from the early 1970’s, seniors over 65 have lost an
average of 13 teeth (including wisdom teeth), and 26% of seniors
over 65 have no remaining teeth (20).
This study showed that the subjects of both genders were sat-
isfied with the dentures they were using. They claimed that the
denture makes eating easier, improves physical appearance and
has a positive influence on the psyche. The success of prosthetic
treatment, full adaptation and patient satisfaction also depended
on the patient’s general and oral hygiene.
However, the dentist’s skills and knowledge are just as impor-
tant as the state of the patient’s oral cavity. By applying the best
236
treatment and providing patients with proper hygiene instructions,
the dentist may contribute to improving both oral and systemic
health (21, 22). According to the many studies the oral health in
elderly patients was unsatisfactory. Impact on this state of afairs
was often inadequate care and prevention in earlier periods of
life. All dental activity should be primarily aimed at saving as
many teeth as possible and delay prosthetic treatment until old
age. Hence, an aging society creates new tasks for the health
care system which predominantly consist of prophylaxis and
promotion (23). The aim of the study was to asses oral hygiene,
frequency of visit to the dentist and the number of own teeth in a
sample of elderly population in Southern Poland. The findings of
our research suggested that the oral problems are very important
in elderly patients. The results showed that the patients shoud be
educated to change their habits by planning preventative health
programme. Further research is needed.
The findings of this study do suggest that:
1. People aged over 65 neglect hygiene and oral care.
2. Women more often practice oral hygiene and they have more
own teeth than men.
3. The most frequent cause of oral hygiene neglect in the elderly
could be gender, the socio-economic conditions, behaviour
habits and lack of sufficient health education.
4. The dentist may need to consult with the patient’s GP the
development of the appropriate personalised treatment plan
in elderly patients.
5. Young dentists need to be educated in order to provide ap-
propriate dental care to the elderly.
Conflict of interests
None declared
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Received August 17, 2011
Accepted in revised form June 14, 2012