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Assessment of Oral Hygiene in Adults

Authors:

Abstract

The aim of the research was to assess the oral hygiene habits in the elderly group of study population of Southern Poland. The study was conducted in dental services in two selected cities in Southern Poland. The group of subjects consisted of 664 respondents (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. 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 the groups: women and men. But there were differences in technologies used, the examined men significantly 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 significantly more often stated use of a toothbrush and taking care of oral hygiene and compared to men, they declared higher number of own teeth. 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 sufficient 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.
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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 signicant differences were found between the groups: women and men. But there were
differences in technologies used, the examined men signicantly 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 signicantly 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
sufcient 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
... Therefore, addressing oral health needs for older people should reflect continuity in care for older patients and should be readjusted to suit the stages of life appropriately 11,12 . The oral cavity is an important part of the body and is used in chewing, swallowing, speaking and forming facial expressions; it also plays a crucial role in maintaining nutritional status, systemic health and psychological self-esteem 6,13,14 . These functions are important for individuals of all ages; however, it gains more importance especially for older individuals who have increased susceptibility to malnutrition and infection 15 . ...
... Oral diseases have the potential to influence overall health through various pathways; conversely, general health conditions can impact oral health, given their mutual association with shared risk factors 16 . Oral hygiene directly linked to systemic infections, autoimmune disorders, chronic cardiovascular diseases, diabetes, cancer and many other diseases 11,13,17 . In conducted research, a strong relationship has been established between periodontal disease and diabetes 12,[18][19][20] , as well as between inadequate nutrition and tooth loss 7 . ...
... In addition, it has been determined that estrogen deficiency seen in menopausal or postmenopausal women may create a high risk for severe periodontal disease and tooth loss. Hormonal changes seen in older women can also cause various oral disorders such as dry mouth, burning in the gums, and changes in the sense of taste 13 . These diseases can cause severe pain and psychological sensitivity, which significantly reduces an older people's quality of life. ...
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... The stress scale assessed difficulty relaxing, nervous arousal, being easily upset/agitated, irritable or over-reactive and impatient. Depression = Sum of questions (3, 5, 10, 13, 16, 17 and 21) * 2 Normal < 9, Mild/Moderate (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), Severe (21)(22)(23)(24)(25)(26)(27) and Extremely Severe (>28) Re-grading was done into Normal < 9, Significant > 10 Anxiety = Sum of questions (2,4,7,9,15,19 and 20) * 2 Normal < 7, Mild/Moderate (8)(9)(10)(11)(12)(13)(14), Severe (15)(16)(17)(18)(19) and Extremely Severe (>20) Re-grading was done into Normal < 7, Significant > 8 Stress = Sum of questions (1, 6, 8, 11, 12, 14 and 18) * 2 Normal < 14, Mild/Moderate (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), Severe (26-33) and Extremely Severe (>34) Re-grading was done into Normal < 14,Significant > 15. ...
... The stress scale assessed difficulty relaxing, nervous arousal, being easily upset/agitated, irritable or over-reactive and impatient. Depression = Sum of questions (3, 5, 10, 13, 16, 17 and 21) * 2 Normal < 9, Mild/Moderate (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), Severe (21)(22)(23)(24)(25)(26)(27) and Extremely Severe (>28) Re-grading was done into Normal < 9, Significant > 10 Anxiety = Sum of questions (2,4,7,9,15,19 and 20) * 2 Normal < 7, Mild/Moderate (8)(9)(10)(11)(12)(13)(14), Severe (15)(16)(17)(18)(19) and Extremely Severe (>20) Re-grading was done into Normal < 7, Significant > 8 Stress = Sum of questions (1, 6, 8, 11, 12, 14 and 18) * 2 Normal < 14, Mild/Moderate (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), Severe (26-33) and Extremely Severe (>34) Re-grading was done into Normal < 14,Significant > 15. ...
... For instance, a study on periodontal health and oral hygiene practice of elderly Saudis at Riyadh nursing home (22) reported a mean age of 62.3±6.8 years with a maximum age of 94 years. In another study, it was reported that the age range of the respondents was 65-81 years with most of the respondents in the age bracket of 65-69 years category (23). In the studies compared, there were similarities in proportion of the ages of the respondents. ...
Article
Background: The elderly is the most neglected group in our community and are prone to dental problems. Mortality from ten leading causes of death among elderly in sub-Sahara Africa can be traced to poor oral hygiene among elderly. Extensive tooth loss impairs chewing efficiency and restricts social contact. Poor oral hygiene inhibits intimacy and may lower self-esteem. It may also affect speech which in turn limits social interaction leading to depression and stress. Objective: This paper examines oral hygiene and psychological state of the elderly. Methods: This was an analytical cross-sectional study, conducted among 294 elderly patients. Systematic sampling technique was used to recruit respondents. Data was collected using interviewer administered World Health Organisation (WHO) Oral Health Questionnaires. The elderly patients were also assessed using a Depression, Anxiety and Stress Scale (DASS-21). Data obtained was analysed using IBM SPSS version 23. Inferential analysis and logistic regression were used to establish the relationship between anxiety, depression, stress and oral health practices. Level of significance was defined at 95% confidence interval (p<0.05). Results: Respondents with 20 or more natural teeth were less likely to have a significant level of anxiety when compared to those with less than 20 (OR = 0.706, p = 0.528). Respondents with frequent tooth brushing of less than twice a day were 3 times less likely to have a significant level of anxiety when compared to those with brushing frequency of more than or equal to twice a day (OR = 0.345, p = 0.001). Respondents with more than or equal to 20 natural teeth were twice less likely to have a significant level of depression when compared to those with less than 20 natural teeth (OR = 0.455, p = 0.264). Respondents with removable dentures in lower/upper teeth were thrice more likely to have significant anxiety when compared with those without removable dentures (OR = 3.445, p = 0.105). Conclusion: Oral health was associated with psychological state in the elderly. The number of natural teeth, removable dentures and frequency of tooth brushing were associated with depression and anxiety in the elderly.
... Regarding toothbrushing frequency, 42% of the participants brushed their teeth at least twice a day compared to 31% in a previous study among older adults in the same geographical area [33], which is considered significant progress. However, there is large variability in relevant findings among countries [30,31,34,35]. ...
... Previous studies among denture wearers in American, Asian and European countries also reported mechanical brushing alone (36.5-100%) or with toothpaste (29.2-88.9%) as the most prevalent denture cleaning method [26,28,34,[37][38][39][40][41][42][43]. However, only 54% of the study participants cleaned their dentures at least twice a day, and only 22.2% used denture cleansing tablets as recommended [12][13][14]. ...
Article
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The purpose of this cross-sectional study was to explore the sources of daily oral hygiene information among urban community-dwelling older adults in Athens, Greece and associate them with their dental and denture care habits. One hundred and fifty-four older adults (aged 71.7 ± 9.2 years) participated in the study, and their dental status, denture use, daily oral care habits according to current gerodontology recommendations, and oral care information sources were investigated. Daily oral hygiene practices were poor, and a small number of individuals recalled having received oral hygiene advice from a dentist. Only 41.7% of the 139 dentate participants performed toothbrushing with fluoride-based toothpaste at least twice a day, and 35.9% completed regular interdental cleaning. Among 54 denture wearers, 68.5% removed their denture(s) at night, and 54% cleaned them at least twice a day. Oral hygiene information sources included dentists (for approximately half of the participants), media, friends/relatives, non-dental health care providers and dental technicians. Dentate participants who had received oral hygiene information from dentists had a greater probability of brushing their teeth with fluoride toothpaste at least twice a day (p = 0.049, OR = 2.15) and performing regular interdental cleaning (p < 0.001, OR = 29.26). Denture wearers who had received instructions about denture hygiene from dentists were more likely to use a brush and mild soap (p = 0.016, OR = 14.67) and remove their denture(s) at night (p = 0.003, OR = 8.75). Dentists should improve their oral health prevention and promotion strategies for their older patients.
... Research has indicated a notable gender predilection in the prevalence of periodontal diseases, with men more commonly affected than women (3). Men are more prone to periodontal problems due to generally poorer oral hygiene practices and a higher incidence of oral trauma (4,5). Conversely, women tend to be more vigilant about maintaining oral hygiene and more frequently visit dentists for routine check-ups (6). ...
Article
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Background: Periodontitis, characterized by clinical attachment loss (CAL), is a prevalent global oral health issue leading to tooth loss. Various predisposing factors such as smoking, dietary habits, stress, and oral trauma are implicated in its development. Understanding these factors is crucial for targeted interventions and improved periodontal health outcomes. Objective: To assess the predisposing factors of periodontitis in individuals. Methods: A descriptive cross-sectional study was conducted on 50 individuals visiting the College of Dentistry, Sharif Medical and Dental College, Lahore. Data were collected by measuring clinical attachment loss. Patients were classified based on CAL into mild, moderate, and severe periodontitis categories. The Chi-square test was used to analyze associations between periodontitis severity and factors like smoking duration, betel quid chewing, stress, oral trauma, and an unbalanced diet. Results: A significant association was found between smoking duration and periodontitis (p=0.04). Individuals with a smoking history of over five years had higher rates of severe (51%) and moderate (18.4%) periodontitis compared to those with a history of less than five years (8.2%). Betel quid chewing (p=0.254), stress (p=0.871), oral trauma (p=0.557), and an unbalanced diet (p=0.883) were not significantly associated with periodontitis. Conclusion: Severe periodontitis was more prevalent in individuals with a smoking history of over five years and those consuming an unhealthy diet. Moderate periodontitis was more common in individuals without a betel quid chewing habit. Mild periodontitis was observed in those reporting stress-related gum or tooth pain and those with a history of oral trauma.
... 27,52 The differences between the cited references and this study might be explained by sample demographic characteristics and methodology: The cited studies involved participants with considerably lower age 24,27,52 compared with the sample of this study, where the age of the participants allocated them to a senior age group, with a tendency to begin neglecting self-hygiene and oral care. 53 Furthermore, the sex distribution rendered a higher proportion of females in this study, whereas a balanced allocation 24,27 or higher proportion of males 52 was found in the cited references. In general, women tend to be more proactive and positive about dental visits compared with men, potentially justifying part of the differences. ...
Article
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Objectives Mechanical debridement is the traditional method for the treatment of peri-implant mucositis (P-im) and its success depends on the patient's correct oral hygiene. It is believed that probiotics may help by their ability to modulate the oral biofilm, resulting in anti-inflammatory and antibacterial plaque action. The aim of this study was to evaluate the adjuvant effect of the probiotic Limosilactobacillus reuteri (LR) in the mechanical treatment of P-im. Materials and Methods This exploratory study included 29 subjects with implant-supported total rehabilitation and P-im, divided into test (TG) and control (CG) groups, equally subjected to professional mechanical debridement, with the administration of a daily GUM PerioBalance lozenge for 30 days added to the TG. The modified Plaque Index (mPlI) modified Sulcus Bleeding Index (mBI) and pocket depth (PD) were evaluated before the intervention (baseline) and 6 and 10 weeks later. Statistical Analysis Parametric and nonparametric tests with 5% significance level were used in the statistical analysis, using IBM SPSS Statistics 27.0 software. Results Both treatments resulted in reduced mPlI, mBI, and PD at 6 weeks; while from 6 to 10 weeks there was an increase in mPlI and mBI and maintenance of PD. Compared with baseline, differences were close to statistical significance in the reduction in PD at 10 weeks in the CG (p = 0.018), after Bonferroni correction, and statistically significant in the mPlI at 6 weeks in the CG (p = 0.004) and in the TG (p = 0.002) as well as at 10 weeks in the TG (p = 0.016). Comparing the groups in the postintervention assessments, no statistically significant differences were found. Conclusion LR adjuvant mechanical treatment of P-im does not show a clear benefit compared with mechanical treatment alone, with both interventions achieving similar clinical results. Further prospective and long-term studies are needed.
... (4) Returning to a European context, a study on 1,200 participants regarding oral hygiene habits revealed that 97% of Portuguese people used their toothbrush daily: 77% of women brush their teeth twice a day, but only 68% of men do. (8) Studies in a Polish population reported that approximately 80% performed oral hygiene once or twice a day (9) and 30% performed oral hygiene only once a day or less. (10) However, few studies on home hygiene habits on a population in conditions of isolation or rapid economic difficulty, such as the conditions brought about by the COVID-19 pandemic, are available. ...
Article
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Objective This work aimed to report values regarding oral hygiene habits at home during the pandemic and compare the difference with previous oral hygiene habits. Methods This study was performed anonymously and had patients answer an online questionnaire. The questionnaire consisted of 11 closed-answer questions (except 1) concerning oral hygiene habits at home at the time of COVID-19 and participant characteristics, including gender and age. A total of 1,136 questionnaires were filled in via a link sent by email to the patients. Results Among the 1,136 patients examined, 32.4% (372) were male and 67.6% (775) were female, and almost half (47.9%) of the patients who answered the questionnaire were aged 18-40 years. Patients who participated in our survey were asked questions related to dental and tongue hygiene. The answers showed that although they had more time during the pandemic, they brushed their teeth less and did not brush their tongues regularly. Conclusion Patients with periodontal problems usually have less time for brushing and do not have good plaque control. The questionnaire showed the opposite, such that the patient’s compliance and motivation matters more than time. Thus, dentists and dental hygienists must encourage and make patients understand the importance of oral hygiene at home. Oral hygiene; Oral health; Patient compliance; Epidemiologic studies; COVID-19; Coronavirus infections; Surveys and questionnaires
... The literature reveals neglect of hygiene and oral care in people aged over 65 years [23], especially in persons in need of care [5]. Since cognitive and fine motor skills decrease with older age [24], it becomes more difficult to perform effective oral hygiene autonomously. ...
Article
Full-text available
Objective: To investigate the effectiveness of individual oral health care training (IndOHCT) on dental plaque removal and denture cleaning in hospitalized geriatric inpatients. Background: The literature reveals neglect of hygiene and oral care in people aged over 65 years, especially in persons in need of care. Hospitalized geriatric inpatients have poorer dental health than those non-hospitalized. Furthermore, the existing literature reporting on oral healthcare training interventions for hospitalized geriatric inpatients is scarce. Materials and methods: This pre-post-controlled intervention study dichotomized 90 hospitalized geriatric inpatients into an intervention group (IG) and a control group (CG). Inpatients in the IG received IndOHCT. Oral hygiene was assessed using the Turesky modified Quigley-Hein index (TmQHI) and the denture hygiene index (DHI), at baseline (T0), at a second examination (T1a), and after supervised autonomous tooth brushing and denture cleaning (T1b). The influence of the Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Barthel Index (BI) scores on oral hygiene was examined. Results: There was no significant plaque reduction on teeth or dentures between T0 and T1a in either group. Between T1a and T1b, plaque reduction on the teeth was more effective in the IG than in the CG (p < 0.001). Inpatients with 1-9 remaining teeth removed significantly more dental plaque than inpatients with 10 or more remaining teeth. Inpatients with lower MMSE scores (p = 0.021) and higher age (p = 0.044) reached higher plaque reduction on dentures. Conclusions: IndOHCT improved oral and denture hygiene in geriatric inpatients by enabling them to clean their teeth and dentures more effectively.
... Similar to the results from El Salvador, Lu Liu et al. reported in northeastern China that one third of the elderly brush their teeth less than once a day [17]. In Poland, Wojciech Skorupka et al. report that the majority of older adults brush their teeth only 1 or 2 times a day (80%) [18]; these similarities lead to the inference that regardless of the cultural or developmental differences between countries, there are common factors that could influence the oral hygiene of this susceptible group, among these, the economic difficulty for the population of this age group to buy toothbrushes and toothpaste, prioritizing other needs such as food and medicines, together with the ingrained habits of older adults and the decrease in social life, since many of them are without productive activity, which forces them to spend most of the day in their own homes or in nursing homes for the elderly. Consistent with the infrequency of brushing found in this study, it was also identified that more than half of Salvadoran older adults have "Poor or Very Poor" hygiene, similar to the results of other studies such as those conducted in India and Turkey in which deficient levels of oral hygiene were also reported [3,19]. ...
Article
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Introduction Older adults are a highly vulnerable group in their general health condition, including oral health that can be influenced by different factors, among them, changes in oral tissues inherent to the physiological processes of aging and by systemic condition. In El Salvador, it is a group that has received little attention at the public health level. Objective To determine the profile of the oral health status and treatment needs of the elderly population in El Salvador. Materials and methods Secondary cross-sectional analysis of data from the last oral health survey in 471 Salvadorans aged 60 years and older. The variables under study were: sociodemographics, brushing frequency, oral hygiene according to simplified oral hygiene index (OHI-S), caries experience according to decayed, missing, and filled teeth index (DMFT) modified with international caries detection and assessment system (ICDAS) criteria, periodontal status through the community periodontal index of treatment needs (CPITN), edentulism and treatment needs. Statistical analysis was conducted using chi-square test, ANOVA, z-test and linear regression (p < 0.05). Results The older adults presented poor oral hygiene, low brushing frequency, high tooth loss with an average of 16 missing teeth while one third presented total edentulism. Most of the older adults were categorized as having "poor or very Poor" oral hygiene. Almost all respondents presented some degree of periodontal disease and required restorative intervention. Conclusion The oral health status of elderly Salvadoran is poor. Furthermore, the development of public policies and specific oral health strategies aimed at this population is urgent.
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The purpose of this study was to investigate the relationship between oral and dental health in cancer patients and control group, which was conducted in Tabriz Shahid Gazi hospital. A researchers-made and validated questionnaire including oral and dental health criteria, was filled by the cancer patients (201 cases) and healthy controls (199 cases). Then, the results of the study were analyzed by SPSS software, and reported as Odds ratios (95 % confidence intervals) in tow groups. The results indicate that comparison of filled tooth, tooth extraction, dental caries, and gingival problems including bleeding, gum surgery and inflammation in cancer and controls were significantly meaningful. However, the comparison between the two groups was not significant in terms of the type of the tooth (natural or denture) and the number of daily toothbrushes, but they were considered as risk factors due to statistical results. Environmental factors, and especially oral hygiene, can play an important role in the incidence of different cancers. Among these, the type of oral microorganisms, and their overgrowth and released antigens should be studied further in the emergence of different kinds of cancer in humans.
Article
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Recently, it has been recognized that oral infection, especially periodontitis, may affect the course and pathogenesis of a number of systemic diseases, such as cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight. The purpose of this review is to evaluate the current status of oral infections, especially periodontitis, as a causal factor for systemic diseases. Three mechanisms or pathways linking oral infections to secondary systemic effects have been proposed: (i) metastatic spread of infection from the oral cavity as a result of transient bacteremia, (ii) metastatic injury from the effects of circulating oral microbial toxins, and (iii) metastatic inflammation caused by immunological injury induced by oral microorganisms. Periodontitis as a major oral infection may affect the host's susceptibility to systemic disease in three ways: by shared risk factors; subgingival biofilms acting as reservoirs of gram-negative bacteria; and the periodontium acting as a reservoir of inflammatory mediators. Proposed evidence and mechanisms of the above odontogenic systemic diseases are given.
Article
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The purpose of this study was to assess the oral health-related quality of life in Czech population. Data were collected from 1,380 subjects aged 30 to 69 years attending the Department of Dentistry, Medical Faculty of Charles University in Hradec Králové or attending three private dental practitioners collaborating on the study. Oral health-related quality of life was measured with the Oral Health Impact Profile (OHIP-14) questionnaire that was translated to Czech. The OHIP-14 scores were assessed in relation to chosen clinical and sociodemographic characteristics and oral health behaviour. Statistical analyses included descriptive analyses, the Mann-Whitney test, the Kolmogorov-Smirnov test and the Kruskal-Wallis test using the NCSS 2007 program. The chi2 test of independence in contingency tables or Fisher's exact test was used for qualitative data. Internal reliability for the 14 items overall was very high (Cronbach's ac = 0.924). The two most frequently scored items using the answer other than "never" during the last year were "painful aching" (62% of subjects) and "uncomfortable to eat" (44.4%), representing subdomain physical pain. The domain of social disability was reported least frequently. The OHIP-14 was significantly associated with dental status, dental behaviour, income and age. The findings of this study do suggest that the culturally adapted OHIP-14 version may be a good research instrument to be considered for use in measuring the impact of oral problems on the quality of life in Czech population.
Article
Full-text available
Recently, it has been recognized that oral infection, especially periodontitis, may affect the course and pathogenesis of a number of systemic diseases, such as cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight. The purpose of this review is to evaluate the current status of oral infections, especially periodontitis, as a causal factor for systemic diseases. Three mechanisms or pathways linking oral infections to secondary systemic effects have been proposed: (i) metastatic spread of infection from the oral cavity as a result of transient bacteremia, (ii) metastatic injury from the effects of circulating oral microbial toxins, and (iii) metastatic inflammation caused by immunological injury induced by oral microorganisms. Periodontitis as a major oral infection may affect the host's susceptibility to systemic disease in three ways: by shared risk factors; subgingival biofilms acting as reservoirs of gram-negative bacteria; and the periodontium acting as a reservoir of inflammatory mediators. Proposed evidence and mechanisms of the above odontogenic systemic diseases are given.
Conference Paper
PERIODONTAL DISEASES ARE INFECTIONS, and many forms of the disease are associated with specific pathogenic bacteria which colonize the subgingival area. At least two of these microorganisms, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans, also invade the periodontal tissue and are virulent organisms. Initiation and progression of periodontal infections are clearly modified by local and systemic conditions called risk factors. The local factors include pre-existing disease as evidenced by deep probing depths and plaque retention areas associated with defective restorations. Systemic risk factors recently have been identified by large epidemiologic studies using multifactorial statistical analyses to correct for confounding or associated co-risk factors, Risk factors which we know today as important include diabetes mellitus, especially in individuals in whom metabolic control is poor, and cigarette smoking. These two risk factors markedly affect the initiation and progression of periodontitis, and attempts to manage these factors are now an important component of prevention and treatment of adult periodontitis. Systemic conditions associated with reduced neutrophil numbers or function are also important risk factors in children, juveniles, and young adults. Diseases in which neutrophil dysfunction occurs include the lazy leukocyte syndrome associated with localized juvenile periodontitis, cyclic neutropenia, and congenital neutropenia. Recent studies also point to several potentially important periodontal risk indicators. These include stress and coping behaviors, and osteopenia associated with estrogen deficiency. There are also background determinants associated with periodontal disease including gender (with males having more disease), age (with more disease seen in the elderly), and hereditary factors. The study of risk in periodontal disease is a rapidly emerging field and much is yet to be learned. However, there are at least two significant risk factors-smoking and diabetes-which demand attention in current management of periodontal disease.
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This full colour, simple, interesting and easy to understand textbook introduces the novice dental student to the many oral disease processes. For the practising specialist and general dentist it provides a review of processes fundamental to clinical problems and an understanding of recent developments and changing concepts. The chapters are organised to coincide with the more recent trends in dental education where students are seeing patients earlier and therefore requiring immediate knowledge of some of the more common and less complicated aspects of oral pathology. To accommodate this trend the subjects that are less difficult conceptually and require fewer prerequisites science courses are in the earlier chapters with more complex topics to be found in later chapters. Each chapter includes an outline of the topics, an introduction to the disease processes, followed by a thorough discussion of the common disorders, organised by aetiology, pathogenesis, clinical and radiographic features, histopathology, differential diagnosis, treatment and prognosis. Each chapter concludes with a short bibliography of the most recent and pertinent review articles and classic publications.
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The aims of this study were to determine the prevalence of oral sensorial complaints, salivary flow rate and oral mucosal lesions in the institutionalized and non-institutionalized elderly. The study included 280 institutionalized and 61 non- institutionalized elderly people. Dry mouth, burning mouth sensations, taste disturbances, salivary flow rate and oral mucosal lesions were assessed and compared between groups. A greater number of the institutionalized elderly had dry mouth (P = 0.001) and taste disturbance (P = 0.035) compared to non-institutionalized elderly. The institutionalized elderly also had significantly lower salivary flow rate (P < 0.0001). Positive correlation was found between salivary flow rate and perception of dry mouth in the institutionalized elderly (r(s) = 0.26; P < 0.05), as well as in the non-institutionalized elderly (r(s) = 0.35; P < 0.05). Moreover, positive correlation was observed between salivary flow rate and the sensation of burning mouth in the institutionalized elderly (r(s) = 0.13; P < 0.05) and non-institutionalized elderly (r(s) = 0.31; P < 0.05). The number of institutionalized elderly people with oral mucosal diseases was higher compared with non-institutionalized ones (P = 0.01). The most common oral mucosal lesions in both groups were related to wearing dentures. It can be concluded that the institutionalized elderly are significantly affected with oral sensorial complaints, including dry mouth and taste disturbance, as well as decreased salivary flow rate and oral mucosal diseases compared with the non-institutionalized elderly.
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The demographic shift in the Indian population has been caused in part by an increase in the life expectancy. Increased longevity has resulted in a gradual transition in the population, with a reduction in the percentage of the child population (0-14 years) and an increase in the percentage of the elderly (60+ years). Geriatric dentistry is a science that is a multidisciplinary and multidimensional approach to the management of the oral health problems of the elderly. The elderly population in India is predicted to increase to comprise 12.5% of the total population by 2026. At present, only a few 'geriatric medicine' OPD services exist and they lack the required infrastructure. No oral health care centers exist in India. Although there is an increasing demand for geriatric oral health care, as yet, no formal training on this subject has been introduced in the dental curriculum. It is essential that future dental professionals have a proper conception of the dimensions of the services to be provided to the elderly, along with the appropriate skills. This would only be feasible through an education programme in geriatric dentistry, which should be started without further delay.
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Oral health is important to general health because stomatologic disease affects more than the mouth. Increasing preservation of teeth among present and future cohorts of older people has increased their risk for serious disease from oral pathogens. The intent of this paper is twofold: first, to alert non-dental health personnel to the significance of oral health and oral disease in the older adult; and second, to recruit the assistance of non-dental professionals in helping patients to achieve and maintain an optimal oral condition. Normative aging processes alone have little effect on the oral cavity, but common disease processes affecting oral health include tooth loss, dental caries, periodontal diseases, and oral mucosal diseases (including candidiasis and squamous cell carcinoma). Systemic diseases and their treatments frequently affect salivary, oral motor, and oral sensory functions. As a result of bacteremia or aspiration of oral contents, organisms of oral origin can be responsible for serious nonstomatological infections. Clinicians caring for older people need to recognize the importance of stomatological health, include an oral component in the multidisciplinary geriatric assessment, support the education of patients on aspects of dental health, and advocate the expansion of personal and public oral health benefits for older adults.
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Peridontal diseases are infections, and many forms of the disease are associated with specific pathogenic bacteria which colonize the subgingival area. At least two of these microorganisms, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans, also invade the periodontal tissue and are virulent organisms. Initiation and progression of periodontal infections are clearly modified by local and systemic conditions called risk factors. The local factors include pre-existing disease as evidenced by deep probing depths and plaque retention areas associated with defective restorations. Systemic risk factors recently have been identified by large epidemiologic studies using multifactorial statistical analyses to correct for confounding or associated co-risk factors. Risk factors which we know today as important include diabetes mellitus, especially in individuals in whom metabolic control is poor, and cigarette smoking. These two risk factors markedly affect the initiation and progression of periodontitis, and attempts to manage these factors are now an important component of prevention and treatment of adult periodontitis. Systemic conditions associated with reduced neutrophil numbers or function are also important risk factors in children, juveniles, and young adults. Diseases in which neutrophil dysfunction occurs include the lazy leukocyte syndrome associated with localized juvenile periodontitis, cyclic neutropenia, and congenital neutropenia. Recent studies also point to several potentially important periodontal risk indicators. These include stress and coping behaviors, and osteopenia associated with estrogen deficiency. There are also background determinants associated with periodontal disease including gender (with males having more disease), age (with more disease seen in the elderly), and hereditary factors. The study of risk in periodontal disease is a rapidly emerging field and much is yet to be learned. However, there are at least two significant risk factors-smoking and diabetes-which demand attention in current management of periodontal disease.
Article
Evidence is increasing that oral health has important impacts on systemic health. This paper presents data from the third National Health and Nutrition Examination Survey (NHANES III) describing the prevalence of dental caries and periodontal diseases in the older adult population. It then evaluates published reports and presents data from clinical and epidemiologic studies on relationships among oral health status, chronic oral infections (of which caries and periodontitis predominate), and certain systemic diseases, specifically focusing on type 2 diabetes and aspiration pneumonia. Both of these diseases increase in occurrence and impact in older age groups. The NHANES III data demonstrate that dental caries and periodontal diseases occur with substantial frequency and represent a burden of unmet treatment need in older adults. Our review found clinical and epidemiologic evidence to support considering periodontal infection a risk factor for poor glycemic control in type 2 diabetes; however, there is limited representation of older adults in reports of this relationship. For aspiration pneumonia, several lines of evidence support oral health status as an important etiologic factor. Additional clinical studies designed specifically to evaluate the effects of treating periodontal infection on glycemic control and improving oral health status in reducing the risk of aspiration pneumonia are warranted. Although further establishing causal relationships among a set of increasingly more frequently demonstrated associations is indicated, there is evidence to support recommending oral care regimens in protocols for managing type 2 diabetes and preventing aspiration pneumonia.