Oral health care needs among the middle-aged and the elderly in Hong Kong

Abstract A sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds were clinically examined in an oral health survey of Hong Kong Chinese conducted in 1991. The examination procedures and diagnostic criteria for assessing restorative and extraction treatment need followed those recommended by the World Health Organization. The Community Periodontal Index-based periodontal treatment needs involving index teeth or their replacements were computed from separate clinic scores for maximum probing depth, presence of calculus, and bleeding after probing. A set of criteria for assessing prosthodontic treatment need was specially laid down for this survey. Examiners were calibrated before the survey, and the interexaminer reliability was found to be generally good. Besides reporting the various individual normative treatment need items in the traditional way, the present analysis used some holistic treatment-need categories which may have manpower-requirement implications for the classification of subjects. All dentate subjects surveyed required some treatment. Only 6% of the elderly, all edentulous, required denture work only. Of the 35–44-yr-olds, 42% needed scaling and oral hygiene instruction only, which could be provided by dental hygienists. The treatment needs of the vast majority of the middle-aged and the elderly (mainly scaling; simple fillings; and extractions, dentures, or both) could be easily handled by general dentists. Only about one-fifth of the subjects in both age groups required some complex care such as endodontics, crowns, and advanced periodontal treatment, which could be delivered by senior dentists or dentists with specialist training.     

Tooth and root conditions in the middle-aged and the elderly in Hong Kong

Abstract In an oral health survey of Hong Kong Chinese conducted in 1991, a sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds were interviewed and clinically examined. The examination procedures, instruments, and diagnostic criteria used to detect coronal caries followed those recommended by the World Health Organization (1987). The diagnostic criteria used to assess root-surface caries were based on those used in a national oral health survey of US employed adults (National Institute of Denial Research. 1987). Calibration of examiners was conducted before the survey and the interexaminer reliability was found to be very high; the kappa statistics were 0.93 and 0.91 for the younger and older age groups, respectively. None of the 35–44-yr-olds were edentulous and 96% had 21 teeth or more. The prevalence of edentulousness among the elderly was 12%. The DMFT indices of the younger and older age groups were 8.7 and 18.9, respectively. In both age groups, MT was the major component of the DMFT index, and female subjects had a slightly higher score. The prevalences of decayed/filled roots were 7% and 26%i for the 35–44- and 65–74-yr-olds, respectively. As compared with previous surveys conducted in Hong Kong, there has been a 40% reduction in the DMFT index of the 35–44-yr-olds since 1968, but little change in the tooth and root conditions was noted between 1984 and 1991.     

Tooth loss, denture wearing and oral health-related quality of life in elderly Chinese people

OBJECTIVES: To investigate the relationship between tooth loss, denture wearing and oral health-related quality of life (OHQoL) among community-dwelling elderly people in Hong Kong. METHODS: A questionnaire study of elderly people aged 60-80 years who were recruited at neighborhood social centres for the elderly. The Chinese version of the General Oral Health Assessment Index (GOHAI) was used and information about natural tooth number and denture wearing were obtained. RESULTS: 233 elderly subjects were recruited and interviewed. Around 20% of the partially dentate subjects had their last tooth loss within the previous year and a quarter within the last five years. Significantly fewer edentulous subjects had their last tooth loss within the previous year (3%) and within the last five years (12%, p < 0.001). Twenty two percent of the subjects had difficulty in accepting tooth loss. More edentulous subjects (69%) were satisfied with their dentures than partially dentate denture wearers (37%, p < 0.001). Edentulous elderly subjects had a higher mean GOHAI score (53.0) than partially dentate denture wearers (49.1, p < 0.001). Results from a multiple factor ANOVA revealed that elderly subjects who had loose teeth, difficulty in accepting tooth loss and were not satisfied with their removable dentures had a lower mean GOHAI score. CONCLUSIONS: In general, tooth loss and denture wearing did not have a major impact on OHQoL in elderly Chinese people. However, partially dentate denture wearers experienced a greater adverse impact on OHQoL than edentulous subjects most probably due to less satisfaction with their dentures and discomfort associated with loose teeth.     

Survey of the dental health and denture status of institutionalized elderly patients in Ireland

An investigation was conducted to establish the dental status of 368 elderly patients in two geriatric hospitals in Limerick, Ireland, in terms of denture status and the number of teeth present. Seventy eight percent of those examined were edentulous, but only 27% of edentulous patients were wearing maxillary and mandibular dentures. A further 18% wore a maxillary denture only, 21% had dentures made but no longer wore them, and 33% had never had dentures. Forty-four patients had some maxillary and mandibular teeth present and 20 of these had sufficient teeth for masticatory purposes. Very few patients, edentulous or dentate, complained of any problems, although 27 were felt to require extraction of one or more teeth.     

Dental treatment needs in an elderly population referred to a geriatric hospital in Switzerland

Of 219 elderly patients admitted consecutively to a geriatric hospital in Switzerland, 59.4% were edentulous. A high proportion of the dentate patients exhibited tooth loss patterns requiring free-end partial dentures in the maxilla (36.0%) or the mandible (69.7%). Of the remaining teeth, 29.3% were decayed, and 45.1% had severe periodontitis. Virtually all (97.8%) dentate and 31.5% of the edentulous subjects were judged to need some kind of dental treatment. In contrast, the subjective need for dental treatment was low in dentate (30.4%) and edentulous (13.1%) subjects. Prosthesis hygiene was poor in 73.8% of the 191 denture wearers whether they needed assistance with oral hygiene or not. The objectively-assessed need for a new prosthesis in edentulous patients was determined by income, marital status, and patient mobility, whereas the need for a prosthesis alteration was related to cognitive function. These findings should help to plan future dental prophylactic and therapeutic services in geriatric hospitals.     

Emotional effects of tooth loss in community-dwelling elderly people in Hong Kong

PURPOSE: This study investigated the emotional effects of tooth loss among community-dwelling elderly people in Hong Kong and compared the effects among edentulous and partially dentate elderly. MATERIALS AND METHODS: A questionnaire study involved 233 southern Chinese elderly who were recruited and interviewed at social centers for elderly people throughout Hong Kong. Data were analyzed using chi-square or chi-square exact tests. RESULTS: Twenty-two percent of the participants reported difficulty accepting tooth loss, with no difference between the edentulous and partially dentate. However, 95% stated that their confidence was unaffected. For more than half of elderly people, tooth loss had a negative effect on food choice and enjoyment of food, with removable denture wearers having greater restrictions. Avoiding going out, eating in public, and forming close relationships were less-common problems. Twenty-two percent felt unprepared for the effects of tooth loss, and more than half said that better communication with the dentist would have helped. CONCLUSION: The emotional effects of tooth loss were not marked among elderly people, and there were no differences between edentulous and partially dentate individuals. However, significant disability was experienced because of restrictions in daily living activities. Restrictions were more severe in people who had lost enough teeth to necessitate denture wearing.     

Prosthetic rehabilitation in the elderly inhabitants of Helsinki, Finland

The aim of this study was to document the number of remaining natural teeth, to examine the prosthetic rehabilitation and to evaluate further prosthetic treatment needs among a representative sample of 76–86-year-old inhabitants of Helsinki. The edentulous made up 46% (168) of the subjects, 40% of the men and 48% of the women. Of these edentulous, 94% (158) wore complete dentures in both jaws, 2% wore only a maxillary denture, and 4% wore no dentures at all. One edentulous subject had an implant-supported overdenture in the lower jaw. More than half (54%) of all subjects had 1–32 natural teeth left. These dentate subjects had 47% (mean 13·2, excluding the wisdom teeth) of their natural teeth remaining. Of the remaining teeth, 13% (mean 1·8) were crowned and 5% (mean 0·6) were indicated to be extracted. Among the dentate, 37% (mean 10·4) of their natural teeth were missing and replaced by some type of fixed or removable prosthesis. Eleven per cent (mean 3·1) of missing teeth had not been replaced and were considered not to need prosthetic replacement. However, 5% (mean 1·3) of the missing teeth without prosthetic replacement were judged to need a prosthesis. Among the dentate, 37% wore a complete denture in one jaw; 34% of the dentate subjects used acrylic removable partial dentures (ARPD), and 19% used metallic removable partial dentures (MRPD). Of the dentate, 45% had crowns and fixed bridges. Altogether, 25% wore some kind of combination of fixed and removable prosthesis, whereas 14% had no type of prosthetic rehabilitation at all. The age of the current prosthesis varied from less than one year to over 50 years. Of all the subjects, 37% (6% of the edentulous and 63% of the dentate) had experienced inadequate prosthetic rehabilitation.     

Oral disorders and treatment implications in people over 75 years

The oral health of subjects over 75 yr and living independently in the southwest of Britain was assessed. The majority (80%) of the sample were edentulous, and a large proportion of both edentate and dentate subjects were using dentures. More than half of the denture wearers were using loose, very unhygienic, or structurally defective dentures. Mucosal pathoses were quite common, although most of the lesions were denture-induced stomatitis found in association with unhygienic dentures. The dentate subjects had, on average, 11 natural teeth, frequently with evidence of root caries and deep periodontal pockets or extreme bone loss. The oral health problems suggest that there is a significant need to develop effective methods of improving oral hygiene in this age group. The prosthetic treatment is related principally to denture repairs while there is a need to control root caries among the growing population of elderly dentate people.     

402名老年人口腔健康调查

目的：调查金山区敬老院内老年人的口腔健康状况,描述其现状,为老年人口腔护理提供相关依据。方法：采用分层整体抽样方法,收集金山区6家敬老院共402名老年人牙缺失、义齿修复以及刷牙次数等情况,采用SPSSl3．0软件包进行统计学分析。结果：金山区敬老院402名老年人中牙缺失人数为390人,失牙率达到97．01％,而义齿修复率仅为25．64％;其中全口无牙颌人数为102名,全口义齿修复率为72．54％;每天不刷牙的人数为180人,占到44．77％。结论：目前金山区老年人口腔健康自我重视程度不够,且缺乏保健意识,口腔状况不容乐观。建议金山区牙防所进一步加强辖区老年人的龋病和牙周病防治的宣教力度,提升居民口腔保健意识,减少失牙,改善老年人的缺牙修复水平,提高生活质量。     

402名老年人口腔健康调查

目的：调查金山区敬老院内老年人的口腔健康状况,描述其现状,为老年人口腔护理提供相关依据。方法：采用分层整体抽样方法,收集金山区6家敬老院共402名老年人牙缺失、义齿修复以及刷牙次数等情况,采用SPSSl3．0软件包进行统计学分析。结果：金山区敬老院402名老年人中牙缺失人数为390人,失牙率达到97．01％,而义齿修复率仅为25．64％;其中全口无牙颌人数为102名,全口义齿修复率为72．54％;每天不刷牙的人数为180人,占到44．77％。结论：目前金山区老年人口腔健康自我重视程度不够,且缺乏保健意识,口腔状况不容乐观。建议金山区牙防所进一步加强辖区老年人的龋病和牙周病防治的宣教力度,提升居民口腔保健意识,减少失牙,改善老年人的缺牙修复水平,提高生活质量。     

Oral status and nutrition in the institutionalized elderly.

OBJECTIVES: To evaluate, in an elderly population, whether poor oral status might be a contributing factor to the development of undernutrition and might be associated with less eating pleasure, more subjective eating difficulty and increased mashed food consumption. METHODS: An oral examination and an evaluation of masticatory capacity were performed on 120 institutionalized elderly subjects. The nutritional assessment included serum albumin concentration, the Mini Nutritional Assessment and a questionnaire on eating habits. RESULTS: Edentulous subjects without dentures or with only one complete denture had significantly lower MNA scores than edentulous subjects with two complete dentures (p < 0.05). Edentulous subjects with two complete dentures more frequently reported taking pleasure from eating (p = 0.05), and had less frequent difficulties with hard foods (p = 0.01) than edentulous subjects without dentures or with only one complete denture. Mashed food consumption (p < 0.01) was also reported more frequently in edentulous subjects without dentures or with only one complete denture. Subjects with two complete dentures had similar or better MNA scores as dentate subjects with relatively few remaining teeth (10.4 +/- 7.8 teeth). About half of the subjects (53%) could not perform the masticatory test. These subjects had lower MNA scores (p = 0.001) and a larger proportion ate mashed food (p < 0.001) compared to those who were able to perform the test. CONCLUSIONS: Poor oral status (edentulous without dentures or with only one complete denture) increased difficulty in eating hard foods, increased mashed food consumption and decreased eating pleasure. It seemed also to put institutionalized subjects at higher risk of undernutrition.     

Tooth loss and dental caries in institutionalized elderly in Italy

An epidemiological survey of dental health status and needs was conducted in a group of 234 randomly selected institutionalized elderly people in Naples, Italy. The mean age of the patients was 81.4 yr, 71.4% were women and 28.6% men. A total of 140 (59.8%) people were totally edentulous; an additional 13.7% were edentulous in one jaw. A significant increase in prevalence of edentulousness with increasing age was recorded. 44.3% of the edentulous in both jaws wore complete dentures. The mean number of remaining sound teeth, decayed teeth and root remnants in the elderly with maxillary and mandibular natural teeth decreased with increasing age. Of the 94 dentate elderly, 29.8% had no need of dental treatment. Of all dentate patients 68.1% needed one or more dental extractions with a mean need of 3.9 per patient; 37.2% needed restorative treatment for one or more teeth with a mean need per patient of 2.9. Analysis of the results showed poor dental health in this target group and the necessity of improving the dental health services programs for the elderly living in institutions.     

Changing dentate status of adults, use of dental health services, and achievement of national dental health goals in Denmark by the year 2000

OBJECTIVES: This study analyzes the current profile of dentate status and use of dental health services among adults in Denmark at the turn of the millennium, assesses the impact on dentate status of sociodemographic factors and use of dental health services in adulthood and in childhood, and highlights the changes over time in dental health conditions among adults. Finally, the intention of the study was to evaluate the Danish dental health care system's level of achievement of the official goals for the year 2000 as formulated by the World Health Organization and the National Board of Health. The subjects of this study included a national representative sample of 16,690 Danish citizens aged 16 years and older (response rate=74.2%). A subsample (n=3,818) took part in a survey of dental care habits in childhood and prevalence of removable dentures; 66 percent of persons selected responded. METHODS: Personal interviews were used to collect information on dentate status, use of dental health services and living conditions; data on dental care habits in childhood and prevalence of removable dentures were collected by self-administered questionnaires. RESULTS: In all, 8 percent of interviewed persons were edentulous, while 80 percent had 20 or more natural teeth. At age 65-74 years, 27 percent were edentulous and 40 percent had 20 teeth or more; 58 percent wore removable dentures. Dentate status and prevalence of dentures were highly related to educational background and income, particularly for older age groups. Among persons interviewed, 80 percent paid regular dental visits and visits were most frequent among persons of high education and income. At age 35-44 years 95 percent had participated in regular dental care in childhood compared to 49 percent of 65-74-year-olds. Multivariate analyses revealed that sociobehavioral factors had significant effects on dentate status. CONCLUSIONS: Compared to similar studies carried out in 1987 and 1994, the present survey indicates a positive trend of improved dentate status in adult Danes in general and regular use of dental health services increased considerably over time. The WHO goals for better dental health by the year 2000 were achieved for 35-44-year-olds, whereas the goal of more people with functional dentitions at age 65 years or older was not achieved. It remains a challenge to the Danish dental health system to help even out the social inequalities in dental health.     

Orthodontic and prosthetic rehabilitation of unilateral free-end edentulous space

Most patients prefer fixed dentures, even in the presence of uni and bilateral free-end saddle. The most suitable treatment for this is an implant or implant-supported prosthetic restoration. A combined prosthetic and orthodontic treatment with distalization of a posterior tooth towards the edentulous region is an alternative approach. This study involved a 34.3 year old female patient who had a free-end edentulous space on the left mandibula and missing 1st and 3rd molars on the right mandibula. The patient was offered both a removable partial denture and implant treatment options. A detailed explanation of her situation and suitable treatments were given but she refused both options. Therefore, an alternative combined treatment involving prosthodontic and orthodontic disciplines was performed. The second premolar tooth was distalized orthodontically and used as a distal bridge abutment. After 65 months, prosthetic restoration was functional and abutment teeth and periodontium were pathology free, and the patient was satisfied with the results.     

Use of dental services by the middle-aged and the elderly in Hong Kong

Abstract The objectives of this analysis were to describe the dental service use pattern of the 35–44- and 65–74-yr-old age groups and to determine to what extent this pattern could be explained by selected sociodemographic and attitudinal variables. The study populations comprised 398 35–44-yr-old and 559 65–74-yr-old Hong Kong Chinese. Use of dental services was determined on the basis of the respondents' own perception of the regularity of their dental visits and by the time since the last denial visit. The younger groups was categorized into regular users, irregular users, and nonusers, and the older group was categorized into three groups according to last dental visit (within 2 yr, 2–5-yr, 5 yr or more). A modification of the Andersen and Newman model for individual determinants of health care use was used as the framework for a logistic regression analysis. Predisposing variables were sex, education, occupation, altitudes, knowledge, preventive orientation, and dental anxiety; enabling variables were Family Possession Index, income, family support and access to a dental programme; need variables were perceived conditions of teeth, denial problems, denial pain, need for treatment, normative need for treatment, and denture wearing. In general, use of denial services was low. For the 35–44-yr-olds, the best regression model (sensitivity: 62%, specificity: 95%, overall correct classification: 88%) indicated that there was an increased probability of having a regular dental care pattern if respondents were prevention oriented, had access to a dental benefit programme, had not experienced pain, had a higher income, perceived their teeth as fair or poor, and perceived a need of treatment. For the 65–74-yr-olds, three variables remained in the final model (sensitivity: 51%, specificity: 68%, overall correct classification: 61%). Respondents who had not seen a dentist within the last 2 yr were more likely to have had pain and to know less about dental caries. As the number of teeth in need of treatment increased by 1, respondents were 1.09 times more likely not to have seen a dentist within 2 yr.     

湖南省老年人牙齿缺失及修复情况抽样调查

目的了解湖南省老年人牙齿缺失及义齿修复情况。方法采用分层随机整群抽样的方法,对湖南省老年人牙齿缺失及义齿修复情况进行抽样调查。结果老年人牙齿缺失率为64.8%,无牙颌率为2.44%,义齿修复率为35.6%,牙齿修复率为41.8%。不同性别、城乡间牙齿修复率有差异（P〈0.05）,缺牙率差异无统计学意义（P〉0.05）;义齿修复种类以＂不良修复体＂所占比例最高。结论湖南省老年人牙齿修复率有待进一步提高,且要避免不良修复体。     

Attitudes toward dentists and the dental care system among the middle-aged and the elderly in Hong Kong

Abstract A sample of 398 35–44-yr-old and 559 65–74-yr-old Hong Kong Chinese were interviewed by trained interviewers using a structured questionnaire in an oral health survey conducted in 1991. The present analysis aimed to describe the dental-care-seeking behaviour and attitudes of these subjects. It was found that 43% of the younger and 23% of the older age group had visited a dentist within the past year. More than half of the elderly and a quarter of the adults had not been to a dentist for 3 yr or more, and the main reason given by these subjects was that they felt that nothing was wrong. The vast majority of the subjects consulted a dentist only when they had toothache or other dental problems. Less than 20% of the 35–44-yr-olds visited a dentist for a check-up or teeth cleaning, and these subjects were described as having a prevention-oriented attitude toward oral care. The result of a logistic regression analysis showed that there was a higher chance for subjects to have this attitude if they had dental programme coverage, perceived their teeth to be good, had better dental health knowledge, had a more positive dental attitude, and were less anxious about dental care. However, the influence of these factors was quite weak, because the overall percentage of correct classification of the model was 83.7% and the sensitivity was only 23.3%.     

Oral health status and need of dental treatment in the elderly Danish population

ABSTRACT Oral health and dental treatment needs were investigated in 560 elderly persons in the county of Vestsjælland (West Zealand) in Denmark. Of the population aged 65 and above in three typical communities in the county, 10 % were selected by random sampling and totaled 633 persons. Of these, 560 persons (88.5 %) were interviewed and examined in their homes. The final sample population was representative of the total Danish population in relation to sex and socioeconomic status for this specific age group. Oral health was generally poor. In all, 68.2 % of the population were edentulous (64.7 of the males, 70.7 % of the females), while the dentate persons had an average of 12 teeth; 3.6 % were totally edentulous and lacked dentures in both jaws, a further 5.5 % were totally edentulous and lacked a denture in one jaw, and 83.4 % had removable dentures. Only 3.4 % of the dentate and 28.2 % of the edentulous persons did not need any dental treatment. The total percentage of people needing treatment was 80. Prosthetic treatment was the main requirement, applying to 80 % of the group. In contrast with this, only 25 % of the interviewed subjects had a subjective need for treatment. Information and economic aids for dental treatment are obviously needed in the elderly Danish population.     

A 5-year follow-up study on the prosthetic rehabilitation of the elderly in Helsinki, Finland

In 1990, 364 elderly (76-86 years) inhabitants of Helsinki, Finland, attended a dental and oral examination study that was conducted as part of the Helsinki Aging Study. In spring 1996, these subjects were recalled for a 5-year follow-up. Between the baseline and follow-up examinations, 114 (31%) subjects had deceased (86 women and 28 men), whereas 134 had either moved, were too ill, or refused to participate in the follow-up. Follow-up examination was conducted for 113 subjects (79 women and 34 men), with the participating rate being 46%. Five subjects became edentulous during the follow-up. Of the subjects, 61% had 1-32 teeth at follow-up. In these subjects, the mean number of teeth decreased from 14.9 (+/-8.3) to 13.5 (+/-8.6) (P < 0.0001). Prosthetic status changed in 40% of the elderly dentate people: 25% received new prostheses whereas 15% lost prostheses that were not replaced. New fixed partial dentures were made in five maxillae and in nine mandibles during the follow-up. Acrylic removable partial dentures (ARPD) were most frequently used: 35% of dentate subjects had an ARPD. Subjects with removable prostheses had higher levels of salivary microbes and higher root caries incidence than those with natural teeth. Furthermore, the presence of removable prostheses at baseline, together with the male gender, was clearly associated with tooth loss during follow-up. This study indicates that fixed rather than removable prostheses should be used in elderly patients. The need for a removable denture ought to be carefully considered.     

Oral conditions and need for dental treatment in an elderly population in Northern Norway

abstract Oral conditions and dental treatment needs were investigated in a group of persons aged 65–79. A sample comprising 280 persons was drawn systematically to cover all persons in this age category living in the county of Troms in Norway. 241 persons attended, leaving a participation-rate of 86. The participants were examined mainly in their homes by dentists in graduate training. Sixteen percent of the group were in constant need of assistance or care due to a poor general state of health. In all, 80% were edentulous: 72% of the men and 87% of the women. Ninety-two percent wore removable dentures, 5% had natural teeth only, and 14% had natural teeth combined with a denture. Furthermore, 4% had neither teeth nor dentures, while dentures in both jaws were found in 66%. The “objective” treatment needs were extensive and had mainly accumulated due to neglected care. Forty percent of the total group needed new complete dentures and 20% a more comprehensive correction of their dentures. By contrast only 30% intended to seek treatment in the near future. There seemed to be a definite need for a dental program to overcome or reduce the economic and other situational barriers.