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ORIGINAL ARTICLE
Year : 2019  |  Volume : 17  |  Issue : 2  |  Page : 103-107

Assessment of oral mucosal condition and periodontal status of the institutionalized elderly living in geriatric homes of Dakshina Kannada District, Karnataka, India


1 Department of Public Health Dentistry, Vaidik Dental College and Research Center, Daman, India
2 Department of Public Health Dentistry, A.J. Institute of Dental Sciences, Mangaluru, Karnataka, India

Date of Submission17-Sep-2018
Date of Acceptance29-Apr-2019
Date of Web Publication20-Jun-2019

Correspondence Address:
Dr. R Pandya Sajankumar
Department of Public Health Dentistry, Vaidik Dental College and Research Centre, Daman
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_184_18

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  Abstract 


Background: It is recognized that in developing countries like India, institutionalized health care is expensive. Thus, individual residing in geriatric homes have a higher rate of oral disease. To promote the oral health of the elderly, we need to know the oral mucosal condition and periodontal status. Aim: The aim of this study is to assess the oral mucosal conditions and periodontal status of the institutionalized elderly living in geriatric homes. Material and Methods: A cross-sectional survey was conducted in geriatric homes of Dakshina Kannada district. The sample size was estimated to be 384. The WHO oral health assessment pro forma (1997) was used to collect the data. The American Dental Association Type III examination method was used. The data obtained was coded and fed into the Statistical Package for the Social Sciences (Chicago, IL, USA) version 16.0 for analysis. Differences in proportions were compared using the Chi-squared test. Results: In terms of oral mucosal conditions, 13.80% and 16.15% of the total study participants had oral submucous fibrosis and denture stomatitis, respectively. On periodontal examination, 1.82% of participants had bleeding on probing. Calculus was present in 21.36% of participants. 49.47% of study participants had pocket depth measuring 4–5 mm. Conclusion: The present study concludes that oral mucosal condition and periodontal status are poor in the institutionalized elderly living in geriatric homes of Dakshina Kannada district.

Keywords: Aged, oral health, survey


How to cite this article:
Sajankumar R P, Hegde V. Assessment of oral mucosal condition and periodontal status of the institutionalized elderly living in geriatric homes of Dakshina Kannada District, Karnataka, India. J Indian Assoc Public Health Dent 2019;17:103-7

How to cite this URL:
Sajankumar R P, Hegde V. Assessment of oral mucosal condition and periodontal status of the institutionalized elderly living in geriatric homes of Dakshina Kannada District, Karnataka, India. J Indian Assoc Public Health Dent [serial online] 2019 [cited 2019 Oct 19];17:103-7. Available from: http://www.jiaphd.org/text.asp?2019/17/2/103/260870




  Introduction Top


Man, from time immemorial, is trying to prolong the life span with the help of various medical innovations and intervention. With the help of it, the average life span of an individual has increased and quality of life has improved. Therefore, the group of people above the age of 60 is on rise.[1]

In common with other developing nation, Indian population is experiencing a demographic revolution too.[2] Currently, at the national level, 8.0% of the total population are in the age group of 60 years and above. Moreover, it is expected to be doubled in coming 10 years.[3]

The scenario is changing, and surveys on geriatric people have highlighted poor oral health. Different studies have shown that the oral health status (OHS) of elderly care home residents is poor, and there is an urgent need to improve it.[2],[4],[5],[6] The reasons for poor oral health among older people are a high level of tooth loss, dental caries experience, and high prevalence rates of periodontal disease, xerostomia, and oral precancer/cancer.[4]

Studies showed, the oral lesions in the geriatric patient greatly vary according to each country, region and even in hospitalized, institutionalized and community patient. Studies reported that tobacco consumption, prosthetic use, and trauma were reasons for the presence of oral mucosal condition among the elderly. Hence, close follow-up and systemic evaluation are required in this population group.[4],[5],[6],[7],[8],[9]

It is recognized that in developing countries like India, institutionalized health care is expensive. Thus, individual residing in geriatric homes has a higher rate of oral disease.[5]

To promote the oral health of the elderly, we need to know the OHS and treatment needs. For that purpose, oral mucosal condition and periodontal status need to be assessed explicitly. Hence, the present study was conducted with the aim to assess the oral mucosal condition and periodontal status of the institutionalized elderly living in geriatric homes of Dakshina Kannada district, Karnataka, India.


  Material And Methods Top


A cross-sectional survey was conducted to assess the oral mucosal condition and periodontal status of the institutionalized elderly living in geriatric homes of Dakshina Kannada district, Karnataka, India. The study population consisted of the inmates living in geriatric homes. The study was carried out for a period of 1 year from September 2014 to September 2015.

Ethical clearance was obtained from the institutional ethical committee (AJEC/Rev/109/2014-15) explaining the aim and importance of the study. Permission was obtained from the concerned authorities of the selected geriatric homes, and informed consent was obtained before the examination from each participant. Convenient sampling was employed to collect the data.

All the old-age homes listed by the district headquarter and social organizations were obtained. A total of 17 old-age homes were listed. Of 17 old-age homes that were functional, only 12 of them gave permission to carry out the survey.

Individuals giving consent for participation and present on the day of the study were included in the study. Individuals with oral diseases or any other systemic conditions and terminal illness that limit them from oral examination were excluded. Furthermore, physically challenged and mentally compromised elderlies were excluded.

The clinical examination of all the participants was carried out by a single examiner who was trained under the guidance of teaching staff to limit the intra-examiner variability. The intra-examiner variability was checked by carrying out repeat examination on 10% randomly selected participants, and intra-examiner kappa coefficient values were calculated to be 0.78 for community periodontal index and loss of attachment (LOA).

A pilot study was carried out to check the feasibility of the methodology and to estimate the sample size. The sample size was estimated to be 384. The power of the study was 80% with confidence interval of 95%. Sample size determination:



Where, n = size of sample, Zα = value at a specific confidence level 95%,

p = Prevalence percentage 50%, E = maximal permissible error.



The study pro forma consisted of two parts. The first part was a structured questionnaire to record the following information on name, age, sex, habit related to tobacco and alcohol, and duration of habit. The second part was to record the oral mucosal condition and periodontal status of the study participants using a part of the WHO oral health assessment pro forma (1997). The clinical data were collected using the American Dental Association Type III examination method.

Statistical analysis

The data obtained was coded and fed into the Statistical Package for the Social Sciences (Chicago, IL, USA) version 16.0 for analysis. Differences in proportions were compared using the Chi-squared test. A difference was considered to be of statistical significance if the P < 0.05.


  Results Top


The study population consisted of 384 institutionalized elderlies aged 60 years and above with their mean age being 70.1 ± 7.7 years. Out of 384 study participants, 57.03% of them were male and 42.97% of them were female.

The present study results showed that none of the study participants had habit of consuming tobacco and alcohol. Thirty percent of males had habit of consuming smokeless tobacco previously. The duration of consumption was 10–11 years before they became institutionalized elderly. None of the study participants had habit of smoking previously.

In case of oral mucosal conditions, 13.80% and 16.15% of the total study participants had oral submucous fibrosis (OSMF) and denture stomatitis, respectively. 21.91% and 11.43% of the male study participants had OSMF and denture stomatitis, respectively. The female study participants of OSMF and denture stomatitis were 3.03% and 22.43%, respectively. The differences were statistically significant (P = 0.04) between genders based on oral mucosal condition [Table 1].
Table 1: Number and percentage of participants with oral mucosal condition

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The most prevalent locations of oral mucosal conditions among study participants were buccal mucosa and alveolar ridge, and it was found to be present among 21.94% and 11.4% of the male study participants, respectively. 3.03% and 22.43% of the female study participants had an oral mucosal condition in buccal mucosa and alveolar ridge, respectively. Totally 13.8% of the study participants had the oral mucosal condition in the buccal mucosa and 16.15% of the study participants had oral mucosal condition in the alveolar ridge. The results showed a statistically significant difference (P = 0.04) among genders based on the location of oral mucosal condition [Table 2].
Table 2: Number and percentage of participants by location of oral mucosal conditions in the mouth

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On periodontal examination, 1.82% of participants had bleeding on probing. Calculus was present in 21.36% of participants. 49.47% of study participants had pocket depth measuring 4–5 mm whereas 14.06% of study participants had pocket depth measuring 6 mm or more [Table 3].
Table 3: Number and percentage of participants with community periodontal index by highest score

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Out of 384 study participants, 2.28% of males and 1.21% of females had bleeding on probing. Calculus was present in 21% of males and 21.82% of females. In the present study, 48.42% of males and 50.90% of females had pocket depth measuring 4–5 mm, whereas 14.15% of males and 13.94% of females had pocket depth measuring 6 mm or more. The differences were statistically insignificant (P = 0.81) between genders based on periodontal status [Table 3].

Periodontal status based on LOA shows that 23.28% of males and 23.03% females had score 0 (LOA: 0–3 mm). 48.42% of males and 50.90% of females had score 1 (LOA: 4–5 mm). Out of 384 study participants, 14.15% of males and 13.94% of females had score 2 (LOA: 6–8 mm). Totally 23.18% and 49.47% of study participants had score 0 and score 1, respectively. Score 2 was present in 14.06% of study participants. Evaluation results showed a statistically insignificant (P = 0.79) difference between genders based on LOA [Table 4].
Table 4: Number and percentage of participants with loss of attachment by highest score

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  Discussion Top


The study participants belonged to the age range of 60–80 years, where the mean age was 70.1 years. This is similar to a study conducted by Shenoy and Hengde,[2] Bansal et al.,[1] and Sinor [6] where the mean age of the study participants was 71.2 years, 70.49 years, and 71.2 years, respectively. However, a study conducted by Gaszynska et al.[7] showed that the mean age was 75.5 years.

In the present study, 57.03% and 42.97% of the study participants were male and female, respectively. This is similar to a study conducted by Shenoy and Hengde [2] where 54.9% and 45.1% of the study participants were male and female, respectively. However, studies conducted by Gaszynska et al.[7] where 37.4% and 62.54% of the study participants were male and female, respectively.

In the present study, none of the study participants had habit of consuming tobacco and alcohol. The reason was prohibition of tobacco and alcohol consumption in geriatric homes. Thirty percent of males had habit of consuming smokeless tobacco previously.

The present study results showed that the percentage of OSMF among the study participants was 13.80%. The prevalence may probably be due to the use of tobacco among the study participants. Definite fibrous band on palpation was used as a main diagnostic criterion for OSMF. However, studies conducted by Tang et al.[8] and Yang et al.[9] showed that OSMF was present in 5.49% and 23.2% of the study participants, respectively.

The analysis of study results showed that the percentage of denture stomatitis among the study participants was 16.15%. This is similar to the study conducted by Mujica et al.,[10] where denture stomatitis was present in 18% of the study participants. The possible reason could be poor oral hygiene among the elderly. Studies conducted by Espinoza et al.[11] and Sahebjamee et al.[12] showed that denture stomatitis was seen among 22.3% and 35.5% of study participants, respectively.

Different sites in the oral cavity show inclination toward different disease. It is known that certain lesions are more common in certain parts of the oral cavity. The present study results showed that 13.8% of the study participants had oral mucosal condition in the buccal mucosa. These may be because of the use of smokeless tobacco products which are commonly kept in the buccal vestibule for a longer period of time which may lead to fibrosis of buccal mucosa.[13] The study conducted by Patil et al.[14] shows that the most commonly affected site was hard palate which was 23.1%, whereas 12.3% of the study participants had oral mucosal lesion located on the buccal mucosa.

The most common disease present among dentures wearing patients is denture stomatitis. It is a chronic inflammatory disease of the soft tissue.[15] The present study results showed that 16.15% of study participants had denture stomatitis on the alveolar ridge. The possible reason may be due to misfit dentures, continuous wear of dentures, presence of candida and other microorganisms, faulty design of dentures which distribute uneven load on supporting structures and causes resorption of the bone. Whereas, the study conducted by Puskar et al.[15] showed that 46.7% and 26.7% of the study participants had denture stomatitis in the upper and lower jaw, respectively.

The present study results showed that none of the study participants had healthy periodontium. This is similar to the study conducted by Shaheen et al.[16] and Agrawal et al.[17] However, a study conducted by Mary et al.[4] showed that 0.91% of participants had healthy periodontium.

The analysis of the results showed that 1.82% of study participants had bleeding on probing. This is similar to the study conducted by Shaheen et al.[16] where 1.2% of study participants had bleeding on probing. However, studies conducted by Agrawal et al.[17] and Mary et al.[4] showed that 0.26% and 0.91% of study participants had bleeding on probing, respectively. The possible reason could be poor oral hygiene practice which leads to the accumulation of plaque and deposit.

The current study results showed that calculus was present in 21.36% of study participants. This is similar to the studies conducted by Agrawal et al.[17] where calculus was present in 24.5% of study participants. It was contradictory to the study conducted by Shaheen et al.[16] where calculus was present in 9.4% of study participants.

In the present study, results showed that 49.47% of study participants had pocket depth measuring 4–5 mm. This is similar to the study conducted by Agrawal et al.[17] and Mary et al.[4] where 52.1% and 51.3% of study participants had pocket depth measuring 4–5 mm, respectively. The possible reason could be deleterious oral hygiene practices like finger, datum or red tooth powder to clean teeth.[17] However, a study conducted by Shaheen et al.[16] showed that 22.5% of study participants had pocket depth measuring 4–5 mm.

The analysis of the study results showed that 14.06% of study participants had pocket depth measuring 6 mm or more. This is similar to the study conducted by Mary et al.[4] where 16.5% of study participants had pocket depth measuring 6 mm or more. The possible reason could be an experience with previous periodontal disease which may harbor large number of pathogens in multiple periodontal sites, thus facilitating the spread of infection and periodontal destruction.[18] However, the studies conducted by Shaheen et al.[16] that 22.5% of study participants had pocket depth measuring 6 mm or more.

The present study results showed that 23.18% of study participants had score 0 (LOA: 0–3 mm). This was due to the presence of calculus in the gingival sulcus. However, studies conducted by Agrawal et al.,[17] Shaheen et al.,[16] and Mary et al.[4] showed that score 0 (LOA: 0–3 mm) was present in 16.7%, 10.3%, and 3.7% of study participants, respectively. The possible reason may be a good maintenance of oral health.

The present study results showed that 49.47% and 14.06% of study participants had score 1 (LOA: 4–5 mm) and score 2 (LOA: 6–8 mm), respectively. The possible reason may be a plaque accumulation (poor oral hygiene) resulting in the passage of bacteria and their products through the nonkeratinized junctional epithelium, leading to a series of host responses that result in pocket formation and attachment loss.[19] However, studies conducted by Shaheen et al.[16] showed that score 1 was present in 22.5% and score 2 (LOA: 6–8 mm) was present in 26.8% of study participants, respectively. The possible reason could be the effect of toothbrushing on the maintenance of periodontal health which has a dual role. Brushing reduces plaque accumulation and in turn prevents gingivitis and periodontitis, whereas forceful, frequent, and improper brushing technique may result in gingival recession and attachment loss.[19]

Oral health mucosal condition and periodontal status could be assessed using the WHO oral health assessment pro forma (2013) instead of the WHO oral health assessment pro forma (1997).


  Conclusion Top


The present study concludes that oral mucosal condition and periodontal status are poor in the institutionalized elderly living in geriatric homes of Dakshina Kannada district, Karnataka, India. The most prevalent condition was denture stomatitis, followed by OSMF. Periodontal disease was found to be high among the institutionalized elderly.

There is a need to encourage public health care administrators and decision-makers to design effective and affordable strategies and programs for better oral health and quality of life of the institutionalized elderly, which are integrated into general health programmes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bansal V, Sogi GM, Veeresha KL. Assessment of oral health status and treatment needs of elders associated with elders' homes of Ambala division, Haryana, India. Indian J Dent Res 2010;21:244-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Shenoy RP, Hengde V. Dental prosthetic status and prosthetic needs of the institutionalized elderly living in geriatric homes in Manglore: A pilot study. ISRN Dent 2011; 2011:1-3.  Back to cited text no. 2
    
3.
Government of India. India Census. Government of India; 2011. Available from: http://www.censusindia.gov.in/2011-common/censusdataonline.html. [Last accessed on 2016 Jan 18].  Back to cited text no. 3
    
4.
Mary AV, Ebenezar R, Chaly PE, Ingle N, Reddy VC. Oral health status and treatment needs of geriatric population of old age homes of Chennai city, India. J Oral Health Res 2010;2:82-6.  Back to cited text no. 4
    
5.
Singh AP, Kumar KL, Reddy CM. Psychiatric morbidity in geriatric population in old age homes and community: A comparative study. Indian J Psychol Med 2012;34:39-43.  Back to cited text no. 5
  [Full text]  
6.
Sinor MZ. Oral health assessment among elderly staying in shelter (Rumah Seri Kenangan), Kelantan, Malaysia. Int J Humanit Soc Sci Invent 2013;2:43-8.  Back to cited text no. 6
    
7.
Gaszynska E, Szatko F, Godala M, Gaszynski T. Oral health status, dental treatment needs, and barriers to dental care of elderly care home residents in Lodz, Poland. Clin Interv Aging 2014;9:1637-44.  Back to cited text no. 7
    
8.
Tang JG, Jian XF, Gao ML, Ling TY, Zhang KH. Epidemiological survey of oral submucous fibrosis in Xiangtan city, Hunan Province, China. Community Dent Oral Epidemiol 1997;25:177-80.  Back to cited text no. 8
    
9.
Yang YH, Lee HY, Tung S, Shieh TY. Epidemiological survey of oral submucous fibrosis and leukoplakia in aborigines of Taiwan. J Oral Pathol Med 2001;30:213-9.  Back to cited text no. 9
    
10.
Mujica V, Rivera H, Carrero M. Prevalence of oral soft tissue lesions in an elderly Venezuelan population. Med Oral Patol Oral Cir Bucal 2008;13:E270-4.  Back to cited text no. 10
    
11.
Espinoza I, Rojas R, Aranda W, Gamonal J. Prevalence of oral mucosal lesions in elderly people in Santiago, Chile. J Oral Pathol Med 2003;32:571-5.  Back to cited text no. 11
    
12.
Sahebjamee M, Basir Shabestari S, Asadi G, Neishabouri K. Predisposing factors associated with denture induced stomatitis in complete denture wearers. Shiraz Univ Dent J 2011;11:35-9.  Back to cited text no. 12
    
13.
Ahmad MS, Ali SA, Ali AS, Chaubey KK. Epidemiological and etiological study of oral submucous fibrosis among gutkha chewers of Patna, Bihar, India. J Indian Soc Pedod Prev Dent 2006;24:84-9.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Patil S, Doni B, Maheshwari S. Prevalence and distribution of oral mucosal lesions in a geriatric Indian population. Can Geriatr J 2015;18:11-4.  Back to cited text no. 14
    
15.
Puškar T, Michal P, Dubravka M, Slobodan P, Danimir J, Tijana L, et al. Factors influencing the occurrence of denture stomatitis in complete dentures wearers. Health Med 2012;6:2780-5.  Back to cited text no. 15
    
16.
Shaheen SS, Kulkarni S, Doshi D, Reddy S, Reddy P. Oral health status and treatment need among institutionalized elderly in India. Indian J Dent Res 2015;26:493-9.  Back to cited text no. 16
[PUBMED]  [Full text]  
17.
Agrawal R, Gautam NR, Kumar PM, Kadhiresan R, Saxena V, Jain S. Assessment of dental caries and periodontal disease status among elderly residing in old age homes of Madhya Pradesh. J Int Oral Health 2015;7:57-64.  Back to cited text no. 17
    
18.
Ogawa H, Yoshihara A, Hirotomi T, Ando Y, Miyazaki H. Risk factors for periodontal disease progression among elderly people. J Clin Periodontol 2002;29:592-7.  Back to cited text no. 18
    
19.
Rao SR, Thanikachalam S, Sathiyasekaran BW, Vamsi L, Balaji TM, Jagannathan R, et al. Prevalence and risk indicators for attachment loss in an urban population of South India. Oral Health Dent Manag 2014;13:60-4.  Back to cited text no. 19
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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