|Year : 2016 | Volume
| Issue : 3 | Page : 298-301
Normative need in relation to perceived oral health among institutionalized adults of South India: A cross-sectional study
S Hari Krishnam Raju1, Fareed Nusrath2, KM Sudhir3, R.V.S Krishna Kumar3, K Vandana4
1 Department of Public Health Dentistry, GSL Dental College and Hospital, Rajahmundry, Andhra Pradesh, India
2 Department of Public Health Dentistry, KVG Dental College and Hospital, Sullia, Karnataka, India
3 Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
4 Department of Public Health Dentistry, Dr. Sudha and Nageaswararao Siddhartha Institute of Dental Sciences, Gannavaram, Vijayawada, Andhra Pradesh, India
|Date of Web Publication||6-Sep-2016|
S Hari Krishnam Raju
Department of Public Health Dentistry, GSL Dental College and Hospital, Rajahmundry, Nellore - 524 002, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: The number of adult individuals living alone is rising worldwide, especially in India, and their oral health-related quality of life is an increasing public health concern. Aim: The aim of the study is to assess the impact of periodontal status and dental caries experience on perceived oral health among institutionalized adults. Materials and Methods: A cross-sectional study was conducted among institutionalized adults in Nellore district of Andhra Pradesh. Self-perceived oral health was assessed using Geriatric Oral Health Assessment Index (GOHAI). Clinical examination was done for recording the periodontal status and dental caries according to the World Health Organization criteria (1997). Results: A total of 328 subjects were included with a mean age of 69.7 years. The mean GOHAI score of dentate participants was 48.24 (standard deviation [SD] 5.93). The overall prevalence of periodontal disease in the present study was 89.09% and mean caries experience was 10.85 (SD 9.36). There was a negative correlation between GOHAI scores and periodontal status and dental caries experience among the study participants. Conclusion: Low oral health, self-perception is directly correlated with a worse oral health; hence, perceived oral health can be a surrogate measure for clinical oral examination.
Keywords: Geriatric Oral Health Assessment Index, institutionalized adults, oral health status
|How to cite this article:|
Raju S H, Nusrath F, Sudhir K M, Krishna Kumar R, Vandana K. Normative need in relation to perceived oral health among institutionalized adults of South India: A cross-sectional study. J Indian Assoc Public Health Dent 2016;14:298-301
|How to cite this URL:|
Raju S H, Nusrath F, Sudhir K M, Krishna Kumar R, Vandana K. Normative need in relation to perceived oral health among institutionalized adults of South India: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2020 Nov 27];14:298-301. Available from: https://www.jiaphd.org/text.asp?2016/14/3/298/189837
| Introduction|| |
With advances in the fields of medicine and public health, life expectancy has extended throughout the world. Globally, the proportion of adult population increased and will continue to grow. It is anticipated that an increase in the population of people aged 60 years or above will account for more than half of the total increase of the world population. India, a developing country, has about 100 million elderly at present and the number is expected to increase to 323 million, constituting 20% of the total population of 2050, posing the greatest challenge to provide affordable, accessible, and equitable health care to this population. The prevalence of elderly population in Andhra Pradesh is 8.8% according to the 2011 census; this presents enormous challenges to health and social policy planners, particularly because disease patterns will shift concurrently.
Recent literature strongly emphasizes the importance of the patient's feelings and their relation to professional assessments. Self-perceptions of health status, as measured by general and oral health, have been shown to be independent predictors of health. Self-rated health is also a strong predictor of mortality and functional ability. Perceived need reflects subjective well-being in functional, social, and psychological dimensions., Oral health-related quality of life (OHRQoL) indicators provide information on the perceived need for oral health care. The role of subjective perceptions and perceived needs is an essential part of any health issue. It is the outcome of an interaction between and among oral health conditions, social and contextual factors.,
The Geriatric Oral Health Assessment Index (GOHAI) was designed to determine perceived oral health status.,, Globally, poor oral health among older people has particularly been seen as high level of tooth loss, dental caries experience, and high prevalence rates of periodontal disease, dry mouth, and oral cancer. There exists a lacuna in published literature correlating perceived oral health and oral health status among the elderly population in India. The present study was intended to assess the impact of periodontal status and dental caries experience on perceived oral health among institutionalized adults.
| Materials and Methods|| |
A cross-sectional study was conducted among institutionalized subjects in Nellore district of Andhra Pradesh, South India, during July–August 2012. Ethical clearance was obtained from the Institutional Review Board before the start of the study. Permission was sought from the respective old age home authorities, and informed consent was obtained from the participants.
The sample size was calculated based on the prevalence of edentulousness (29.5%) as reported by the National Oral Health Survey and Fluoride Mapping (2002–2003), with a power of 80% and a minimum possible error of 0.05. The final sample size arrived at was 328. There were 15 residential institutions in Nellore district, out of which 9 were selected by stratified random sampling and the subjects from these institutes who satisfied the inclusion criteria were included in the field until the required sample size was reached. All willing participants aged 55 years and above, residing in the old age homes for at least 1 year were included in the survey. Participants who were bedridden and mentally challenged were excluded from the survey.
GOHAI is a 12-item questionnaire developed by Atchison and Dolan 1990 that measure the self-reported oral impairment. The GOHAI is a 12-item instrument that measures three different aspects of OHRQoL, including physical functioning, pain and discomfort, and psychosocial functioning. A back translation was conducted for the three modified items to ensure their linguistic equivalence. Cronbach's alpha of the translated GOHAI subscales was calculated and found to be ranging from 0.79 to 0.85.
The examiner was calibrated in the Department of Public Health Dentistry for recording the pro forma. The intraexaminer kappa statistic calculated which was found to be 0.89. The pro forma consisted of three parts. Part one consisted of basic demographic details of the subjects. Second part regarding oral health using GOHAI, followed by a clinical oral examination according to the World Health Organization oral health survey 1997. Periodontal status was evaluated using a community periodontal index and loss of attachment while dental caries in the form of decayed, missing, and filled teeth (FT) index was extracted from dentition status and treatment needs. After filling the questionnaire, Type III examinations (ADA) were carried out by the investigator and recordings were done with the help of an assistant within the premises of the institution under strict aseptic condition.
Data were entered into SPSS 16.0 version (SPSS 20, IBM, Armonk, NY, United States of America). Basic descriptive statistics were computed. Statistical significance was calculated by performing Chi-square test, ANOVA, and Pearson correlation analysis.
| Results|| |
A total of 360 institutionalized adults were approached, out of which 328 were included in the survey with an age ranging from 56 to 95 years. Majority of participants (39.56%) were in the age range of 66–75 years with a mean age of 69.7 ± 1.58 years. There was a marginally higher representation of females (58.2%). Among the study participants, 86.81% of them received financial help from their families.
The majority of the participants (62%) rated their oral health as poor, followed by moderate (35%) and good [Figure 1]. Prevalence of edentulousness of varying degrees was 100% and 31.6% of subjects was completely edentulous. The mean GOHAI score of the dentate participants (n = 228) was 48.24 ± 5.92. GOHAI scores were higher among participants who had cavities, missing teeth (MT), and pathological mobility.
|Figure 1: Percentage of participants rated their oral health according to Geriatric Oral Health Assessment Index|
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Among the dentate participants, majority of participants 39.56% had shallow pockets, followed by 23.08% with excluded sextants and deep pockets. Thirty-one percent had 0–3 mm, 16.48% had 6–8 mm, and 3.30% had 9–11 mm loss of attachment. Participants who perceived poor oral health, according to the GOHAI scale, showed poorer periodontal status on clinical examination [Table 1].
|Table 1: Periodontal status and dental caries experience in relation to Geriatric Oral Health Assessment Index among study participants|
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The overall prevalence of caries among dentate subjects was 87.01% and mean caries experience was 10.85 (9.36), mean MT was higher, 7.45 (8.43) than mean decayed teeth, 3.38 (3.51), followed by mean FT that was almost negligible. The prevalence of root caries was 12.05%. One-way ANOVA revealed no significant differences between GOHAI and caries experience and its components [Table 1].
GOHAI showed negative correlation with periodontal status, which was significant, and a negative but a nonsignificant correlation with dental caries, indicating that dental caries experience increased and periodontal status worsened with decrease in the GOHAI score [Table 2].
|Table 2: Correlation coefficient between Geriatric Oral Health Assessment Index with community periodontal index, loss of attachment, and decayed, missing, and filled teeth scores by Karl Pearson's correlation method|
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| Discussion|| |
Rapid aging of populations throughout the world has resulted in much interest in the study of elders. Poor oral health among old age people is an important public health issue and a growing burden to countries worldwide. Most industrialized countries have information about the oral health status of old age people, whereas such data are scarce in developing countries. Very few studies have been conducted in India, pertaining to the periodontal status and dental caries of people living in geriatric homes. No documented data was available for the institutionalized adults in the Nellore district of Andhra Pradesh.
Globally, poor oral health among older people has particularly been seen as a high level of tooth loss, dental caries experience, and high prevalence rates of periodontal disease and oral cancer. Research on the epidemiology of periodontal disease in older adults suggests that the disease is probably not due to greater susceptibility, but instead the result of cumulative disease progression over time.
In the present study, mean age of the subjects was 69.7 ± 1.58 years and majority of the respondents perceived their oral health as poor. The prevalence of dental caries (87%) was higher than national and lower than regional values. Khan KF  conducted a study in Karnataka and found a prevalence of coronal caries (65%) which was lower than the present study, but root caries was found to be higher (32% vs. 18%).
The present study GOHAI scores were higher compared to the study conducted in Lucknow by Agarwal et al. (2014), but the sample size was low compared to the present study. Negative correlation between periodontal status and GOHAI scores demonstrated that a low oral health, self-perception is directly correlated with a worse oral health. Similar findings have been reported by Piuvezam et al. in a study conducted in Brazil. These findings underscore that subjective aspects likely have greater impact on self-perceived oral health status than do objective clinical signs. The use of OHRQoL as an evaluative outcome measure is congruent with patient-centered care stated by Locker et al. in South Ontario. Along with other clinical assessments, it allows oral health-care professionals to evaluate the efficacy of treatment protocols from patients' perspectives.
The study was institutionalized based and may not represent the general population. Further research is needed to determine the stability of GOHAI over different time periods and to examine it as a tool to evaluate dental treatment outcomes in Indian populations.
| Conclusion|| |
The study found a significant relationship between the GOHAI and periodontal status. However, associations between the GOHAI scores and caries experience were not significant. The present study highlights that a low oral health, self-perception is directly correlated with a worse oral health; hence, perceived oral health can be a surrogate measure for clinical oral examination.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]