|Year : 2018 | Volume
| Issue : 1 | Page : 18-21
Risk indicators for root caries in geriatric population of Lucknow City: A cross-sectional study
Avnica Agarwal1, L Vamsi Krishna Reddy1, Sabyasachi Saha1, Shivanjali Grover2, Pooja Sinha1
1 Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, India
2 Department of Public Health Dentistry, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
|Date of Submission||09-Jan-2018|
|Date of Acceptance||29-Jan-2018|
|Date of Web Publication||23-Mar-2018|
Dr. Avnica Agarwal
Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental & Medical Sciences, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: Prevention of root caries among geriatric population is of concern for both general and oral health. It is generally accepted that appropriate prevention regimes for root caries should be based on accurate risk assessments. Aim: This study aims to assess the risk indicators for root caries in geriatric population of Lucknow. Materials and Methods: A cross-sectional study was designed to determine the risk indicators for root caries in elderly population of Lucknow. A sample of 295 subjects was taken, aged 60–74 years. Data collection was done using a pro forma and all relevant information was noted. Statistical analysis was performed using Statistical Package for the Social Sciences 17.0 (Chicago, Inc., USA). Chi-square test and multiple logistic regression analysis were applied to know the statistical significance. Results: The prevalence of root caries was 93.5%. Statistically significant differences (P < 0.05) observed across family income, education, tobacco history, oral hygiene index simplified, and community periodontal index. Conclusion: Overall, the prevalence of root caries was very high among geriatric population. Oral health policies and preventive measures are needed focusing on the special needs and socially deprived population to improve the quality of life.
Keywords: Geriatric population, prevalence, risk indicators, root caries
|How to cite this article:|
Agarwal A, Reddy L V, Saha S, Grover S, Sinha P. Risk indicators for root caries in geriatric population of Lucknow City: A cross-sectional study. J Indian Assoc Public Health Dent 2018;16:18-21
| Introduction|| |
Dental practitioners face a unique challenge of providing specialized dental care to the elderly population. India's 60 and older population is expected to encompass 323 million people by mid of 21st century. Among the oral diseases which are observed by dental practitioners in elderly, root caries is considered as a significant one.
Root caries is defined as a soft, progressive lesion that is found anywhere on the root surface that has lost its connective tissue attachment and is exposed to oral environment. Root caries is a multifactorial disease that can cause major clinical problem such as pain, discomfort, or tooth loss in the geriatric population and might have negative impacts on oral health-related quality of life. The incidence for root caries has been reviewed, and it was found that age, educational level, use of dental services, coronal caries, loss of attachment (LOA), and number of teeth are possible risk factors in elderly.,
A number of epidemiological studies have been reported in various parts of country and it states that there is high prevalence of root caries among the geriatric population.,,, The diagnosis of root caries is a problematic issue as it is not easy to distinguish the clinically accessible sound area and the carious lesion. Lesions often extend to proximal surfaces and sometimes subgingivally. Management of such lesion are quite difficult in removing the carious lesion and also to control the moisture during the restorative placement. Therefore, prevention of root caries is one of the crucial factors to promote oral health for the geriatric population.
However, to date, no study has been reported about the problem of root caries in and around Lucknow city. Therefore, the present study aimed to assess the prevalence and risk indicators associated with root caries in geriatric population of Lucknow.
| Materials and Methods|| |
A cross-sectional study design was carried out from May to September 2016 for 5 months in Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow. Before the start of the study, ethical clearance was taken from the Institutional Ethical Committee. Written permission was obtained from the head of the department. Informed consent was taken from each volunteer before the start of the study.
Pilot study was conducted on 30 geriatric populations from the outpatient department of the institution to evaluate the validity and reliability of the questionnaire and operational feasibility of the study. Interexaminer reliability was calculated which was found to be good (0.84). These subjects were not included in the final sample. The following formula was used to assess the sample size:
where, N = Population size, Z = Standard normal deviate, P = Prevalence of condition, and D = Permissible error. According to the above-mentioned equation, the minimum sample size was estimated to be 255. The sample size was increased to 295 to cover for the nonrespondents. Hence, the final sample was comprised 295 subjects.
The geriatric population aged 60–74 years was considered for the study. A nonprobability convenience sampling method was used. The subjects were taken from the outpatient department of oral medicine and outreach programs conducted by the department of public health dentistry. Subjects who were willing to participate were included in the study while subjects who were completely edentulous or have the history of dental pain, abscess, swelling, etc., were excluded from the study.
A predesigned questionnaire was used to collect the data that included demographic information, socioeconomic status (Kuppuswamy's socioeconomic status scale 2014), oral hygiene practices, history of tobacco, prosthetic status, and wasting diseases (i.e. attrition, abrasion, and erosion). Clinical assessment was done using oral hygiene index simplified (OHI-S) for oral hygiene status, community periodontal index (CPI)-modified and LOA of the WHO oral health survey assessment form 2013 for periodontal status and root caries index  for assessing root caries. The teeth were neither cleaned nor dried before the assessment. However, food debris was removed if there was any food lodgment. No radiographs were taken to check for the severity of caries.
The single investigator was trained and calibrated in the department of public health dentistry before the start of the study. The investigator with one recording clerk collected the data on the scheduled dates. Subjects present on the day of examination were made to sit on a chair with backrest, the recorder sitting in front of the subject close to the examiner. Each subject was examined (American Dental Association Type III examination) by the examiner with sterile instruments under natural light. Disposable mouth masks and gloves were used by the examiner during examination. Autoclaved instruments were used for examining the oral cavity.
Data were analyzed using Statistical Package for the Social Sciences for Windows version 17.0 (SPSS Inc. 233 South Wacker Drive, 11th Floor Chicago, IL, USA). Statistical analysis was done using descriptive analysis; Chi-square test was applied to know the statistical significance (level of significance, P < 0.05). Multiple regression analysis was done to determine the effect of independent variables (family income, education, smokeless tobacco, OHI-S, and CPI) on dependent variable (root caries).
| Results|| |
A total of 295 subjects participated in the study and demographic analysis of the study population revealed that 52.5% were males and 47.5% were females. Furthermore, it was found that 45.8% belonged to urban area, whereas 54.2% belonged to the rural areas. In addition, 190 (64.4%) of the study populations belonged to upper-lower class, 50 (16.9%) belonged to lower class, 45 (15.2%) to lower middle class, and only 10 (3.3) belonged to upper middle class. In addition, it was observed that most of the elderly participants used finger for tooth cleaning with tooth powder (49.2%) and less frequently used toothbrush for tooth cleaning with toothpaste (47.5%) and rarely used any other material for cleaning of the tooth (3.4%). Among the total population of 295 adults, 120 (40.7%) subjects reported that they are tobacco users. Among them, 40.7% subjects used smokeless tobacco while 42% used smoking tobacco while only 8% consumed both smokeless as well as smoking tobacco [Table 1].
|Table 1: Distribution of study population according to different categories (n=295)|
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In the present study, the mean oral hygiene score was found to be 2.34 ± 0.89.
Of the total, 55.9% of the study population had code 1 and 35.9% of the study population had code 2 while only 5.4% had code 0. Corresponding to LOA, majority of the population had code 1 (52.5%), 37.9% of the study population had code 2, 6.5% had code 0 while only 1.3% had code 3 [Table 2].
|Table 2: Distribution of study population according to the community periodontal index codes and loss of attachment|
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The prevalence of root caries in the present study was found to be 93.5%. The root caries assessment showed highest number of root caries on mesial surface (33.9%) followed by distal surface (27.1%) and least were found on lingual surface and buccal surface (20.3% and 16.9%), respectively [Table 3].
There was a significant change in fit of the model. The most fit model consisted of independent variables: family income, education, type of tobacco, OHI, and CPI. The factors which were not found to be significant were occupation, gender, age, geographical location, oral hygiene measures and practices, prosthetic status, and LOA codes [Table 4].
|Table 4: Multiple regression analysis showing positive co-relation of risk indicators for root caries|
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| Discussion|| |
Root surface caries is a soft, progressive, and destructive lesions, either totally confined to the root surface or involving undermining of enamel at the cementoenamel junction. Root surface caries is one of the significant oral health problems in the elderly, and the incidence of the root caries surface has been found to be one of the main risk factors for tooth loss in the older adults., It is an increasing clinical problem with the elderly population during the last two decades. Evidence shows that 90% of the sample had at least one root surface caries lesion.,
The prevalence of root caries in the current study was found to be 93.5% which was similar to the results of the previous studies done by Kularatne and Ekanayake  and Du et al. However, in contrast with the studies done by Nicolau et al. and Imazato et al. in which the prevalence of root caries was reported to be 43%–18%. In this study, root surface caries data are presented along with the numbers of teeth present to give a better picture of the prevalence of root caries in relation to different tooth types. The root caries is high as those teeth were also taken into consideration which has caries in more than one tooth surface and needs to be treated.
Of the several variables that were considered in this study, the significant factors of root caries were low family income, education, smokeless tobacco, oral hygiene status, and community periodontal status. Almost similar findings were reported by the previous studies conducted by Kumara-Raja and Radha et al. and Tan and Lo  which found that existing sociodemographic factors, that is, low-income families and low level of education are main factors for the root caries because adults have lack of awareness about the oral health and poverty which were responsible for the higher probability of oral diseases.
The root caries was associated with smokeless tobacco users which were statistically significant. The finding was in the agreement with earlier studies done by Du et al. and Kumara-Raja and Radha  which found that the use of smokeless tobacco increased the prevalence of gingival recession with LOA, cervical abrasion, and root caries. This finding is not in agreement with the previous studies by Imazato et al. and Kularatneand Ekanayake  in which they found that betel chewing was negatively associated with the development of root surface caries. A plausible explanation reported was betel stains on root surfaces act as a chemical or physical barrier against acid attack.
The current survey also showed poor oral hygiene status and periodontal pocket with LOA was found to be the strongest predictor for root caries. A positive association was found between root surface caries and the number of root surfaces with recession. Gingival recession and periodontal pocket is prerequisite for the development of root caries and this is the finding to be expected. This is in line with the studies conducted previously by Tan and Lo, Kularatne and Ekanayake, and Watanabe. Tooth loss is the outcome of untreated dental caries and periodontal diseases, and subjects with fewer teeth could also be considered as those who are susceptible to these conditions. Thus, it is possible that the prevalence of root caries could be higher in those subjects with higher number of retained tooth.
However, The result of the present study indicate the high prevalence of root caries. So, further longitudinal studies were needed to assess the risk indicators of root caries and their prevention.
Therefore, to overcome this problem, it has been recommended from the present study that there is a need for proper education for oral hygiene maintenance, regular dental checkups, improve in the brushing methods, tobacco counseling for the tobacco users, and chemical plaque control measures should be advocated.
| Conclusion|| |
The prevalence of root caries among older people was high in Lucknow city. Preventive measures and oral health policies are very much needed focusing on the special needs of geriatric population and socioeconomically deprived population to improve their quality of life. Moreover, low family income and low level of education, smokeless tobacco, poor oral hygiene, and periodontal pockets with LOA were identified as significant risk indicators of root caries.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]