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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 20
| Issue : 1 | Page : 25-30 |
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Oral impacts of number of natural teeth and posterior occluding pairs on daily performance of an elderly population
Ruchi Nagpal1, Amrita Jaggi2, Charu Mohan Marya1, Pratibha Taneja1, Sakshi Kataria1, Sukhwinder Singh Oberoi3
1 Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad, Haryana, India
2 Department of Public Health Dentistry, Faculty of Dental Sciences, SGT University, Gurugram, Haryana, India
3 Department of Public Health Dentistry, Genesis Institute of Dental Sciences and Research, Firozpur, Punjab, India
| Date of Submission | 10-Dec-2019 |
| Date of Decision | 06-Mar-2020 |
| Date of Acceptance | 16-Oct-2021 |
| Date of Web Publication | 25-Feb-2022 |
Correspondence Address:
Amrita Jaggi
Department of Public Health Dentistry, Faculty of Dental Sciences, SGT University, Gurugram, Haryana
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jiaphd.jiaphd_121_19
Background: Globally, poor oral health among older people has been assessed in terms of high levels of tooth loss, dental caries experience, high prevalence rates of periodontal disease, xerostomia, and oral precancer/cancer. Aim: The aim of the study is to compare impacts of total number of natural teeth (NT) and posterior occluding pairs (POPs) present in the oral cavity on daily performances among elderly population. Materials and Methods: It was a cross-sectional study which included 300 subjects recruited through convenience sampling from a physiotherapy center. The included subjects were asked in a face-to-face interview about their demographic information (i.e., age and gender), tobacco habits (type and frequency), oral hygiene habits (frequency and material used), oral health-related quality of life, and various symptoms of xerostomia. Impacts on daily performances were measured by the use of oral impacts on daily performances index. Clinical examination was done to measure number of NT and POPs. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 21, IBM Inc., and for inferential statistics, Mann–Whitney U-test and Chi-square tests were used. Level of statistical significance was set at P < 0.05. Results: The overall mean age of the study population was found to be 63.81 ± 4.50 with gender wise no statistically significant difference (males = 63.82 ± 4.13, females = 63.79 ± 4.94; P ≤ 0.05). Overall, mean number of NT present in the study population was found to be 24.76 ± 7.21 with 25.90 ± 6.29 among males and 23.32 ± 8.03 among females. Mean number of NT present was significantly more among males as compared to females (Mann–Whitney U-test, P = 0.003). Conclusion: Number of NT and POPs were found to be the significant predictors of daily performances among elderly population.
Keywords: Geriatric population, natural teeth, oral health-related quality of life, oral impacts on daily performances index, posterior occluding pair
How to cite this article:
Nagpal R, Jaggi A, Marya CM, Taneja P, Kataria S, Oberoi SS. Oral impacts of number of natural teeth and posterior occluding pairs on daily performance of an elderly population. J Indian Assoc Public Health Dent 2022;20:25-30 |
| Introduction | |  |
The global demographic trend tells us that, with the passage of time, the countries have experienced aging of population. Life expectancy among geriatric population of India has increased. Due to economic well-being, better health-care system, good medicines, etc., there is substantial reduction in mortality in the society. Reduced mortality has led to reduction in fertility too. These factors together have resulted in increasing number of elderly persons in the population. This phenomenon, called population aging, is a dynamic demographic trend all over the world. Old age comes with a lot of ailment and diseases including oral diseases. Globally, poor oral health among older people has been assessed in terms of high levels of tooth loss, dental caries experience, high prevalence rates of periodontal disease, xerostomia, and oral precancer/cancer.[1] Deterioration of oral health with increasing age has been reported in a number of epidemiological studies in terms of increasing number of teeth lost, higher prevalence of dental caries, poor oral hygiene, presence of calculus, gingival recession, and deep probing depth.[2] Moreover, studies show an increase in percentage edentulousness with increasing age.[3]
When a tooth is lost, the integrity of the dental arch is impaired. Epidemiological studies have shown that molars are the most affected tooth type by caries and periodontal diseases.[4] Besides, molars have the lowest bone height scores and the lowest attachment levels. Consequently, molars are the most frequently extracted teeth, followed by premolars and lower anteriors.[5] Studies have shown that tooth loss can have a substantial influence on the oral function.[6] However, although many epidemiologic studies express oral functionality by numbers of teeth, it is questioned whether just the number of teeth is adequate to describe the functional status of the dentitions. It has been claimed that the occluding pairs of natural teeth (NT) are strongly correlated with oral functional status.[7] A recent systematic review provided circumstantial evidence that besides the number of teeth also teeth type, tooth location and number of occluding pairs determine the functionality.[8] It has been observed that a large number of patients attend dental clinic for extractions while they have already lost one or more teeth resulting in an interrupted dentition (interrupted dental arch). However, demand for replacement of the lost teeth is low.
It would be interesting to know the minimum number of posterior occluding pairs (POPs) required for adequate chewing function. The ability to chew is not only an important dimension of oral health[9] but also is increasingly recognized as being associated with general health status because the ability to chew food may affect dietary choices and nutritional intake and may therefore have consequences for general health.[10]
A satisfactory dentition is important for a person to feel acceptable and to be socially accepted. Several organizations have stated goals for the number of retained NT in the elderly. The World Health Organization (WHO) proposed that people should have at least 20 NT. The World Dental Federation (FDI) recommended that 50% of individuals aged 65 years and above should have 20 or more teeth.[9]
Hence, the present study was done with the aim of comparing impacts of total number of NT and POPs present in the oral cavity on daily performances among elderly population.
| Material and Methods | | |
A cross-sectional epidemiological study was carried out to compare impacts of total number of NT and POPs present in the oral cavity on daily performances among elderly population in Faridabad. The study protocol was approved by Institutional Ethical Committee (clearance number 3048A Dated June 1, 2016). Verbal consent was obtained from each participant before recruiting them for the study. The study sampling frame was comprised of elderly population residing in Faridabad city. A sample of 300 subjects was recruited through convenience sampling from a physiotherapy center. Participants who had completed 60 years of age, who were healthy or with controlled systemic diseases, and who did not suffer from psychiatric problems were included in the study. Participants who were completely edentulous and who were not ready for the participation in this study and third molars were excluded. A pilot study was conducted to check the feasibility of the methodology planned. It was done on 50 subjects satisfying the inclusion criteria of the study. Data were collected through a combination of structured interview and clinical examination performed on participants. It was recorded on a pro forma especially designed for the study. The included subjects were asked in a face-to-face interview about their demographic information (i.e., age and gender), tobacco habits (type and frequency), oral hygiene habits (frequency and material used), oral health-related quality of life (OHRQoL), and various symptoms of xerostomia. Impacts on daily performances were measured by the use of oral impacts on daily performance (OIDP) Index. The OIDP instrument is to be used to assess the OHRQoL of geriatric population in this study population, and translation into Hindi language was essential. OIDP inventory was translated into Hindi by two Public Health Dentist professionals fluent in both English and Hindi languages. Then, it was back translated into English by two independent translators. Internal consistency was evaluated by Cronbach's alpha coefficient. The value was 0.804 which can be interpreted as good. The values of corrected items varied from 0.345 to 0.590. Data were collected on the significant impacts of the participants' oral health condition on their ability to perform eight daily activities (eating and enjoying food, speaking and pronouncing clearly, cleaning teeth, carrying out major work or social role, sleeping and relaxing, maintaining usual emotional state without being irritable, smiling, laughing and showing teeth without embarrassment, and enjoying contact with other people).
Frequency scores of the impacts ranged from 0 to 5. The consideration of the frequency score of OIDP has two patterns based on the problem occurrence. First, if the problems occur regularly, repeatedly, and continuously within the past 6 months, the frequency score will be recorded by the frequency of the problem occurrence. It is called “regular pattern.” Second, if the problems occur once and disappear and do not repeat again within the past 6 months, the frequency score will be recorded by the duration of the problem occurrence. It is called “spell pattern.” Noted that the frequency score of OIDP can only be considered using either “regular pattern” or “spell pattern.”
Severity scores of the impacts ranged from 0 to 5. Major symptoms are pain, discomfort, functional limitation, and dissatisfaction with appearance.
Main oral impairments such as tooth loss and toothache. The OIDP score for each activity in the present study was calculated by multiplying the frequency score by the severity score (ranging from 0 to 25). The total score was the sum of the activity scores (ranging from 0 to 200). The higher OIDP score indicates the poorer OHRQoL.
Clinical examination
The American Diabetes Association recommended Type III clinical examination with the aid of plain mouth mirror, and community periodontal index probe was performed to measure number of NT and POPs.
Posterior occluding pairs
An occluding pair of teeth consists of a tooth in the upper arch and the corresponding tooth in the lower arch that it bites against. The number of functional POPs of NT were calculated and scored as follows:
- 1 = each pair of premolars
- 2 = each pair of molars.
If any of the participants were wearing removable dentures/fixed bridges, the number of POPs were determined while the dentures were in place. Dentition status index (2013) was used to record the number of NT and POPs. Tooth mobility was recorded according to Miller's classification. Oral mucosal lesion was recorded using codes given in the WHO, basic oral health survey, 1997 (4th edition).[11]
Statistical analysis
The data were analyzed using the SPSS software (IBM corp., 2015, Virginia, US) 21 version (Statistical Package for the Social Sciences). Categorical variables were summarized as frequencies, and continuous variables were summarized as means. For bivariate analysis, nonparametric tests, i.e., Mann–Whitney U-test and Chi-square test, were used. Level of significance was set at <0.05.
| Results | | |
A total of 300 elderly population of Faridabad city were included in the study out of which 167 were males and 133 were females. The overall mean age of the study population was found to be 63.81 ± 4.50 with gender-wise no statistically significant difference (males = 63.82 ± 4.13, females = 63.79 ± 4.94; P ≤ 0.05). Overall, mean number of NT present in the study population was found to be 24.76 ± 7.21 with 25.90 ± 6.29 among males and 23.32 ± 8.03 among females. Mean number of NT present was significantly more among males as compared to females (Mann–Whitney U-test, P ≤ 0.05). Overall mean OIDP score was found to be 10.21 ± 18.18. Mean OIDP scores (among subjects having <20 NT) were found to be 21.63 ± 23.36 and 7.82 ± 15.15 among subjects having <20 NT and ≥20 NT, respectively. The score among subjects having <20 NT was found to be significantly higher compared to those having ≥20 NT [Table 1] and [Table 2]. | Table 1: Severity distribution of different items of oral impacts on daily performances
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 | Table 2: The relationship between the number of functional natural teeth and the oral impacts on daily performances scores
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The number of POPs and the oral impacts on daily in which overall mean OIDP score were found to be 10.21 ± 18.18. Mean OIDP scores were found to be 22.13 ± 24.04 among subjects having ≤4 POPs and 5.65 ± 12.76 among subjects having ≥4 POPs. The participants who had at least 4 POP had significantly higher OHRQoL compared to those having <4 POPs. Distribution of the study population according to the impact on their daily performances based on number of NT showed that among all the subjects with ≤20 number of NT present in the oral cavity, problem in maintaining social contacts was reported by 10 (19.2%) and among the subjects with >20 number of NT, problem in eating was reported by 25 (10.1%). This difference failed to reach the level of statistical significance as P = 0.092 [Table 3] and [Table 4]. | Table 3: Relationship between the number of posterior occluding pairs and the oral impacts on daily performances scores
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 | Table 4: Distribution of the study population according to the impact on their daily performances based on number of natural teeth
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| Discussion | | |
According to the WHO, the global population is increasing at the annual rate of 1.7%, while the population of those over 65 years is increasing at a rate of 2.5%. Both the developed and the lesser developed countries are expected to experience significant shifts in the age distribution of the population by 2050. The fastest-growing population segment in most countries is the adults older than 80 years, which according to the United Nations estimates, will make up nearly 20% of the world's population. This study contains a homogeneous elderly population in terms of gender distribution. In the present study, males (167) were more than females (133) which is in line with the study conducted by Shah and Sundaram,[12] i.e., 57.2% were males and 42.8% were females. In the present study, almost half of the study population were using finger for oral cleaning and rest were using toothbrush stick and other aids. Study conducted by Petersen[13] showed similar findings, i.e., toothbrush was less frequent used in developing countries than in developed countries. Meanwhile, traditional oral self-care by use of chew sticks or powder is common in developing countries. Type and frequency of oral cleaning emerged as significant predictors when compared genderwise in this study. The prevalence of tobacco use was only 7%. The study conducted by Shah and Sundaram,[12] i.e., oral abusive habits were surprisingly very low, tobacco smoking and chewing were practiced by 19.5% of the elderly. Study conducted by Pang et al.[14] showed similar findings in which a total of 236 respondents were current tobacco users (9.5%). The majority of older tobacco users were men (88.1%). The meta-analysis conducted by Marinho et al.[15] suggested a higher smoking prevalence among men which is also in accordance with the present study. Gender differences in tobacco use are well known among adults although recent cohorts have shown an increased use in young women.
Natural teeth
Several organizations have stated goals for the number of retained NT in the elderly. The WHO proposed that people should have at least 20 NT. The World Dental Federation (FDI) recommended that 50% of individuals aged 65 years and above should have 20 or more teeth. Overall, mean number of NT in the present study population was found to be 24.76 ± 7.21 which was higher as compared to that found in study done by Somsak and Kaewplung (2016),[16] i.e., 13.0 ± 9.5. Among males, mean number of NT present was found to be 25.90 ± 6.28 whereas among females, mean number of NT present was found to be 23.32 ± 8.03. This finding of the study is dissimilar to the study conducted by Somsak and Kaewplung (2016)[16] where average number of teeth present was found to be 13.0 ± 9.5. According to the National Health and Nutrition Examination Survey of Seniors in the United States, over age 65 have an average of 18.90 remaining teeth and 27.27% of seniors over age 65 have no remaining teeth.
Number of posterior occluding pairs
The number of POPs of NT was a pair of premolars and molars opposing each other. Overall, mean number of POPs in the present study population was found to be 6.86 ± 4.25 which is in contrast to the study conducted by Somsak and Kaewplung (2016)[16] who found the average number of POP to be 3.5 ± 2.7 pairs. While the number of NT is a standard and widely used measure of oral health and function for this age group, the number of occluding pairs is a more refined clinical indicator as it includes both the number and distribution of NT and is therefore particularly relevant among older adult populations where tooth loss levels are greater.
The present study also showed that the participants who had at least 4 POP had significantly higher OHRQoL than those who had <4 POPs which is in accordance with the study conducted by Somsak et al.[16] and Tsakos et al.[17]
The study of a sample of older people showed a high prevalence of oral impacts with the most prevalent impact referring to difficulty in eating (i.e., 53%) which corresponds to previous studies conducted in Europe, Montero et al.[18] and in studies conducted in Africa.[19],[20] The least affected daily performances were physical activity and emotional stability. The percentage of study participants experiencing eating problem was nearly three times that of who had problems in sleeping which was the second most reported problem. The prevalence of subjective dry mouth and reduced stimulated salivary flow rate was found to be 25% and this corroborates the study findings conducted by Takeuchi et al.,[21] i.e., 19.9%.
The mean OIDP score for the present study population was found to be 10.21 ± 18.18. The prevalence of OIDP was very high, as 55% of respondents reported at least one daily activity affected in the past 6 months. This is similar to studies conducted by Kida et al.[22] in Tanzania, Srisilapanan et al. (2003)[23] in Thailand, Jung et al.[24] in Korea. Back in 1982, the WHO established the goal to keep functional and esthetic dentition with at least 20 NT to 50% of individuals aged between 65 and 74 years by the year 2000 Ribeiro et al.,[25] and the preference for keeping NT even among older people exists in some areas.[26] The results indicate that OHRQoL seems to be predominantly comprised by functional disability, rather than by social disability, in this age. There was a strong and consistent association between OHRQoL and clinical dental indicators of function, such as number of NT. The result showed that the participants in at least 20 teeth group had more problems in cleaning, eating speaking, and emotional stability (higher OIDP score) than those in <20 teeth group.
| Conclusion | | |
Despite the importance of the results of the study, its cross-sectional design, which does not allow the identification of causal associations, limits the investigation. Thus, evidence from longitudinal studies is needed to determine such associations. The conclusions derived from this study are of considerable importance for Indian policy makers in their work with planning and implementing public oral health strategies for geriatric population.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]
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