|Ahead of print publication
Impact of dentures on oral health-related quality of life in assisted living facility elders, Guntur District, Andhra Pradesh
Parveen Sultana Shaik1, Anuhya Medapati1, Srinivas Pachava1, Nijampatnam P M Pavani1, Srinivas Ravoori1, Chinnababu Palli2
1 Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2 Department of Public Health Dentistry, St. Joseph Dental College, Duggirala, Andhra Pradesh, India
|Date of Submission||01-Nov-2021|
|Date of Decision||16-Mar-2022|
|Date of Acceptance||29-Mar-2022|
|Date of Web Publication||17-Jun-2022|
Parveen Sultana Shaik,
Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Takkellapadu, Guntur - 522 509, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Dentures can improve dental function and appearance in older people, but they may reduce oral health-related quality of life. Further research is needed to determine how denture wearing affects the general health and well-being of assisted living home residents. Materials and Methods: A cross-sectional questionnaire-based study was performed among 587 inmates of old-age homes in Andhra Pradesh with a self-administered, pretested questionnaire that consists of two sections. The first section of the questionnaire includes information on demographic factors and duration of stay in an old-age home, and data about denture maintenance and usage. The second section of the questionnaire consists of an Oral Health Impact Profile (OHIP). For data presentation and analysis, IBM SPSS Statistics was used; descriptive statistics, the Chi-square test, and correlation were employed. P ≤ 0.05 was considered statistically significant. Results: In this study, the total satisfaction rate of complete denture (CD) users with good responses was 21.4% and for removable partial denture (RPD) users was 23.7%, which was statistically significant and was positively correlated. The overall OHIP for 1–5 years of denture users was high, with a mean of 53.8 ± 78.102, and a statistically significant difference existed between the CD and RPD users (P = 0.028). Conclusion: The overall satisfaction rate of RPD users was higher than the CD users and esthetics mainly impacts the satisfaction of dentures and the overall OHIP for 1–5 years of denture users was high.
Keywords: Assisted living facility, complete denture, dental care for aged, health-related quality of life, partial denture, quality of life
|How to cite this URL:|
Shaik PS, Medapati A, Pachava S, Pavani NP, Ravoori S, Palli C. Impact of dentures on oral health-related quality of life in assisted living facility elders, Guntur District, Andhra Pradesh. J Indian Assoc Public Health Dent [Epub ahead of print] [cited 2022 Aug 12]. Available from: https://www.jiaphd.org/preprintarticle.asp?id=347729
| Introduction|| |
Aging in humans reflects the species' dynamic character and may be defined as a multidimensional shift in growth and development through time. Individuals above the age of 60 are considered elderly by the World Health Organization. The worldwide ratio of old people to other age groups is rising exponentially, with the number of individuals over 60 years old expected to reach 1.2 billion by 2025. As aging is inevitable, the care of the geriatric population has become critical.
As oral health is seen as an indication of quality of life in senior individuals and oral illnesses are complicated, advanced, and amassed, it is critical to maintain and enhance oral health. Furthermore, better dental health helps older patients to acquire self-confidence, expand social networks, and enhance physical and mental abilities. In the elderly, root caries, attrition, periodontal disease, missing teeth owing to prior neglect, poor quality of alveolar ridges, ill-fitting dentures, mucosal lesions, oral ulcers, and dry mouth (xerostomia) are more prevalent.,,, Furthermore, the elderly have barriers to oral health care such as fear and anxiety, illness, limited mobility, socioeconomic status, transportation, and negative attitudes regarding oral health, all of which may prevent them from consulting a dentist.
Geriatric dentistry is a branch of dentistry that focuses on the diagnosis, treatment, and prevention of oral disorders in the elderly. It focuses on dental care for the elderly and the resolution of age-related oral diseases. Denture status, denture satisfaction, perceived loose denture, presence of oral pain, presence of oral ulcer, perceived halitosis, and perceived dry mouth are denture-related factors that specifically influence the oral health-related quality of life (OHRQoL) of older persons who wear removable dentures. Kuo et al. found that enhanced denture satisfaction was substantially connected to an improvement in elderly patients' OHRQoL.,,,,
A number of measures have been created to quantify the quality of life related with oral health, which were used to assess patient well-being and oral function. The Oral Health Impact Profile (OHIP) revealed that denture status was a significant indicator of low oral health-related quality of life. Hence, the aim of the study was to assess the influence of dentures on OHRQoL in assisted living facility elderly in Guntur district, Andhra Pradesh.
| Materials and Methods|| |
A cross-sectional questionnaire-based study was performed from a period of December 2020 to March 2021 among inmates of old-age homes in the Guntur district of Andhra Pradesh, India. A total of 22 old-age homes were selected and through a simple randomization sampling technique, 11 old-age homes were included in the study. Permission was obtained after getting ethical approval (41/IRB/SIBAR/2020) to survey residents in old-age homes. They were briefed on the study's aims and assured that participation was voluntary and anonymous, which might aid in obtaining their actual perspectives.
Through convenience sampling, a total of 587 inmates of old-age homes aged 45–90 years were selected for the study.
Anonymity of the participants was secured by following the ethical guidelines of the World Medical Association Declaration of Helsinki. Written informed consent was obtained for each study participant prior to the study.
All willing subjects who were there on the day of the survey, people who were wearing denture, and people who were able to read and write were included in the study.
Incompletely filled forms, subjects who were not present on the day of survey, mentally challenged individuals; and medically compromised individuals (people with Xerostomia, Parkinson's disease) were excluded from the study.
The self-administered, pretested questionnaire consists of two sections in the local language. The first section of the questionnaire includes information on demographic factors such as age, gender, and duration of stay in an old-age home, as well as data about denture maintenance and usage (13 questions). The second section of the questionnaire consists of an oral health profile, with each item rated on a 5-point Likert scale of severity, with 1 indicating very frequently, 2 indicating moderately frequently, 3 indicating rarely, 4 indicating scarcely ever, and 5 indicating never. A convenience sample of 30 people from the same population was used in a pilot study to assess the internal consistency and reliability of the questionnaire. Cronbach's alpha was computed to measure the questionnaire's internal consistency and had an alpha of 0.83. Two examiners who were aware of the study delivered the questionnaire on the spot and gathered responses from participants.
IBM SPSS Statistics for Windows, Version 20.0. IBM Corp, Armonk, New York, USA, was used to enter data and execute the analysis. For data presentation and analysis, descriptive statistics, the Chi-square test, and correlation were used. To describe the characteristics of the samples, descriptive statistics were employed (gender, age, and duration in the old-age home). P ≤ 0.05 was considered statistically significant.
| Results|| |
A total of 487 subjects participated in the study, of which 28.7% were male and 71.3% were female, 32.2% of the participants were between the ages of 56 and 64, and 32.2% had complete dentures (CD), while 67.8% had removable partial dentures (RPD). About 48.3% of participants stayed in old-age homes from 1 to 5 years, 23.3% stayed from 6 to 10 years, 18.4% stayed from 11 to 15 years, and 10.3% stayed from 16 to 20 years [Table 1].
|Table 1: Distribution of the participants according to age, gender, duration of their stay in assisted living facility and type of denture using|
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[Table 2] illustrates the knowledge and practices of individuals living in old-age homes aged about 45–90 years on their denture usage and care. About 39.1% of the respondents in the study have been wearing dentures for 6–10 years and 31% have not received any denture maintenance instructions from their dentist. About 37.9% of participants clean their dentures once a day, while 35.7% clean their dentures twice daily, followed by 24.1% clean their dentures immediately after eating, and 2.4% never clean their dentures. About 57% of participants clean their dentures using a brush and paste, while 2.3% use chemical solutions. About 59.8% of participants remove their dentures every day at night, while 88.5% of participants keep their dentures in a container with water.
|Table 2: Knowledge and practices of denture usage and maintenance in elderly adults|
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[Table 3] illustrates the factors influencing the subjects' satisfaction rate of dentures. Good Aesthetics were reported by 47.5% of RPD users and 32.1% of CD users, which was positively correlated (R = 0.035) and is statistically significant (P = 0.042). Only 32.1% of CD users and 28.8% of RPD users had high retention, indicating a positive correlation (r = 0.011) and is also statistically significant. The total satisfaction rate of CD users with a good response was 21.40% and for RPD users was 23.7%, which was statistically significant and was positively correlated (r = 0.034). The overall satisfaction rate was similarly statistically significant (P = 0.003) and positively correlated (r = 0.020) with the duration of denture usage.
|Table 3: Factors affecting the satisfactory rate of dentures in the participants|
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[Table 4] illustrates the OHIP on denture type and duration of use. The mean of psychological discomfort among RPD users was 3.6 ± 0.95, which was statistically significant (P = 0.048). When compared to 1 year and 6–10 years of usage, the overall OHIP for 1–5 years of denture users was high, with a mean of 53.8 ± 78.102, and a statistically significant difference (P = 0.028) existed between CD and RPD users.
|Table 4: Oral health impact profile on type of denture used and duration of use|
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| Discussion|| |
It is critical to understand which variables truly impact the OHRQoL of people living in old-age homes, in order to build patient-oriented strategies in public health care and offer adequate oral health care to them. Therefore, the present study aimed to assess the impact of dentures on oral health-related quality of life in assisted living facility elders, Guntur district, Andhra Pradesh, India.
According to the outcomes of this study, esthetics, retention, ability to speak, and mastication all play a role in fair satisfaction with removable dentures. Previous research has found a correlation between self-reported denture satisfaction and OHRQoL in the elderly. In a 2-year longitudinal study, Stober et al. reported that older patients' satisfaction with CDs was correlated with OHRQoL, based on scores on the shortened version of the OHIP. According to Kuo et al., patients' satisfaction with CDs was substantially associated with an improvement in their OHRQoL, as evaluated by the OHIP-14. Lee et al. observed in a cross-sectional study that if the elderly are satisfied with their dentures, their OHRQoL, as evaluated by the OHIP, may be unaffected by oral health issues.
In the present study, CD users had substandard oral health quality of life when compared to RPD users which was in contrast with the findings of a study conducted by Bae et al., which revealed that RPD users had worse OHRQoL compared with CD users based on OHIP responses. Wong et al. also showed that individuals who had RPD had greater OHRQoL impairment (as measured by GOHAI) than those who had a CD in a population of community-dwelling elderly Chinese adults. These observations are most likely to the results of the unreasonable expectations of users for their teeth, which is that RPD users like to compare their teeth with natural teeth. Researchers, on the other hand, have found that CD users who had formerly used RPD may accept tooth loss and oral discomfort as a natural part of the aging process. As a result, CD users may be more tolerant of impaired denture function than RPD users.,
The duration of dentures has an impact on elder people's OHRQoL. Functional limitation, physical pain, psychological discomfort, physical disability, psychological impairment, social disability, and handicap were all frequent in the first 5 years of denture usage, which contradicts the findings of Hadzipasic-Nazdrajic.
As per the Report of the Technical Group on Population Projections for India and States 2011–2036, an increase of nearly 34 million elderly persons was seen in 2021 over the Population Census 2011 and is further expected to increase by around 56 million elderly persons in 2031. Prevention is the only choice in a country like India, where primary health care is incapable of fulfilling oral health-care needs and private dental treatment is out of reach for the majority of people. Several strategies, such as oral health education, dietary counseling, and denture care, should be implemented to preclude oral health issues in the elderly.
Regardless of the significant results, our study included certain limitations that should be considered when inferring the data. First, we used a convenience sample from old-age homes rather than a population-based sample, thus our study only reflects a fraction of the general public. Second, because this was a cross-sectional study, we cannot make implications regarding the direction of the perceived associations. Since the responses were completely self-assessed by the participants, there is a possibility of reporting bias.
| Conclusion|| |
The overall satisfaction rate of RPD users was higher than the CD users and a statistically significant difference exists between both. Aesthetics had a crucial part in denture satisfaction, and overall OHIP assessments were better for denture users who had been wearing dentures for 1–5 years. Denture satisfaction is useful as a tool for assessing OHRQoL of elderly individuals wearing dentures.
We would like to acknowledge all the old-age home authorities for their contribution, time, and support to conduct this survey.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gavrilov LA, Gavrilova NS. Evolutionary theories of aging and longevity. ScientificWorldJournal 2002;2:339-56.
The uses of epidemiology in the study of the elderly. Report of a WHO Scientific Group on the Epidemiology of Aging. World Health Organ Tech Rep Ser 1984;706:1-84.
Kalache A, Gatti A. Active ageing: A policy framework. Adv Gerontol 2003;11:7-18.
Petersen PE, Yamamoto T. Improving the oral health of older people: The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2005;33:81-92.
Khan KF, Ravishankar TL, Nikhath F. Dental health status and treatment need of institutionalized geriatric population: An Indian scenario. J Indian Acad Geriatr 2011;7:154-8.
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.
] [Full text]
Chaware S, Ghodpage SL, Sinha M, Chauhan V, Thakare V. Prosthetic status and prosthetic needs among institutionalized geriatric individuals in Nashik City, Maharashtra: A descriptive study. J Contemp Dent Pract 2011;12:192-5.
Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and oral health-related quality of life: A systematic review and meta-analysis. Health Qual Life Outcomes 2010;8:126.
Stober T, Danner D, Lehmann F, Séché AC, Rammelsberg P, Hassel AJ. Association between patient satisfaction with complete dentures and oral health-related quality of life: Two-year longitudinal assessment. Clin Oral Investig 2012;16:313-8.
Lee IC, Yang YH, Ho PS, Lee IC. Exploring the quality of life after denture-wearing within elders in Kaohsiung. Gerodontology 2012;29:e1067-77.
Wong MC, McMillan AS. Tooth loss, denture wearing and oral health-related quality of life in elderly Chinese people. Community Dent Health 2005;22:156-61.
Kuo HC, Kuo YS, Lee IC, Wang JC, Yang YH. The association of responsiveness in oral and general health-related quality of life with patients' satisfaction of new complete dentures. Qual Life Res 2013;22:1665-74.
IBM Corp. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp; 2011.
Hassel AJ, Rolko C, Grossmann AC, Ohlmann B, Rammelsberg P. Correlations between self-ratings of denture function and oral health-related quality of life in different age groups. Int J Prosthodont 2007;20:242-4.
Bae KH, Kim C, Paik DI, Kim JB. A comparison of oral health related quality of life between complete and partial removable denture-wearing older adults in Korea. J Oral Rehabil 2006;33:317-22.
Komagamine Y, Kanazawa M, Kaiba Y, Sato Y, Minakuchi S, Sasaki Y. Association between self-assessment of complete dentures and oral health-related quality of life. J Oral Rehabil 2012;39:847-57.
Hadzipasic-Nazdrajic A. Quality of life with removable dentures. Mater Sociomed 2011;23:214-20.
Republic of India Ministry of Statistics and Programme Implementation. Available from: https://www.mospi.gov.in/
. [Last accessed on 2021 Dec 14].
Khare A, Gupta A. Oral health-related quality of life in geriatric patients: A narrative review. J Orofac Res 2018;7:40-2.
[Table 1], [Table 2], [Table 3], [Table 4]