Geriatric oral health issues in Australia

AIM

To identify and discuss geriatric oral health issues in Australia.

METHODS

A discussion of the demographic trends, oral health trends, and barriers to dental care for older Australians is presented, together with a review of Australian public and private sector geriatric dental services, geriatric dental research, and geriatric dental education.

CONCLUSIONS

Key geriatric oral health issues for Australia include: edentulism is decreasing and older Australians are retaining more natural teeth; coronal and root caries are significant problems, especially as older adults become more functionally dependent, cognitively impaired, and medically compromised; the oral health status of institutionalised older Australians is poor; the onset of severe oral diseases appears to occur in many older Australians prior to their institutionalisation, when they are homebound and dependent upon carers; carers of older adults do not have access to practical education about dental care; the majority of older Australians are eligible to use public-funded dental services, but barriers limit their access to these services; few Australian public or private dental services are designed with a geriatric focus; geriatric dental education does not have a high profile in Australian dental schools; no specialty exists in Australia for geriatric dentistry, nor is there a national geriatric dentistry association.

Geriatric oral health issues in the United States

Of the more than 270 million people in the United States, about 13 per cent are aged 65 years or older. As in most other countries throughout the world, this proportion of the population is projected to increase in the coming years. To care for this ageing and racially/ethnically diverse population, health care professionals, especially dentists, must initiate changes in public policies, available resources and access to services. The dental profession especially must improve awareness among the general public and health care professionals of the link between oral health and general health. Immediate improvements should be made to increase the proportion of dentists who are willing and qualified to treat these patient groups. Increasing the reimbursement rates available through the Medicaid programme and expanding the types of services Medicaid recipients can seek are critical. Dental education programmes must continue to provide more training opportunities to prepare professionals to meet the needs of these patients.

A review of the oral health of American Indian and Alaska Native elders

OBJECTIVES

This paper reviews the demographics, access to care barriers, and the oral health of American Indian and Alaska Native (Native American) elders aged 65 years and older using complete tooth loss as a measure to compare with the US population. Strategies for improving oral health and increasing access to care for Native American elders also are discussed.

METHODS

We reviewed the results from patient surveys conducted by the Indian Health Service (1983-84 and 1991) and data from other sources, including the second International Collaborative Study of Oral Health Outcomes (ICS-II) conducted in 1990 on the Sioux and Navajo reservations. We compared complete tooth loss data from these studies with findings of the 1985 National Institute of Dental Research Oral Health Survey of US Employed Adults and Seniors and the Third National Health and Nutrition Examination Survey (NHANES III).

RESULTS

The 1991 Indian Health Service (IHS) patient survey reported a complete tooth loss prevalence of 42 percent among elders. Although it is based on a patient sample, this finding is comparable to the rate of 40 percent found among a random sample of Navajo and Lakota adults aged 65-74 years reported in the ICS-II study. The 1991 IHS patient survey also found complete tooth loss among diabetics to be much higher than among nondiabetics.

CONCLUSIONS

The prevalence of complete tooth loss for Native American elders is higher than in population surveys of US elders based on random samples. The actual prevalence of complete tooth loss is probably even higher in Native American elders because estimates presented in this paper are clinic based.

Tooth loss and need for extractions in American Indian and Alaska Native dental patients

OBJECTIVE

This article reports results of the 1991 Indian Health Service Patient Oral Health Survey in the areas of tooth loss and need for tooth extraction.

METHODS

The survey examined a sample of American Indian and Alaska Native dental patients. Tooth loss and need for tooth extraction are explored for a total of 12,349 individuals aged 18 years and older.

RESULTS

Complete tooth loss in patients aged 35 years and older was 11 percent; in patients aged 65 years and older, it was 42 percent. The mean number of remaining teeth in dentate patients aged 35 years and older was 20.7; the mean number of remaining teeth decreased in each older age group. Partial and complete tooth loss were more severe in diabetic patients. In 35- to 44-year-old patients, only 20 percent had not lost at least one permanent tooth. The prevalence of tooth loss differs by geographic region. The percentage of dental patients with 20 or more teeth increased between 1984 and 1991.

CONCLUSION

Tooth loss remains a substantial problem in American Indian and Alaska Native adult dental patients. This article presents results of an Indian Health Service (IHS) oral health survey conducted in 1991 of the American Indian and Alaska Native (Native American) population with respect to tooth loss. Limited comparisons of tooth loss observed in the 1991 patient survey are made to the 1984 patient survey.

Demonstrating successful aging using the International Collaborative Study for Oral Health Outcomes

As the lifespan increases and people are faced with 15 to 20 years of "old age," we ask what one considers successful aging with respect to oral health. We propose a comprehensive combination of outcome variables, maintenance of teeth, manageable periodontal condition, positive perceived oral health, satisfaction with their access to and receipt of dental services, and minimal functional problems, that together comprise a definition of successful aging. The International Collaborative Study for Oral Health Outcomes provides a data set for exploring the oral health of a diverse sample of older adults in US and international sites using the modified Andersen Behavioral Model. The percent of adults who report no natural teeth ranged from 16 percent in San Antonio to 59 percent in New Zealand. Seventy percent or more of the adults from each site rated their oral health as good/fair or better except in Poland. The current cohort of older adults is faring better on some indicators than others; nevertheless, ethnic minorities and poorer countries still demonstrate inequities. Dentistry must attempt to educate individuals early in their lifespan that a combination of personal oral health practices and current dental techniques offers the potential for successful oral health throughout one's lifetime.

[A survey of oral health status of the elderly individuals in Chengdu of China]

OBJECTIVE

The aim of this survey is to investigate the oral health status of the oldsters over 65-year-old in Chengdu of China.

METHODS

The oral health status, including oral hygiene, caries, periodontal diseases and the tooth loss of 468 elderly individuals over 65 years old were surveyed and analyzed.

RESULTS

It was found that all these older individuals brushed their teeth everyday, but most of them had tooth decay, gingivitis and periodontitis. About 7.47% of them were edentulous, and 2.56% of them were half edentulous. The masticatory ability of most of them declined and the chewing ability of them was low.

CONCLUSION

The oral health status of these elderly individuals in Chengdu is poor. It is therefore necessary to improve the health status of this population.

Total tooth loss in the United Kingdom in 1998 and implications for the future

The 1998 Adult Dental Health Survey, published this year, showed that the number of people without teeth should fall over the next three decades, to only 4% of the UK population. Patterns of tooth loss and retention are also changing. This article, the first of a series on the interpretation of the Adult Dental Health Survey, discusses the implications of these trends for dentistry.

Patterns of dental caries and treatment experience in elderly Lithuanians

OBJECTIVE

The aim of the study was to evaluate patterns of caries experience in a representative sample of Lithuanians, aged 65-74.

METHODS

This cross-sectional study included 301 participants (response rate 54%). Information was obtained from a clinical examination (caries experience, stimulated salivary flow rates and oral hygiene levels) and a questionnaire. The questionnaire comprised questions about oral, general, physical, mental and social health and about background, knowledge, attitudes and lifestyle. The study had a multidimensional approach to negative consequences of disease and positive aspects of health. For bivariate testing, t-test, ANOVA and Spearman's correlation were used. Factor analysis was combined with linear multiple regression for a multivariate study of caries experience patterns.

RESULTS

Elderly Lithuanians were found to have lower levels of edentulousness (range 11-15%) than elderly people in other European countries. The mean number of missing teeth was also lower than in any of the neighbouring countries. A comparison of dentate and edentulous groups did not show any major differences. Those who reported that they had general disease had higher levels of oral health maintenance. In dentate elderly, caries experience differed according to place of residence, fluoride content in the drinking water, socioeconomic status, gender, lifestyle, and many other factors. The multivariate approach explained 52%, 61% and 55% of the variation in the number of filled or sound teeth (FS-T), decayed (DT) and missing teeth (MT) respectively.

CONCLUSION

Levels of oral health maintenance and caries experience show substantial variation among elderly Lithuanians, according to many health-related characteristics. These elderly people require appropriate oral care, just as much as people in other population sub-groups.

Trends in caries prevalence in Dutch adults between 1983 and 1995

In 1995, a dental survey was performed among adults aged 25-54 in the Dutch city of 's-Hertogenbosch. A similar study was performed in the same city in 1983 and the aim of the present study was to describe trends in oral health from 1983 to 1995. National data show that the percentage of edentulous persons aged 30-39 and 40-49 decreased from 11.3 to 3.3 and from 28.5 to 13.8, respectively, between 1984 and 1993/94. The same trend was found in 's-Hertogenbosch. In persons with natural dentition under the age of 35 the mean number of DMFT decreased significantly between 1983 and 1995. In 1995 the mean number of FT was higher, and the mean numbers of DT and MT were lower than in 1983 in all age categories. It can be concluded that oral health in Dutch adults, as measured by caries prevalence, treatment level of caries and percentage of edentulous persons, improved significantly between 1983 and 1995.

The dental needs, demands and attitudes of a group of homeless people with mental health problems

OBJECTIVE

This study investigated the dental needs, demands and attitudes of a group of homeless people living in a hostel in Birmingham, many of whom had mental health problems.

BASIC RESEARCH DESIGN

Seventy subjects underwent a dental examination. The clinical criteria for the examination were especially selected to be simple and cause minimal discomfort to the subject, but be reproducible and cover the wide range of conditions expected to be found. Five of the subjects were selected to take part in semi structured interviews.

RESULTS

Thirty-one per cent of the subjects were found to be edentulous, with only 32% wearing dentures. The dentate subjects had a mean DMFT (+/-SE) of 15.9 (+/-7.8). High levels of dental need were found amongst the dentate subjects who had an average of 3.6 (+/-3.9) decayed teeth and 54% had one or more teeth with obvious pulpal involvement. Eighty-five per cent of the dentate subjects had some dental wear leading to exposed dentine. The periodontal condition was generally poor, 50% of dentate subjects having excessively mobile teeth. The interviews revealed a low level of perceived need and indicated that difficulties would be encountered in tailoring services to meet this client group's requirements.

CONCLUSIONS

High levels of normative need were found in this group of people, however it was concluded that providing dental services to meet this need would prove difficult.

Trends and prognoses of dental status in the Swedish population: analysis based on interviews in 1975 to 1997 by Statistics Sweden

The aims of this study were to describe changes in dental status over the 22-year period from 1975 to 1997, and to make a prognosis of dental status based on these data for the years 2005 and 2015. The study is based on regular investigations of the living conditions performed by Statistics Sweden of samples varying between 11,582 and 14,964 participants and a response rate from 78% to 86%. The questions of the interview used in this study were focused on dental status and utilization of dental services. The prevalence of edentulism in the age group 25-74 years decreased from 19% in 1975 to 3% in 1996/97. The proportion of dentate persons increased from 75% in 1975 to 97% in 1996/97 in age group 45-64 years with similar trends in the other age groups. In 1996/97, 2.1% of the whole sample (16-84 years) reported that they had received implant-supported restorations. The rate was higher among the elderly and the edentulous subjects. The great regional differences in dental status found in the first part of the observation period remained only in the oldest age group in 1996/97. The prognosis predicts that 95% of the subjects in age group 65-74 years and 90% in age group 75-84 years will be dentate in the year 2015. The substantial increase of dentate subjects among the elderly that has occurred during the past few decades and its expected continuation in the coming years implies a great change in need and demand for dental care services.

Dental caries in adult Lithuanians

There are few data on the incidence of dental caries in Lithuanian adults. The aim of the present study was to describe caries and treatment experience among 35-44 and 65-74-year-olds, and to relate this to certain selected independent variables (gender, urban/rural residence, drinking water fluoride levels, and years of education). A total of 680 subjects selected based on a stratified random sampling procedure (response rate 52%) were examined by one examiner. Dental caries was recorded as DMFT following the WHO recommendations. The results showed that the median DMFT scores were 18 for the 35-44-year-olds (n = 380) with median DT = 2, MT = 5, FT = 7. For the 65-74-year-olds (n = 300) the median DMFT was 24, with DT = 1, MT = 18, FT = 2, respectively. One percent of all 35 year-olds and 11% of 65-74-year-olds were edentulous. In the younger age group, statistically significant differences in the DMFT scores were related to gender, urbanization and drinking water fluoride levels. Participants from areas with high fluoride content in the drinking water (> 1.5 ppm F/1) had lower DT, MT, and FT values. Females and participants from urban areas had higher numbers of FT. Participants with more years of education had lower DT, MT, and higher FT values. In the elderly, DMFT scores were related to water fluoride levels and years of education. Individuals with more years of education had higher numbers of FT and lower MT values in this age group. Poor oral hygiene was associated with high numbers of DT in both age groups. The data indicate that dental caries is widespread among adult Lithuanians.

[Epidemiology of various oral-dental problems in aging patients]

Demographic projections show an important increase of the elderly population. The percentage of complete edentulous elderly patients is decreasing but their total number will remain constant. The prevalence of caries (essentially root caries) and of periodontal disease is, actually, very important. The increase of remaining teeth in the aging population, is a risk for a higher prevalence of these problems. It's time to become aware of this situation and to develop prevention and adapted treatments for this population.

The change of periodontal treatment needs in a population of Ljubljana, Slovenia, over a ten year period

A follow-up study was performed to assess the change of periodontal treatment needs in the adult population of Ljubljana, Slovenia, over a ten year period. In the initial survey, conducted from 1983-1987, 1,609 dentate subjects in the range from 15-65 years of age were clinically examined. Ten years later of the 1,609 invited subjects a total 555 (34.5%) came to the oral re-examination. During the intervening period 3.1% of them had become edentulous. Periodontal treatment needs in both surveys were assessed by the Community Periodontal Index of Treatment Needs methodology. At the initial examination 2.4% of 1,609 subjects were found to be without any signs of periodontal disease, 97.6% needed oral hygiene instruction, 77.71% needed scaling and 20.3% of them needed complex periodontal treatment. Ten years later, of the 538 dentate subjects aged 25-75 years, only 0.7% of presented with healthy periodontal tissues, 99.3% needed oral hygiene instruction, 93.9% needed scaling and 27.3% needed periodontal surgery. In both surveys advanced periodontal disease in the Ljubljana population was limited to 6.0% and 8.3% of all sextants respectively. After evaluation of the population of the same age in both surveys (25-65-year-old groups) a slight decrease in subjects with healthy periodontal tissues (1.21% vs. 0.84%) was observed. In comparison, there was an increase of subjects with shallow pockets (24.8% vs. 31.1%) and a slight decrease of subjects with deep periodontal pockets (27.7% vs. 24.1%). Comparing the results we concluded that the prevalence and severity of periodontal disease in the Ljubljana population remained similar in both surveys. The findings of the present follow-up study suggest a need for more efficient primary and secondary preventive measures in order to decrease the prevalence and severity of periodontal disease in Ljubljana and Slovenia.

Caries prevalence and distribution in 20-80-year-olds in Jönköping, Sweden, in 1973, 1983, and 1993

In 1973, a cross-sectional study on oral health status was performed on 1000 individuals in the age groups 3-70 years in Jönköping, Sweden. In 1983 and 1993, new cross-sectional studies were carried out in the age groups 3-80 years. The aim of the present study was to analyze caries prevalence and distribution in the three investigations 1973, 1983, and 1993 in the age groups 20-80 years. In the younger age groups (20-40 years), a larger proportion of individuals with good oral health was found in 1993 than in 1973 or 1983. A steady increase in the number of teeth in the age groups 40-80 years could be found, which was also reflected in the increasing number of decayed and filled tooth surfaces (DFS) in the same age groups. A marked decrease in proximal DFS in 20-50-year-olds in 1993 compared to 1973 and 1983 was found. However, a rather large and unchanging group of individuals suffering from severe caries was also observed. This situation demands an individualized caries treatment strategy based on risk assessment.

Trends in self-reported use of dental services among Finnish adults during two decades

OBJECTIVE

To analyse trends in the prevalence of and determinants for dental care utilisation among Finnish adults of working age during two decades.

BASIC RESEARCH DESIGN AND PARTICIPANTS

The National Public Health Institute has, since 1978, conducted annual surveys of health behaviour among the whole Finnish adult population (aged 15-64 years). Data collected through mailed questionnaires have included questions on dental utilisation. Sample sizes have varied from 5,000 to 6,000 and response rates from 68% to 85%.

RESULTS

The use of dental services increased in the period 1978 to 1997 from 53% to 64% (P<0.001) of the population. Women and persons belonging to the younger age groups were the most frequent visitors, and older persons the least frequent due to the greater prevalence of edentulousness. During the period, differences in the use of services associated with region, level of education and occupation declined. During the first decade, a clear increase in dental utilisation was found in younger age groups and during the latter decade in older age groups. Significant predictors for the utilisation of services were the number of missing teeth, age, gender, occupation and toothbrushing frequency in 1997.

CONCLUSIONS

The utilisation of dental services has increased slowly since 1978 but remains lower than in other Nordic countries. In a country where the supply of services is abundant, the major determinant of the use of services is the number of teeth an individual has.

Acute-phase inflammatory response to periodontal disease in the US population

Moderate elevation of serum C-reactive protein (CRP) is a risk factor for cardiovascular disease among apparently healthy individuals, although factors that create this inflammatory response in the absence of systemic illness have not been clarified. This study aimed to: (1) evaluate associations among periodontal disease, established risk factors for elevated CRP, and CRP levels within the US population; and (2) determine whether total tooth loss is associated with reduced CRP. Data were obtained from the third National Health and Nutrition Examination Survey. A random sample of the US population was interviewed in their homes and examined at mobile examination centers. CRP was quantified from peripheral blood samples and analyzed as a continuous variable and as the prevalence of elevated CRP (> or = 10 mg/L). Some 12,949 people aged 18+ years who had periodontal examinations and an additional 1,817 edentulous people aged 18+ years were included in the analysis. Dentate people with extensive periodontal disease (> 10% of sites with periodontal pockets 4+ mm) had an increase of approximately one-third in mean CRP and a doubling in prevalence of elevated CRP compared with periodontally healthy people. Raised CRP levels among people with extensive periodontal disease persisted in multivariate analyses (P < 0.01), with established risk factors for elevated CRP (diabetes, arthritis, emphysema, smoking, and anti-inflammatory medications) and sociodemographic factors controlled for. However, CRP levels were similarly raised in edentulous people. Furthermore, the established risk factors for elevated CRP modified relationships between oral status and CRP levels. Periodontal disease and edentulism were associated with systemic inflammatory response in the US population, most notably among people who had no established risk factors for elevated CRP.

The orodental status of a group of elderly in-patients: a preliminary assessment

OBJECTIVE

To provide a preliminary assessment of the orodental status and dental treatment requirements of a group of elderly in-patients.

DESIGN

Cross-sectional.

SETTING

Acute Care of the Elderly and Stroke Rehabilitation units at teaching hospitals in Merseyside.

SUBJECT

150 patients aged 58 to 94 years, in which a history could be validated at interview.

INTERVENTION

Questionnaire administered by dentist and clinical examination.

MAIN OUTCOME MEASURES

Registration with a dentist, prosthetic status and difficulties with dentures, denture hygiene and identification marking, dental treatment needs and evidence of mucosal pathology.

RESULTS

Only 27% of patients claimed registration with a dentist. Three quarters of the patients were edentulous and 66 patients wore full dentures; 18 had no prostheses. Difficulties were experienced by one quarter of patients with upper dentures, compared with a half of lower denture wearers. Of the dentures available for inspection, 61% had removable soft debris, 66% were left out at night and 75% were cleaned by the patient, whilst on the ward. No dentures had evidence of identification marking. Of the 39 partially dentate patients, 75% required interventive dental treatment. Denture stomatitis was diagnosed in 29% of patients and 19 had evidence of benign mucosal pathology.

CONCLUSIONS

The orodental status of this group of elderly in-patients was poor, with a high proportion being edentulous. Few were registered with a dentist and denture hygiene was inadequate. Lack of identification marking is a matter of concern. Closer liaison between hospital staff responsible for elderly in-patients is required, to improve the orodental health and quality of life of this medically compromised group of patients.

Factors influencing older people's self reported use of dental services in the UK

OBJECTIVES

This study was designed to determine the use of dental services and factors associated with their use among the United Kingdoms' older population.

DESIGN

A national study involving 1,116 older people (aged 60 or older).

SETTING

Home Interviews were undertaken exploring the time and reason for last dental visit. In addition, socio-demographic characteristics and proxy oral health measures (self-reported number of teeth and edentulous status) of the respondents were collected.

RESULTS

Forty seven percent (528) claimed they visited the dentist within the past year, 10% (116) claimed that the reason for their last visit was because of a dental emergency, 43% (484) were classified as "regular attenders"--having attended the dentist within the past year for a non dental emergency. Bivariate analysis identified that regular dental attendance was associated with age (P < 0.01), social class (P < 0.01), income level (P < 0.01), educational attainment (P < 0.01), self-reported number of teeth possessed (P < 0.01) and edentulous status (P < 0.01). In regression analysis, self reported edentulous status and number of teeth possessed emerged as the most important factors in determining service utilisation. Possessing a full denture was associated with a 6-fold decrease, having accounted for other factors, in the likelihood of attending the dentist within the past year for a non dental-emergency (OR = 0.15, CI 0.10, 0.21).

CONCLUSION

Less than half of the sample population were "regular dental attenders", their attendance was associated with a number of socio-demographic and oral health factors. In particular, edentulous state was a major factor associated with their use of services.

Compounding inequalities in the oral health of older women living outside Dublin

BACKGROUND

The Irish population is ageing with an increase in the absolute number of older people. However, there is a deficiency of information on the oral health status of older people in the Republic of Ireland. Traditionally, the primary measure of oral health status in older populations has been the prevalence of edentulousness. The aim of this retrospective study was to obtain information on the edentulous status of older people and to investigate the compounding effects of age, gender and area-of-residency on the prevalence of edentulism, using as a sample those over 65 year-olds who registered at dental hospitals in the Republic of Ireland during 1995.

DESIGN

All patient records from both dental hospitals in the Republic were identified on electronic databases, and information was collected over a period of six months. Of the 566 patients who registered at the dental hospitals in 1995, it was possible to access 524 (93 per cent) records.

RESULTS

The edentulous rate in the sample was 42 per cent, but significant variations were apparent with age, gender and geographical residency. In addition, there was evidence of compounding inequalities in the prevalence of edentulism when the combined effects of age, gender and area of residency were studied. Considerable inequalities were observed; at age 65 women resident outside Dublin were 1.65 times more likely (or 65 per cent more likely) to be edentulous than men resident in Dublin of the same age. At age 75, women were 1.46 times more likely to be edentulous than men.

Edentulism among Finnish adults of working age, 1978-1997

OBJECTIVES

The dental health of Finnish children and young adults has improved considerably during the last 25 years. At the same time, there are still middle-aged or elderly individuals who have lost some or all of their teeth, since extractions were commonly used as a treatment for dental infections during earlier decades. The aim of the present study was to analyze changes of the prevalence of and risk indicators for edentulism among Finnish adults of working age (15-64 years) from 1978 to 1997.

METHODS

The National Public Health Institute has, since 1978, conducted annual surveys concerning health behavior among the Finnish adult population. The data were collected through a mailed questionnaire including questions on the number of missing teeth. Sample sizes varied from 5000 to 6000 and the response rates from 70% to 85%.

RESULTS

The dental status profile of the Finnish adult population has changed considerably since 1978. The prevalence of edentulism decreased from 14% to 6% during the study years. At the same time, the number of persons with complete dentition increased from 60% to 80%. The decrease in edentulism was obvious in both sexes, but the change was more remarkable among women. In 1997, the difference between the sexes had almost disappeared. The differences between regional and educational groups were still marked in 1997. Belonging to a certain birth cohort appeared to be the major factor affecting the percentage of edentulous subjects. In 1978 risk indicators of total tooth loss included age, gender, length of education, geographical area, urbanization, marital status, and medication for headache. In 1997 risk indicators included age, length of education, geographical area, history of smoking, and perceived status of health.

CONCLUSIONS

The number of totally edentulous working-age persons is rapidly decreasing in Finland. Edentulism was strongly associated with birth cohorts and is apparently accumulating in a diminishing group of people. Relevant factors that were strongly associated with edentulousness did not vary considerably between the study years.

Oral health in hospitalized and nonhospitalized community-dwelling elderly patients

OBJECTIVE

The purpose of this study was to compare hospitalized and nonhospitalized home-dwelling elderly patients in a single community with respect to oral health and general health and to study risk factors for edentulousness in these patients. The study hypothesis was that hospitalized elderly patients would have poorer oral health than nonhospitalized elderly patients.

STUDY DESIGN

Oral health status was examined according to the World Health Organization's guidelines for 181 hospitalized patients (mean age, 81.9 +/- 5.8 years) in a geriatric ward and for 254 home-living patients (mean age, 76.9 +/- 5.6 years). Data regarding the patientś diseases and medications came from hospital records and doctorś prescriptions and were categorized on the basis of the International Classification of Diseases. Differences between the hospitalized and nonhospitalized patients, between genders, between age groups, and between the various disease and medication groups were analyzed. Logistic regression was used to analyze the effects of study variables on edentulousness.

RESULTS

The mean number of teeth was 10. 3 +/- 7.6 in the hospitalized patients and 16.3 +/- 7.4 in the nonhospitalized patients (P <.001). The mean number of decayed teeth was 1.3 +/- 2.2 in the hospitalized patients and 0.6 +/- 0.9 in the nonhospitalized patients (P <.01). All dentate patients had poor periodontal health. Community Periodontal Index scores were between 2 and 4 in 94.8% of the hospitalized patients and 98.6% of the nonhospitalized patients. Edentulousness was observed in 66.3% of the hospitalized patients and 42.1% of the nonhospitalized patients (P <.001). In both groups, female gender (odds ratio, 2.0; CI, 1.3-3. 1) and age between 80 and 89 years (odds ratio, 2.5; CI, 1.5-4.4) were the strongest risk factors for edentulousness. The number of drugs used daily also correlated significantly with the loss of teeth (P <.05). In the nonhospitalized patients, edentulousness correlated significantly with cardiovascular diseases and drugs taken daily (P <.01), whereas in the hospitalized patients such an association was not found.

CONCLUSIONS

The results of this study confirmed our hypothesis that hospitalized elderly patients who had many concomitant diseases and used many drugs daily had worse dental health than nonhospitalized home-dwelling elderly patients. The nature of a patient's illness was not a significant factor in this respect. Female gender and age between 80 and 89 years were the strongest factors for edentulousness in both patient groups.

The impact of tooth loss in a denture wearing population: an assessment using the Oral Health Impact Profile

OBJECTIVES

To assess the impact of tooth loss in complete denture wearers using the Oral Health Impact Profile (OHIP), and to compare the validity of 49 and 14 item versions of OHIP in a denture wearing population.

DESIGN

In this cross sectional study, data were collected at Newcastle Dental Hospital, UK. Two groups were involved: (1) subjects edentulous in one or both jaws seeking dental implants to retain their intra-oral prostheses (n = 48); (2) an edentulous control group of the same age and gender distribution requesting conventional, complete dentures (n = 35). All participants in the study completed a 49 item OHIP (OHIP-49) and a validated denture satisfaction questionnaire prior to active treatment. OHIP data were computed using the weighted standardised and simple count methods. Non-parametric statistical tests were used to compare the responses of implant and control subjects.

RESULTS

Both groups were dissatisfied with their conventional dentures and had relatively similar levels of dissatisfaction. There were statistically significant differences between the groups for all seven OHIP-49 sub-scale scores. Differences between OHIP-14 sub-scale scores were also significant, with presence of teeth influencing the impact on psychological discomfort.

CONCLUSION

Subjects in the implant group were significantly more impaired, disabled and handicapped by tooth loss than subjects seeking conventional dentures. The results suggested that OHIP-49 and OHIP-14 had a similar ability to discriminate between the groups. This indicates that OHIP-14 may be a useful aid in a clinical setting.