Factors associated with perceived unmet dental care needs of older adults

Oral status of older adults receiving home medical care: A cross-sectional study

AIM

This study examined the oral status and the presence of teeth requiring treatment among older adults receiving home medical care.

METHODS

This cross-sectional study was conducted at a Japanese dental clinic specializing in geriatric treatment. We recruited older adults receiving home medical care in the community who had begun to receive domiciliary dental care. The Japanese version of the Oral Health Assessment Tool (OHAT-J), as well as the presence of teeth requiring extraction and the need for assistance in maintaining oral hygiene were used to evaluate the participants' oral health and its association with other items.

RESULTS

Ninety-three participants (44 male and 49 female, median age: 87.0 years) were surveyed. The median OHAT-J score was 6. The duration since the previous dental visit was 23 months. Sixty-two (73.8%) of 84 participants with ≥1 natural tooth had severe caries or teeth with severe mobility that required extraction. Logistic analysis revealed that requiring assistance in maintaining oral hygiene, mild dementia, severe dementia, and depression were significantly associated with an OHAT score of ≥6.

CONCLUSIONS

Older adults receiving home medical care had poor oral health, with approximately 70% of them requiring tooth extraction. The need for assistance in maintaining oral hygiene and poor mental status contribute to poor oral health. Geriatr Gerontol Int 2024; 24: 706-714.

Global, regional, and national burden and quality of care index (QCI) of oral disorders: a systematic analysis of the global burden of disease study 1990-2017

BACKGROUND

Oral disorders are still a major global public health challenge, considering their perpetuating and chronic nature. Currently, there is no direct index to measure the quality of care on a population scale. Hence, we aim to propose a new index to measure the quality of care for oral disorders worldwide.

METHODS

We generated our database using the data from the Global Burden of Disease (GBD) study 2017. Among different variables such as prevalence, incidence, years lived with disability, and disability-adjusted life years, we utilised principal component analysis (PCA) to determine the component that bears the greatest proportion of information to generate the novel quality of care index (QCI) for oral disorders.

RESULTS

Global QCI for oral disorders gradually increased from 1990 to 2017 (from 70.5 to 74.6). No significant gender disparity was observed during this period, and the gender disparity ratio (GDR) was considered optimal in 1990 and 2017. Between 1990 and 2017, the age-standardised QCI for all oral disorders increased in all the SDI regions. The highest QCI for all oral disorders in 2017 belonged to high-middle SDI countries (=80.24), and the lowest YLDs rate was seen in the low SDI quintile. In 1990, the quality of care in European, Central Asian, and Central and South American countries was in the lowest quintiles, whereas the North American, East Asian, Middle Eastern, and some African countries had the highest quality of dental care. Maynmar (=100), Uganda (=92.5), Taiwan (=92.0), China (=92.5), and the United States (=89.2) were the five countries with the highest age-standardised QCI. Nicaragua (=41.3), Belgium (=40.2), Venezuela (=38.4), Sierra Leone (=30.5), and the Gambia (=30.3) were the five countries with the least age-standardised QCI values.

CONCLUSION

The quality of care for all oral disorders showed an increasing trend on a global scale from 1990 to 2017. However, the QCI distribution was not homogenous among various regions. To prevent the exacerbation of imminent disparities in this regard, better attention to total tooth loss in high-income countries and prioritising primary healthcare provision in low-income countries are recommended for oral disorders.

Is there a sexual difference in the relationship between sociodemographic information and the unmet dental care needs of disabled adults? An analysis from a national survey on persons with disabilities

BACKGROUND

Health status and health care utilization in people with disabilities are more likely to be poorer than those without disabilities. Previous studies showed that there were gaps in health-related conditions by sociodemographic information and gender but the association between these factors was not explained. This study aims to analyze the relationship between sociodemographic information and the unmet dental care needs of people with disabilities and explore the effect of sex within this relationship.

METHODS

The 2014 national survey on persons with disabilities was used, which separated unmet healthcare needs into medical and dental services. Unweighted samples included 6,824 people with disabilities in total and 6,555 (96.1% of the total, weighted as 6,583) people aged 20 years or older were selected as the study population. Frequency and chi-square tests were conducted to determine differences in the prevalence of unmet dental needs based on socioeconomic information, chronic diseases, and behavioral factors after applying weights. Logistic regressions were performed using an adjusted model with sociodemographic information, chronic diseases, and behavioral variables. All analyses were performed using IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA).

RESULTS

Analysis of the sociodemographic factors related to unmet dental care revealed that they were higher in women and the elderly. In the fully adjusted logistic model, most of the sociodemographic information was significantly associated with unmet dental needs. The lowest group was 4.18 times more likely to have unmet dental care needs than the richest group, and females and middle-school graduates were almost twice as likely to experience unmet dental care needs than males and university graduates. Considering the interaction effect of age on unmet dental needs depending on sex differences, the odds ratio decreased for females with every annual increase in both models. Compared with the younger group, the older group showed a lower risk of having unmet dental needs, especially in females.

CONCLUSIONS

The factor most closely related to the unmet dental care needs of disabled people was socioeconomic problems. Its influence also differed by sex and age. Therefore, economic support measures and sexual differences are needed for long-term policy consideration to reduce the unmet dental care needs of disabled people.

Factors associated with regular dental attendance by aged adults: A systematic review

OBJECTIVES

To determine factors influencing regular dental attendance in aged adults 65 and over according to Andersen's Behavioural Model.

BACKGROUND

Regular attendance for dental visits is vital to improve and maintain oral health, quality of life and general well-being. Aged adults 65 years and older experience barriers to regular dental attendance, which in turn leads to an increased risk for oral diseases.

MATERIALS AND METHODS

An electronic search was undertaken in April 2021 in Cochrane, Embase, Medline, Cinahl, Dentistry & Oral Science Source via EBSCOhost and Embase for papers on factors influencing the frequency of attendance by older people. Risk of bias was assessed according to the Newcastle-Ottawa Scale for cohort and case-control studies, and with modified version of this tool for cross-sectional studies. Frequency effect size was calculated for factors described in Andersen's Behavioural Model (predisposing, enabling and needs-related).

RESULTS

Twenty-one studies were eligible for inclusion. Factors frequently investigated affecting regular dental attendance included: age, gender, education (predisposing); income, and social support (enabling); and remaining teeth, pain, perceived health (needs-related). Income was the only factors with a 100% positive association with regular dental attendance.

CONCLUSIONS

This systematic review confirms the complex interconnectedness of several factors and dental attendance in older adults. A number of factors were identified which warrant further investigation to improve access to dental care to socio-economically vulnerable older populations.

The association between social isolation and oral health of community-dwelling older adults-A systematic review

AIM

Social isolation and oral health problems commonly exist in older populations and can influence each other. However, evidence on this bidirectional correlation is scarce. This systematic review aimed to provide a comprehensive overview of literature in which social isolation and oral health were associated with each other separately.

METHODS

Electronic searches were performed through six databases. Original cross-sectional and longitudinal prospective studies that evaluated the associations between social isolation and oral health as either exposure or outcome were included.

RESULTS

In total, 282 articles were retrieved. Of these, 10 cross-sectional studies and one longitudinal study were included in the analysis. The level of evidence reported was generally moderate to strong. Most studies found that both stronger objective and perceived social isolation were associated with worse oral health in both directions. The frequency of meeting friends had an inconsistent association with oral health.

CONCLUSIONS

The results of our systematic review showed a bidirectional association between social isolation and oral health in independent community-dwelling older adults. Both objective and perceived social isolation are associated with oral health. As objective social isolation indicators, quality of social connectedness appears to play a more important role in the association with oral health.

Oral Health and Mortality Among Older Adults: A Doubly Robust Survival Analysis

INTRODUCTION

Evidence on the association between oral health and mortality is inconclusive, and few studies have accounted for the nonrandom selection bias in estimating their relationship. This study aims to investigate the link between oral health and mortality in community-dwelling older adults by adjusting for confounding factors with a doubly robust survival estimation.

METHODS

Data came from the third National Health and Nutrition Examination Survey (1988-1994) and were linked to the National Death Index mortality data through December 2015. The analytic sample consisted of 4,880 adults aged ≥60 years. Oral health measures included objective clinical indicators (edentulism, periodontitis, and untreated dental caries) and self-rated oral health. Cox proportional hazards regression models and inverse probability weighting with regression adjustment for observational survival-time estimation were utilized to assess the relationship between oral health and mortality. Analyses were conducted in 2021.

RESULTS

Edentulism (average treatment effect= -26.13, 95% CI= -48.69, -3.57) was associated with a reduction in survival time. Periodontal conditions and dental caries were related to all-cause mortality in Cox models but became nonsignificant when inverse probability weighting with regression adjustment survival estimation was applied. Good self-rated oral health was significantly related to an increase in survival time (average treatment effect=21.50; 95% CI= 4.92, 38.07).

CONCLUSIONS

Both objective and subjective oral health are risk factors for mortality among older adults. Improving access to dental screening and treatment among community-dwelling older adults has the potential to reduce oral health‒related risks of mortality.

A systematic review and meta-analysis of unmet needs for healthcare and long-term care among older people

BACKGROUND

The absolute number of older individuals needing medical care and long-term care (LTC) is increasing globally due to the growing ageing population. However, it is uncertain who and what proportion of the population has access to care. Therefore, a systematic review and meta-analysis of the prevalence and reasons for unmet needs for healthcare and long-term care among older people, 65 years old and above, across countries was conducted.

METHODS

An information specialist performed a comprehensive search of four major databases (PubMed, EMBASE, Web of Science, and CINAHL) from inception to June 2020 without restrictions on language and date. We did random-effects meta-analysis to obtain pooled prevalence. We stratified the meta-analysis by reasons for unmet need categorized by barrier dimension (availability, accessibility, affordability, and acceptability), survey year, geographic location, and socio-demographic characteristics of the older individual.

RESULTS

After screening 3912 articles, we included 101 studies published between 1996 and 2020. Of the 101 studies, 87 studies reported unmet healthcare needs and 14 studies reported unmet LTC needs. Overall, 10.4% (95% CI, 7.3-13.9) of the older population had unmet needs for healthcare. The common reasons for unmet healthcare needs were cost of treatment, lack of health facilities, lack of/conflicting time, health problem not viewed as serious, and mistrust/fear of provider. A significant variation in pooled prevalence of unmet healthcare needs due to cost was found by gender (male [10.9, 95% CI, 8.9-13.1] vs female [14.4, 95% CI, 11.8-17.3]), educational level (primary or less [13.3, 95% CI, 9.6-17.6] vs higher [7.5, 95% CI, 5.9-9.3]), self-reported health (poor [23.2, 95% CI, 18.8-27.8] vs good [4.4, 95% CI, 3.4-5.5]), insurance status (insured [9.0, 95% CI, 7.5-10.6] vs uninsured [27.7, 95% CI, 24.0-31.5]), and economic status of population (poorest [28.2, 95% CI, 14.1-44.9] vs richest [7.1, 95% CI, 3.8-11.3]). One in four (25.1, 95% CI, 17.1-34.2) older people had unmet needs in LTC. Rural residents had a higher prevalence of unmet needs in LTC compared to their urban counterparts.

CONCLUSION

With the population ageing globally, it is necessary to improve access to health care and LTC for older people. Ensuring affordability of health services, reducing geographical barriers, and improving acceptability, will be critical in reducing unmet need. Unmet needs for healthcare were concentrated in population with no education, poor economic group, outpatient health facility user, and uninsured group. With education and economic-based inequalities at the forefront, all countries should focus on improving access to health services by reducing the burden related to healthcare costs.

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.

Gender difference in unmet need for assistance with activities of daily living among disabled seniors in China : a cross-sectional study

OBJECTIVES

This study explores the gender difference in unmet need for assistance with activities of daily living among older adults with disabilities in China.

DESIGN

Logistic regression analysis was employed to examine the gender difference and identify influential factors among disabled male and female seniors.

SETTING

23 provinces throughout China.

PARTICIPANTS

A total of 1700 disabled seniors were included in the analysis.

RESULTS

Of 1700 respondents, 619 (36.4%) were disabled male seniors. Overall, the possibility of unmet need for activity of daily living assistance among disabled female seniors was significantly lower than that among male group (OR 0.728; 95% CI 0.559 to 0.948) than males. Family care resources, economic status and loneliness were influential factors among disabled seniors regardless of genders. Furthermore, disabled female seniors from rural area (p=0.011), whose primary caregiver was willing to take care of them (p=0.022), whose community could provide daily life service (p=0.002) were more likely to have unmet need. Meanwhile, disabled female seniors whose community could provide medical service(p=0.001) were less likely to report unmet need.

CONCLUSIONS

The study showed that disabled male seniors were more likely to experience unmet need compared with female ones. Reducing unmet need for assistance with activities of daily living among disabled seniors and existing gender disparities therefore requires not only universal strategy, but also targeted policies which should be made or modified for disabled seniors of different genders.

Developing a prototype for integrated dental and diabetes care: understanding needs and priorities

BACKGROUND

Periodontal treatment may be a useful adjunct to medical management of diabetes; however, oral health has not been integrated into multidisciplinary diabetes care in Australia. This study aimed to understand the needs of patients and staff at a diabetes clinic to inform a prototype of integrated dental and diabetes care.

METHODS

Quantitative and qualitative data were collected from patients and staff at West Moreton Diabetes Clinic (WMDC) between September-October 2019. Clinical information, survey responses and dental screening results were analysed for 41 patients. Semi-structured interviews were held with six patients and a focus group with seven staff.

RESULTS

Most patients (83%) had not seen a dentist in the previous year. Of the 37 patients with remaining natural teeth, 84% required periodontal assessment and 46% had multiple carious lesions. Unmet treatment needs and rates of access were similar for private and public dental patients. Staff and patients reported high levels of support for incorporation of dental care at WMDC.

CONCLUSIONS

Integrating oral health into diabetes management is well-supported by patients and staff to address significant unmet dental needs for both public and private dental patients. Incorporating dental screening/services within diabetes clinics may increase uptake and improve awareness of its importance in diabetes management.

Income-related inequalities in unmet dental care needs in Spain: traces left by the Great Recession

BACKGROUND

Dental health is an important component of general health. Socioeconomic inequalities in unmet dental care needs have been identified in the literature, but some knowledge gaps persist. This paper tries to identify the determinants of income-related inequality in unmet need for dental care and the reasons for its recent evolution in Spain, and it inquires about the traces left by the Great Recession.

METHODS

Data from the EU-SILC forming a decade (2007-2017) were used. Income-related inequalities for three years were measured by calculating corrected concentration indices (CCI), which were further decomposed in order to compute the contribution of different factors to inequality. An Oaxaca-type decomposition approach was also used to analyze the origin of changes over time. Men and women were analyzed separately.

RESULTS

Pro-rich inequality in unmet dental care needs significantly increased over time (CCI 2007: - 0.0272 and - 0.0334 for males and females, respectively; CCI 2017: - 0.0704 and - 0.0776; p < 0.001). Inequality showed a clear "pro-cycle" pattern, growing during the Great Recession and starting to decrease just after the economic recovery began. Gender differences only were significant for 2009 (p = 0.004) and 2014 (p = 0.063). Income was the main determinant of inequality and of its variation along time -particularly for women-, followed by far by unemployment -particularly for men-; the contributions of both were mainly due to changes in elasticites.

CONCLUSIONS

The Great Recession left its trace in form of a higher inequality in the access to dental care. Also, unmet need for dental care, as well as its inequality, became more sensitive to the ability to pay and to unemployment along recent years. To broaden public coverage of dental care for vulnerable groups, such as low-income/unemployed people with high oral health needs, would help to prevent further growth of inequality.

Insurance coverage expansion and inequalities in unmet oral healthcare needs in Korea: Repeated cross-sectional analysis, 2007-2015

OBJECTIVES

This study aimed to evaluate whether Korea's 2012 health insurance expansion of adult dental care coverage reduced income-based oral health inequalities.

METHODS

This study analysed nationally representative repeated cross-sectional data from waves IV to VI (2007-2015) of the Korean National Health and Nutrition Examination Survey. The main outcome variable is unmet dental needs due to cost, and the independent variable is household income. Further, the slope index of inequality (SII) and the relative index of inequality (RII) were calculated. Calculations were adjusted for income and stratified by age group, gender and survey period. Data from the three waves were pooled to estimate the SII and RII trend coefficients between survey years. These were tested using two-way interaction terms for each age group and gender.

RESULTS

Some changes in income-based inequality trends were identified. Relative and absolute inequalities in unmet needs (indicated by the RII and SII) decreased over time for most age groups. However, this trend was not observed for older women.

CONCLUSIONS

Income-based inequalities in unmet dental needs persisted among older women in Korea despite the insurance expansion. By contrast, after the 2012 insurance expansion, the absolute and relative inequality in unmet dental needs decreased for young and middle-aged as well as older adults.

Exploring the Intersection between Social Determinants of Health and Unmet Dental Care Needs Using Deep Learning

The goals of this study were to develop a risk prediction model in unmet dental care needs and to explore the intersection between social determinants of health and unmet dental care needs in the United States. Data from the 2016 Medical Expenditure Panel Survey were used for this study. A chi-squared test was used to examine the difference in social determinants of health between those with and without unmet dental needs. Machine learning was used to determine top predictors of unmet dental care needs and to build a risk prediction model to identify those with unmet dental care needs. Age was the most important predictor of unmet dental care needs. Other important predictors included income, family size, educational level, unmet medical needs, and emergency room visit charges. The risk prediction model of unmet dental care needs attained an accuracy of 82.6%, sensitivity of 77.8%, specificity of 87.4%, precision of 82.9%, and area under the curve of 0.918. Social determinants of health have a strong relationship with unmet dental care needs. The application of deep learning in artificial intelligence represents a significant innovation in dentistry and enables a major advancement in our understanding of unmet dental care needs on an individual level that has never been done before. This study presents promising findings and the results are expected to be useful in risk assessment of unmet dental care needs and can guide targeted intervention in the general population of the United States.

Unmet Dental Care Needs among Korean National Health Insurance Beneficiaries Based on Income Inequalities: Results from Five Waves of a Population-Based Panel Study

This study investigates whether self-employed beneficiaries experience greater difficulties in accessing dental care than insured employees based on their income level. This analysis uses 2011–2015 data from the Korea Health Panel, a population-based and nationally representative sample, covering 7083 participants aged 18 years and older. We measured barriers to dental access based on unmet needs or the inability to receive necessary dental care owing to the past year’s economic burdens. The type of health insurance and household income are considered independent variables. We applied multiple panel logistic regressions and two-panel logistic regression models with a fixed-effects approach to analyze the data. Self-employed beneficiaries were 1.16 times (95% confidence interval (CI) = 1.08–1.24) more likely to experience unmet dental needs than were insured employees. Insured employees and self-employed beneficiaries belonging to the lowest income bracket were 1.76 times (95% CI = 1.53–2.03) and 2.33 times (95% CI = 1.89–2.87) more likely to have unmet needs than those in the highest income bracket. Self-employed beneficiaries were 1.31 times (95% CI = 1.21–1.43) more likely to experience unmet dental needs caused by economic burdens than are insured employees. Insured employees of the lowest income quintile were 4.15 times (95% CI = 3.41–5.05) more likely to experience unmet needs caused by economic burdens, while the odds ratio for self-employed beneficiaries was 5.47 (95% CI = 4.05–7.39). Our findings indicate gaps in unmet dental needs between self-employed beneficiaries and insured employees. The government should adopt strategies to reduce unmet needs among marginalized groups and redefine the role of national health insurance.

Long working hours are associated with unmet dental needs in south Korean male adults who have experienced dental pain

Backgrounds

We explored the association between working hours and unmet dental needs among adults who have experienced dental pain, and how this relationship varied by demographic and lifestyle factors.

Methods

We used the data of 9594 adults who reported dental pain from the Korea National Health and Nutrition Examination Survey (KNHANES) V and VI. We conducted a logistic regression analysis to determine the association between working hours and unmet dental needs, followed by a subgroup analysis and Cochran-Armitage trend tests.

Results

Among the 4203 male subjects, 1661 (39.5%) experienced unmet dental needs. They also showed a significant dose-response relationship between working hours and unmet dental needs (OR 1.21 [95% CI 0.97–1.51], OR 1.30 [95% CI 0.99–1.69], OR 1.33 [95% CI 1.04–1.71], OR 1.58 [95% CI 1.21–2.07] compared to no working hours), whereas female participants did not. The significance of the association was preserved among participants with increased consumption of alcohol, urban residence, and who brushed their teeth at least twice a day. It was also stronger among those who lacked access to dental services or did not perceive the need for dental care.

Conclusion

Among adults who have experienced dental pain, unmet dental needs had higher odds of occurring in males who worked longer, and this relationship appears to be influenced by consumption of alcohol, region of residence, tooth-brushing frequency, and access to and perception of dental care. Accordingly, policies should be drafted to reduce unmet needs by considering these factors.

Protocol for the evaluation of chewing among older adults

Abstract Objectives : To evaluate the functional and physiological structures of the stomatognathic system of the oral cavity of older adults based on self-perception, comparing the same with a professional clinical evaluation, and investigating the difficulties encountered when chewing. Method : An analytical cross-sectional study with a quantitative approach was conducted with a sample of 53 older adults aged 60 to 90 years. A protocol consisting of three questionnaires was used: a sociodemographic evaluation, a self-perception based interview with 19 questions on the chewing of the older adults and a clinical evaluation containing 30 questions covering aspects of the oral cavity tissue. The self-perception and clinical evaluation scores were compared using the Mann-Whitney test and the proportions observed for each item were compared by the binomial test. Results : It was found that the self-perception of older adults did not correspond to the result of the clinical evaluation. While 31 (58.5%) reported satisfaction with chewing, 16 (30.2%) had high/very high impairment and 14(26.4%) moderate impairment, based on the results of the clinical evaluation found. Conclusion : It was found that the chewing analysis process cannot be exclusively based on the answers provided by the older adults, and assessment proved to be more accurate when combined with a clinical evaluation performed by a professional.

The burden of tooth loss in Italian elderly population living in nursing homes

Background

This survey aims to evaluate the prevalence and severity of tooth loss in the Italian elderly population living in nursing homes and to associate the oral data with demographic, socioeconomic factors, the Mini-Mental State Examination (MMSE), the Body Mass Index (BMI) and the Mini Nutritional Assessment (MNA) scores.

Methods

A cluster sample method was performed using each nursing home as a cluster. Twenty-three nursing homes located in the five areas of the Italy (North-West, North-East, Centre, South and Islands) were selected. An informed consent to participate was distributed by the personnel of the selected nursing homes and signed directly by subjects/caregivers; 2114 forms were distributed, 1998 forms signed and finally 1976 subjects were examined. Chewing ability was scored as good (≥10 functional units (FUs)), sufficient (7–10 FUs), and insufficient (< 7 FUs). The presence of prosthetic dental restorations was summarized as: absent of prosthesis, fixed prosthesis, removable prosthesis, combined prosthesis. Age, gender, socioeconomic status, MMSE, BMI and MNA were obtained from medical charts.

Results

Almost three quarters of the subjects were ≥ 80 years old (74.37%) and women (74.04%). The prevalence of edentulism was 42.10% with a large variation among the five areas of Italy (from 34.43% in Centre to 53.46% in North-West). Insufficient presence of FUs was preeminent in each age group (prevalence 42.10%) and statistically associated to age and to female gender (p <  0.01). Overweight/obese (7.47%) subjects showed the highest FUs. Area of living, MMSE (both < 0.01), BMI (p = 0.01) were statistically significant associated to the type of prosthetic dental restorations in the oldest group. Subjects with no mental impairment showed the highest percentage of prosthetic dental restorations (32.36%).

Conclusions

More than half of the sample has an insufficient number of functional units for chewing and this is more pronounced in females. The presence and the type of prosthetic dental restorations are linked to cognitive impairment: the higher is the mental impairment the higher is the number of subjects with absence of prosthetic restorations. The findings of this national survey highlight the need for public health policy, aiming to increase awareness regarding oral health though health education.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0760-0) contains supplementary material, which is available to authorized users.