UNMET ORAL HEALTH NEEDS OF ELDERLY PATIENTS VISITING DENTAL

HOSPITAL

Abstract
Objective:
Material and Methods:
Results:
Conclusion:
Keywords:
 INTRODUCTION
Conventionally, “elderly” has been defined as a chronological age of 65 years or older, while
those from 65 through 74 years old are referred to as “early elderly” and those over 75
years as “late elderly.”1

Globally, the elderly population is growing faster than other groups. 2 However, it is now
estimated that two thirds of the world’s aging population are in developing countries among
which 55% belong to Asia.2

Based on this population, medical and dental professionals need to pay attention to several
factors in diagnosing, treatment planning, and working with other scientific professionals to
provide their best to this group of population. The amount of tooth loss remains high in
geriatric patients due to caries, periodontal diseases, and lack of information. 3
Advances in dentistry have resulted in retaining more of their teeth along with increased
awareness of oral health care and extended retention of natural teeth.4
As the elderly population is increasing, there is an increased need for health care services.
However, most of these needs are not fulfilled and factors like socio-economic status,
education, health insurance, trust in medical, personal and health needs are associated with
this issue.4 Elderly who belongs to low economic status and educational groups are more
likely to experience unmet oral healthcare needs than those with higher income and more
educational level.3,5 Previous studies have reported that untreated oral health needs, such
as edentulism, poor oral hygiene, dental caries, periodontal diseases, and soft tissue lesions,
can have a negative impact on the quality of life of patients. 6 A study conducted on an
Australian population revealed that 46.7% patients had decayed teeth, 33.3% had bleeding
gums and 66.3% need dental treatments. In a study conducted among Hazara refugees,
participants reported poor oral health status and low priority on their oral health needs.
Furthermore, they faced limited access to oral health practitioners and education resulting
in unmet needs. Another study found that 98% of participants presented with severe
gingivitis due to poor oral hygiene resulting from poverty and cultural differences. 14
These needs are identified with the help of baseline interviews, oral examination and
various questionnaires like Geriatric Oral Health Assessment Index (GOHAI), Oral Health
Impact Profile (OHIP), Dental Impact Profile (DIP), Dental Impact on Daily Living (DIDL) and
Oral Impacts on Daily Performance (OIDP) of which GOHAI and OHIP are the instruments
with good reliability and validity.10 OHIP has also been widely used and validated but this
index has a bias towards more serious conditions like the extent to which oral health
impacts work.7

GOHAI has been validated and is reported to be more successful than OHIP and it does not
change after treatment and does not depend on the intensity of pain. 8 It was developed to
evaluate 3 dimensions of oral health-related quality of life; (a) physical functions (b)
psychological functions (c) discomfort and pain. 7 GOHAI consists of a 12-item questionnaire.
For each answer a score is assigned ranging from 0-5. It has a good reliability and validity of
which the internal consistency in geriatric patients measured by Cronbach Alpha was 0.77. 9
Therefore, the objective of this study is to evaluate the mean values of GOHAI, Community
Periodontal Index of Periodontal Needs (CPITN), Decayed/Missing/Filled Teeth (DMFT) index
and Oral Hygiene Index Simplified (OHIS) and their relationship with dental status of elderly
population visiting Islamabad Dental Hospital in order to assess the unmet oral health
needs2. These indices are helpful as they describe the different unmet and treatment needs
at community level.
 METHODOLOGY
A cross-sectional study was conducted at the department of Prosthodontics, Islamabad
Dental Hospital after ethical approval from Institutional Review Board (Ref #
IMDC ). The study was done from August, 2023 to March, 2024 on all patients
visiting the Prosthodontics department. The sample size was calculated using the WHO
sample size calculator. A sample of 68 patients, who presented in the department of
Prosthodontics and met the inclusion criteria, were included in the study. They were briefed
about the study and written informed consent taken from every patient for participation in
the study. Demographic details, Geriatric Oral Health Assessment Index Score (GOHAI),
DMFT Score, CPITN Score and Oral Hygiene Index Simplified Score (OHIS) were recorded on
the study performa.
The patient was seated comfortably on a dental chair under adequate illumination.
Sterilized instruments including mouth mirror, Community Periodontal Index (CPI) probe,
tweezers and cotton rolls were used. GOHAI Score was obtained through a series of 12
questions, with the patients’ responses duly noted on the performa. This performa was both
in English and Urdu language for the patients’ ease. Subsequently, a thorough oral
examination was done to assess decayed teeth, the count of missing teeth due to caries and
teeth with fillings facilitating the determination of DMFT Score.
A 0.5 mm ball ended CPI probe was used to assess the CPITN Score in accordance with the
WHO standards. Individual scores were determined for each sextant containing a minimum
of two functional teeth, excluding third molars. The scoring was categorized as ‘0’ for no
bleeding and no calculus with no periodontal pocket, ‘1’ for bleeding on probing gingival
margin but no calculus and periodontal pocket, ‘2’ for presence of calculus with or without
bleeding but no pathological pocket, ‘3’ for pathological pocket of 4-5 mm with or without
bleeding and calculus and finally ‘4’ for pathological pocket of 6 mm or more with or
without bleeding and calculus. 15
The collected data were encoded, entered and statistical analysis was done through
Statistical Package for Social Sciences (SPSS) version 22 software. d
 RESULTS
DISCUSSION
CONCLUSION
ETHICAL APPROVAL:
PATIENTS’ CONSENT:
COMPETING INTEREST:
AUTHORS’ CONTRIBUTION:
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