Oral and dental health status of elderly in south

【摘要】 Objective:To know elderly oral and dental health status. Methods: The population (n=202) was elderly from Government Health Center in South and West Jakarta. Oral and dental health examination based on oral hygiene index simplified (OHIS)， decay， missing， filling teeth (DMFT) index， the presence of periodontal and oral mucous lesions， mastication function that was considered by anamnesis， mobility and number lost of maxillary teeth， and occlusion contact.Results: Most respondents had caries lesions (84%)， denture prosthesis needs (97%)， periodontal lesions (79%)， mastication dysfunction (51%)， sublingual varicosities (52%)， and a small number of oral mucous denture related lesions.Conclusion: Many cases needed promotion， curative， and rehabilitative treatments; therefore it was suggested to encourage oral and dental health care education as a part of general health care promotion to increase the quality of elderly health care service with the considerations of social and economy aspects.

【关键词】 Elderly; West and south of Jakarta; Oral and dental health status

　　 　　INTRODUCTION

　　Recently， the elderly population in the world tends to become larger and larger as a result of life expectancy increase. It has been suggested that there is almost 500 millions elderly with the age up to 60 years throughout the world. In Indonesia at the year of 2000， the elderly becomes 22.2 millions. World Health Organization (WHO) stated that around the year of 2020， among 1 000 millions of elderly in the world， 710 millions scattered at developing countries[1].

　　The life expectancy in Indonesia will be increase to 65 years[2]. Indonesian Social Department statement in 1998 revealed that people whose age up to 60 will be categorized as elderly. The data of Regional Office Indonesian Health Department showed that among the total amount of population over 65 years (239.100) in Jakarta， 109.886 is in South and West of Jakarta[3].

　　It has been known that the physical condition of elderly is quite different from healthy adult. Many studies suggested that physiology of human organs was changed as aging processing including their physical， biological， mental， social and economic excesses. Medical and Dental Research proved that systemic and oraldental diseases give a significant impact on human and society. In fact， the elderly diseases are not different from the younger age diseases; however there is an increase of frequency due to the organ physiology changes therefore the elderly common diseases occupy important things. Oral and dental diseases in elderly will impact on the lost of job， nutritional status， discomfort， esthetic disturbances， insomnia， diet pattern and lower social contact[4].

　　Caries lesion is a significant problem in elderly. Cervical caries attacks more than 63% people of 6569 years and more than 70% of 7579 years old people[5，6]. The caries incidence of elderly is high[7]. The reducing of salivary flow factor has an important role in pathogenesis of caries. Periodontal disease is also an important problem of elderly dental health status. The sub gingival calculus acts as a local etiological factor of rapid progressive periodontal disease. The alveolar resorption of mandible and maxilla was a common feature in edentulous areas. Elderly has a high risk factor of ridge atrophy， hyperplasia and hypermobility pathological ridge due to unfitted dentures within the highly adapted tissues. The problems of denture in elderly patients are stomatitis， candidiasis， benign hyperkeratinized lesion， papillary hyperplasia， vestibular ulceration and angular cheilitis[5，6]. Mastication function is related to tooth lost， pain， malposition， attrition， low vertical dimension， unfitted dentures， and temporomandibular disorders. Mastication ability function， social interaction， and nutrition condition were influenced by the lost of teeth， mastication teeth surface destruction， occlusion pattern， arch relationship， neuromuscular function， retention factor of dentures[5，6].

　　Based on the statement above， this study was conducted to find out oral and dental health status of elderly in South and West Jakarta including oral hygiene， caries incidence， edentulous and prosthesis purchasing， oral mucous and periodontal health status， and the mastication function in order to purchase epidemiology data for Elderly Health Program as a supporting material for the intensification and extension of Regional Elderly Health Program Plan， fulfill Government (Indonesian Health Department) objectives to succeed Elderly Health Service Program especially Elderly Oral Health Service Program， inform data for further research， and nourish general knowledge especially in dentistry.

　　MATERIALS AND METHODS

　　This type of research is a cross sectional observational epidemiological study.

　　The population was elderly with the age of &> 60 years from Government Health Center in South and West Jakarta. The total sample was 202 (31 male and 171 female).

　　Oral and dental health examinations based on oral hygiene index simplified (OHIS) index， caries lesion， tooth lost， decaymissingfillingteeth (DMFT) index， oral mucous and periodontal health， and mastication function. Oral mucous health based on the presence of white lesions i.e. leukoedema， homogenous leukoplakia， frictional keratosis， nonerosive lichen planus， acute pseudomembranous candidiasis; red lesions i.e. denture stomatitis; gray lesions i.e. sublingual varicosities， smoker melanosis; red and white lesions i.e. nicotinic stomatitis， erosive lichen planus， speckled leukoplakia; exophytic lesion i.e. denture hyperplasia; ulcer i.e. decubital ulcer， cheilitis angularis， acute necrotizing ulcerative gingivitis. Periodontal health examination was based on the presence of gingivitis. Mastication function was considered by anamnesis， the mobility of teeth， total lost of teeth in maxilla， and the occlusion contact.

　　Janti Sudiono. Oral and dental health status of elderly RESULTS

　　The mean age of respondents was 66.7 years with the ranges of 60～85 years old， including 45 patients in 60 years old， 56 in 61～65 years old， 38 in 66～70 years old and 63 older than 70 years old. Among 170 respondents examined for OHIS， 36 were in good， 108 in moderate and 26 in poor condition. Among 201 respondents examined for oral mucous health status， there were 14 white， 5 red， 3 mixed red and white， and 115 gray lesion cases. Among 185 respondents examined for periodontal health status， there were 147 cases of periodontal lesions. Among 185 respondents examined for DMFT index， 156 had carious lesions， 26 were in total edentulous. Mastication dysfunction was found in 94 cases (Table 1). Among 178 respondents with denture indication， 66% had no denture， 3% needn't denture， and only 57 (31%) wore denture.

　　Table 1 Variables distribution among respondents

　　VariablesMaleFemaleMastication dysfunction(+)1876Mastication dysfunction(-)1279Periodontal lesions(+)9138Periodontal lesions(-)2117Oral mucous lesions(+)21116Oral mucous lesions(-)1054OHIS good(score = 0～1.2)1521OHIS moderate(score = 1，2～3)1098OHIS poor(score = &>3)026DMFT(Score = 0)02DMFT(Score = 1～4)05DMFT(Score = 5～9)021DMFT(Score = 10～14)023DMFT(Score=15～19)036DMFT(Score=20～31)567DMFT(Score=32)251

　　DISCUSSION

　　Elderly is a part of world population who is growing rapidly〔8〕. In Indonesia， the percentage of elderly is 10% of total population. Jakarta as a metropolitan city and capital city of Indonesia will have 239.100 elderly by the year of 2020 whereas 109.886 of them stay in South and West Jakarta.

　　The total sample in this study was 202 elderly (31 male and 171 female) who live in South and West Jakarta. The mean age was 66.7 with the range of 6085 years old， 31% of them were over 70 years old.

　　The increase of life expectancy gives an impact on the increase challenging and demand of oral and dental health treatment for elderly. This condition requires the holistic approaching of clinical， social， function， and communication needs[8]. Generally， the systemic and oraldental health status of elderly is not in good condition， less than 50% of 350 elderly had been in good oral health condition〔9〕.

　　Many studies mentioned that caries lesion is a significant dental health problem in elderly. In population with the age of 6569， 68% of them already had edentulous diseas〔10〕. Caries lesions had been found in more than 63%. In this study， 156 (84%) among 186 respondents had caries lesions and 97% of them needed rehabilitation of mastication function by dentures. However， only 66% of this 97% had been denture wearers.

　　Mastication function in this study was evaluated based on anamnesis， the occlusion contact， the number of mobile teeth. For respondents who wore dentures， the fitness of dentures is one of criteria to consider the mastication function. In this study， more than half of respondents (94/185) had mastication dysfunction.

　　Oral hygiene is one of important factors which responsible for the presence of teeth in oral cavity. The oral hygiene demand among respondents in this study was low. It was reflected by the data of OHIS that 64% (108/170) of dentate respondents were in moderate oral hygiene condition whose score was 1.2  3.0.

　　Research in United States revealed that 34% of 65 years old person had periodontal diseases10. However， this periodontal disease is not due to aging process， but influenced by risk factors such as smoking， lack of oral and dental health care， plaque and calculus， and general periodontal disease historical background〔5，6〕. Periodontal health status in this study was measured by the presence of gingivitis. The periodontal lesion in this study was high (79%). Oral mucous lesion is also a significant problem in elderly. Berkey et al〔10〕 in their study mentioned that as much as 60% of denture wearers showed related lesions including denture stomatitis， candidiasis， hyperkeratosis， papillary hyperplasia， ulceration and angular cheilitis. Oral cancer tends to increase in elderly. In United States〔10〕， it had been suggested that the prevalence of cancer was 2.2%. This rate will increase triple for 55 years over group population. Leukoplakia as one of resources of oral malignancy condition can be found frequently in elderly. Oral mucous lesions in this study had been grouped into white， red， red and white， and gray lesions. Around 52% of respondents (115/201) had gray lesions. Most of gray lesions in this study were sublingual varicosities. Denture related lesions in this study were found in 5 of 56 denture wearers.

　　Among 185 respondents， 84% had caries lesions， 97% needed rehabilitation treatment by denture prosthesis. More than half of respondents had mastication dysfunction. Periodontal lesions had been found in 79% respondents. Most of oral mucous lesions (52%) were sublingual varicosities. There was a small number (9%) of oral mucous related denture lesions. The awareness of how important oral and dental health care was low， whereas more than half (64%) of respondents were in moderate OHIS group.

　　Based on the oral and dental health features of elderly， this study found many cases which needed promotion， curative， and rehabilitative treatment， therefore this study suggested that we need to encourage oral and dental health care education as a part of general health care promotion in addition to increase the quality of elderly health care service with the considerations of social and economy aspects.

参考文献

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　　5 Burt BA. Periodontitis and aging: Reviewing recent evidence. J Am Dent Assoc 1994; 125: 273279.

　　6 Beck JD， Koch GG， Rozir RG， Tudor GE. Prevalence and risk indicators for periodontal attachment loss in a population of older community dwelling blacks and whites. J Periodontol 1990; 61: 521528.

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