| dc.description.abstract | Background
The ageing population is one of the great challenges that will confront health services in developed countries in the coming years. It is estimated that by 2050, the number of adults aged 60 years and older worldwide will increase from 901 million to 2.1 billion, and the adults called ?oldest old? (80 years and over) will more than triple (125 to 434 million), as compared to 2015 (United Nations, 2015). In Ireland, in 2011 adults aged 65 years and over comprised 11.4% of the total population and this proportion is predicted to reach 22.4% in 2041. The proportion of adults aged 80 years or older is predicted to be 7.5% of the total population in 2046 (Central Statistics Office, 2013, Central Statistics Office, 2017).
The ageing population faces the challenge of different chronic diseases including physical, mental and oral health-related conditions. Oral health, directly and indirectly, mirrors the health of the entire body and mind, and poor oral health has been called a silent epidemic (Benjamin, 2010). It is impossible to be healthy without a healthy mouth because oral health has a bidirectional relationship with systemic, physical and mental health (Liljestrand et al., 2015, Petersen and Ueda, 2005, Okoro et al., 2012, Cerutti-Kopplin et al., 2016). For example, older adults may, as a result of poor oral function, eat a poor-quality diet and avoid social interaction and in this way, poor oral health may adversely affect health and wellbeing. Similarly, loss of physical and cognitive function, and increasing frailty, often result in less attention to oral health and reduced access to the care that is needed to maintain oral function.
In Ireland, it is almost eighteen years since the last national data on oral health status was collected. The Irish Longitudinal Study on Ageing (TILDA) Wave 3 provided a timely opportunity to carry out an oral health assessment of a subset of TILDA participants aged 50 years and over, and to relate these oral health findings to the socioeconomic status and systemic health conditions of the same cohort.
Aims of the study
? To evaluate the oral health status of a sample of community-dwelling adults aged 50 years and over in Ireland
? To explore the relationship between self-reported oral health status and objectively measured oral health
? To examine any relationship between systemic health conditions (diabetes, atherosclerotic cardiovascular disease, osteoporosis, and cognition) and objectively measured oral health (number of teeth and periodontal health).
Methods
An opportunistic sample of TILDA Wave 3 respondents, attending for health assessments at the TILDA health assessment centre in Trinity College Dublin, was offered an oral health examination by a dentist. To allow for international and national comparisons, WHO oral health assessment criteria and criteria used in previous oral health surveys in Ireland were used. Edentulism, mean number of teeth, functional dentition (10 or more tooth contacts), periodontal health, tooth wear, DMFT, and restorative treatment needs were recorded. The oral mucosal lesions, salivary flow, and temporomandibular disorders were not recorded.
For evaluation of the relationship between self-reported oral health and objectively measured oral health, the five self-reported questions related to oral health and access to dental care were used to relate with objectively measured oral health (Appendix 1). These oral health questions were included in the Computer Assisted Personal Interview (CAPI) component of TILDA data collection.
For the evaluation of the relationship between systemic health conditions and oral health status of community dwelling adults in Ireland, the objectively measured and self-reported data of systemic health conditions, available from TILDA data of Wave 1 and Wave 3 was used (for details see Chapter 6 methods section). Quantitative methodology was used to obtain the results.
Results
Out of the 3111, TILDA Wave 3 sample, who were offered the oral health assessment, 2539 were examined. For the purpose of analysis, the adults below 50 years of age (n=31) and adults with an incomplete oral health assessment (n=4) were omitted from the sample. The final oral health assessment (OHA) sample consisted of 2504 people, giving a response rate of 80.5%.
Objective 1: among the adults aged 50 years and over, 9.9% (249) were edentate; 11.5% (159) of females and 8% (90) of males. Of those aged 65-74 years, 11.7% (107) were edentate compared with 25.4% (94) edentate in the 75 years and older age group. Of those aged 65 years and older, 15.6% were edentate compared with 40.9% in the 2000-02 Irish national oral health survey (Whelton et al., 2007). The mean number of teeth in those aged 65 years or older was 14.9 for males and 14.2 for females. The 2000-02 figures for the same age group were 9.9 and 7.4 respectively. Approximately 56.8% of the dentate sample had 10 or more tooth contacts. Overall, the mean DMFT at the cavitation level was 18.5 and DMFT at the visual caries level was 18.6. Among the components of DMFT, the mean number of missing teeth was 10.3, mean filled teeth was 7.7 and mean decayed teeth was 0.5 per person. For adults aged 65 years and over, the mean DMFT at cavitation level decreased from 25.9 to 24.4 between 2000-02 and 2014-15.
Among dentate adults aged 50 years and over, 5.7% had deep pockets, 50.8% had shallow pockets, 31.7% had calculus, 3.5% had bleeding and just 5.8% had healthy periodontium reported by maximum CPITN score. In 2014-15, among adults aged 65 years and over, proportion of adults with deep pockets (4.7% vs 12.0%) was less and proportion of adults with shallow pockets (46.4% vs 37.6%) and calculus (35.1% vs 29.5%) was more than in 2000-02. In the dentate sample the highest proportion of adults had dentine exposed on less than one-third of a tooth surface and very few adults had no wear. There was a gradual decrease in tooth wear with age, which is probably a reflection of fewer retained teeth with age. When gender difference was considered, more females were recorded as having no wear. Similarly, more females had wear on less than one-third of a tooth surface whereas there was the opposite trend in respect of wear on more than one-third of teeth the tooth surface. Furthermore, it was also evaluated that adults with medical card, less education, and living in a rural area had poor oral health compared to adults without medical card, higher levels of education and living in Dublin/Co. Dublin.
Objective 2: the self-reported (subjective) complete denture wearing and objectively measured edentulism (9.8% vs 9.9%) were similar in the OHA sample (n=2504). Overall, 9.2% fewer respondents reported the self-reported denture treatment need (46.6%) as compared to clinically assessed denture treatment need (55.8 %). The self-reported denture treatment need (repair or replacement) cannot be used as a replacement of objectively measured denture treatment need because a much lower proportion of adults self-reported treatment need for lower dentures only and a higher proportion of adults self-reported treatment need for upper dentures only, when compared with clinically examined treatment need. In this research, self-reported oral health status (excellent, very good, good, fair and poor) had a statistically significant relationship (p<0.05) with the objectively measured number of teeth (Kruskal-Wallis test) and 10 or more tooth contacts (Chi-square). Self-reported eating and speaking difficulty had a statistically significant relationship with (p<0.05) fewer than 10 tooth contacts. Self-reported difficulties with teeth did not have a statistically significant relationship with objectively measured periodontal health. Self-reported frequency of dental visits was also a good indicator of objectively measured mean number of teeth, mean DMFT and tooth contacts.
Objective 3: among dentate adults in the OHA sample (n=2255), there was no statistically significant relationship of periodontal health with diabetes, osteoporosis, and cognition, both before and after controlling for cofactors of age, gender, BMI, smoking, education, and area of residence. This research found atherosclerotic cardiovascular disease (ACD) was a risk indicator for shallow and deep pockets relative to the healthy periodontium. However, after controlling for the other cofactors of age, gender, BMI, smoking, education, area of residence, there was no relationship between atherosclerotic CVD, and periodontal health.
In relation to edentulism in the OHA (n=2504) sample, diabetes (RRR=1.58, CI= 1.12-2.23) and cognition (RRR=0.94, CI= 0.89-0.98) were risk indicators for being edentate relative to having 20 or more teeth, before and after controlling for other cofactors; age, gender, BMI, smoking, education and area of residence. ACD and osteoporosis were also risk indicators for being edentate relative to have 20 or more teeth, but there was no relationship between ACD and edentulism and osteoporosis and edentulism after controlling for other cofactors; age, gender, BMI, smoking, education, and area of residence. This research also found that in the OHA sample (n=2504), diabetes (RRR=1.38, CI =1.10-1.73), CVD (RRR =1.33, CI=1.07-1.65), osteoporosis (RRR = 1.30, CI=1.02-1.67) and cognition (RRR=0.88, CI=0.86-0.91) were individual risk indicators for having 1-19 teeth relative to have 20 or more teeth, both before and after controlling for other cofactors of; age, gender, BMI, smoking, education and area of residence.
Conclusions
When the findings of this research were compared with the previous Irish oral health survey of 2000-02, the results suggested a considerable improvement in the oral health status of community dwelling adults aged 50 years and over, in Ireland. However, loss of teeth is still common, particularly among older adults. Self-reported edentulism was the same as clinically examined edentulism and could be used as a replacement of clinically examined edentulism, but self-reported denture treatment need (repair and replacement) cannot replace clinically assessed denture treatment need (repair and replacement). Self-reported oral health status, difficulties with teeth and frequency of dental visits were good indicators of objectively measured number of teeth and 10 or more tooth contacts but were not good indicators of objectively measured periodontal health.
Systemic health diseases (diabetes, CVD, osteoporosis, and cognition) were risk indicators for having fewer teeth in presence of cofactors of age, gender, education level, area of residence, BMI, smoking, education level and area of residence. So older adults with these systemic diseases should be prioritised for restorative treatment need relating to missing teeth or no teeth.
These findings provide a valuable resource for oral health policymakers, regarding oral health status and treatment needs of adults aged 50 years and over, and its relationship with sociodemographic and systemic health conditions, in Ireland. This research has also highlighted the high-risk groups for treatment needs, in relation to sociodemographic and systemic health conditions. These groups should be prioritised for oral health care in Ireland. | en |
