Oral diseases are progressive and cumulative across the life span and due to this reason, the oral health of the institutionalized elderly is of concern within the realm of geriatric care. An improvement in oral health among the institutionalized elderly will boost their social life, self-confidence, mastication and nutritional status, thereby bringing a positive outlook. To assess the periodontal status, dental caries experience, prosthetic status, and prosthetic need of institutionalized elderly in Mangalore. A cross-sectional study was conducted to assess the dental caries experience, periodontal status, prosthetic status, and prosthetic needs of 143 elderly individuals living in geriatric homes in Mangalore city. The demographic data, periodontal status, prosthetic status, and prosthetic need was obtained using the WHO Oral Health Assessment Form 1997. Dental caries experience was recorded according to the WHO modified DMFT Index. Descriptive statistics was obtained using SPSS version 16. The mean dental caries experience of the study subjects was 8.80. The presence of supra or sub gingival calculus was noted in 44.8 % of the subjects and the presence of a pathological pocket of 4 mm or more was seen in 32 %. About 33 of the subjects did not require any kind of prosthesis in the upper & lower arch. From this survey of the institutionalized elderly population, it was evident that, half of them had supra or subgingival calculus deposits and more than 76.9 % have one or the other need for a prosthesis.
Ages nearing or surpassing the average life span of human beings is considered as old age.
Homes for the older age people serve as an alternate to home care, to ensure social and financial stability and to provide rehabilitation.
A cross sectional study was conducted during the period from June 2018- September 2019 to determine the dental caries experience, periodontal status, prosthetic status, and prosthetic needs of institutionalized elderly individuals living in geriatric homes in Mangalore city, Karnataka, South India.
Mangalore has a total of 10 old age homes, out of which 1 is acting as a day care recreational centre for the old, without any in-house facilities, and therefore was not included in the study. After obtaining the ethical approval from the Institutional Ethics Committee (AJEC/REV/23/2018) the investigators sought written approval for the conduction of the study from the old age home authorities. A total of 212 inmates were all together present in these homes.
The subjects who gave informed consent and who fulfilled the following inclusion and exclusion criteria were included for the study:
Subjects who were physically and mentally capable for oral examination.
Subjects above the age of 60 years.
Total of 143 inmates from these homes were finally included in the study.
The information related to sociodemographic data, periodontal status, prosthetic status, and prosthetic need was obtained using the WHO Oral Health Assessment Form 1997. Dental caries experience was recorded according to the modified DMFT Index
Descriptive statistics was obtained after the data was tabulated and analyzed using SPSS version 16 (SPSS Inc, Chicago, USA).
Study participants comprised of 143 individuals with a mean age of 62.01 years, about 11.9% of them were males and 87.4% of them were females. (
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143 |
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62.01 years |
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11.9 % |
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87.4 % |
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It can be found from
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4.64 |
1.41 |
0.05 |
6.11 |
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7.00 |
1.72 |
0.52 |
9.20 |
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6.69 |
1.69 |
0.48 |
8.80 |
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Code 0 |
26 (18.2) |
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Code 1 |
18 (12.6) |
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Code 2 |
64 (44.8) |
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Code 3 |
28 (19.4) |
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Code 4 |
04 (4.9) |
The distribution of study population according to prosthetic need of upper and lower arches is shown in
It can be inferred from the table that more than two thirds (76.9%) of the population, required a prosthesis - either a partial or full denture. Out of this, a half of them were in need of either a single/ multi/combination of prosthesis in the upper (48.2%) and lower (49.6%) arch respectively. A full prosthesis in the upper or lower arch was required for about 28% of the population.
The distribution of study population according to their current prosthetic status of upper and lower arch is shown in
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No prosthesis |
126 (87.5) |
127 (88.8) |
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Bridge |
04 (2.8) |
02 (1.4) |
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More than one bridge |
02 (1.4) |
01 (0.7) |
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Partial denture |
03 (2.8) |
06 (4.2) |
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Both bridge and partial denture |
07 (4.9) |
06 (4.7) |
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Full removable denture |
01 (0.7) |
01 (1.4) |
It was found that, 87.5% and 88.5 % of the study subjects had no prosthesis in upper and lower arches respectively. The percentage of study population who had partial denture in upper and lower arches was 2.8 % and 4.2 %. The percentage of subjects with bridge and full removable denture were more in upper arch when compared to lower arch.
The present study aimed at understanding the prosthetic status, prosthetic needs, periodontal status, and dental caries experience among the institutionalized elderly people of Mangalore city. Lack of trained health workers, incapability of caretakers or patients to maintain good oral hygiene, deficit financial support and inefficient dental health-care delivery structure can be considered as the reason for a general lack of oral health among elderly.
The periodontal conditions revealed that 44.8% of the study subjects had calculus, followed by 23.8 % with periodontal pockets, which was in accordance with a study conducted by Thakare V
The present study revealed that 88% of the total population surveyed did not have any prosthesis and none of the subjects had partial dentures, which is in accordance with a study conducted by Shenoy RP
Protecting the dignity of the elderly and stimulating a life with purpose is everyone’s duty to those of the yester years. As dental professionals, the primary key to improving oral health status of the elderly in old age homes is to understand the need and working towards diligent analysis of the various factors that hamper proper oral hygiene in them.
From this survey of the population, it can be drawn that the need is alarming, and the resources are minimum.
Certain recommendations for ameliorating dental disease burden for further perusal maybe:
To create personalized oral care plans for each resident based on their preference and needs.
Promoting collaborative actions amongst private practitioners of the neighbourhood, dental institutions, and the care home authorities to develop and implement targeted oral health promotion programs.
Implementing periodic oral health promotion programs like - nonalcoholic mouth rinse program, hydration-breaks program, lip & oral moisturization program, gentle brushing program, educational talks and video campaigns, training of care providers.
Design and implement standard protocols of care at each level of patient entry.
Facilitate and fund on site dental clinics/mobile dental van services - with once-a-week specialist visits.
Initiate and encourage collaborations with dietitian & nutritionists in treatment planning.
Explore the possibility of automated/ robotic designs/innovations in the area of adaptive oral care products, devices and services.
Combine efforts with a mental health worker in eliminating the fear and resistance in adopting a new oral hygiene practice.
Changes at the policy level in making dental insurance available to the elderly.
Various governmental agencies could promote research in this area, considering the vulnerability and accumulated unmet needs of the institutionalized elderly.
A significant proportion of the population, who appears to be in foster care, suffers a plethora of oral diseases, which could be overcome by incorporating patient compliant, innovative, and comprehensive methods of care and services.
In Mangalore, as a step towards achieving the higher aim of curbing the dental disease burden among this needy population, the authors devised a planned oral health promotion program for the institutionalized elderly, in all the 09 old age homes in Mangalore City during the period from June 2018 - May 2019.
In the initial phase one each session of awareness on various aspects of oral hygiene was given in the local language to the inmates and care takers by a trained dentist. It was succeeded by oral screening camps for all the inmates. We screened around a total of 212 inmates including those who are bedridden.
The phase 2 of the program was subsequently carried forwards with treatment camps at 5 of the old age homes. A total of 48 inmates underwent various treatments for dental problems. Treatments including oral prophylaxis, GIC and Composite restorations, and minor extractions were carried out onsite with the help of portable dental chairs & units and those requiring complex treatment procedures were referred with transport facility to the dental college.
Phase 3 of the program included denture camps for those willing. A total of 08 patients received partial denture, while 01 complete denture was delivered.
Presentations at conference: nil.
Source(s) of support: nil.
Conflicts of Interest: nil.
Dr. Vijaya Hegde: Conceptualization, Methodology, Writing - Review & Editing, Supervision.
Dr. Teenu Thomas, Dr. Aparna M, Dr. Sharanya Sreekumar: Investigation, Formal analysis Writing - Original Draft, Visualization.
We, certify that the manuscript has been read and approved by all the authors, that the requirements for authorship as stated in this document have been met, and that each author believes that the manuscript represents honest work.