Utilization of Dental Care, Tooth Loss, and Oral Health-Related Quality of Life in Older Adults Visiting Dental Care Centers in Indian Settings

Background: Oral illness prevalence is rising globally in a significant means, with a heavier affect and concern on creating international locations like India. Also, restricted knowledge in literature has beforehand assessed oral health-related high quality of life (OHRQoL) in older adults in Indian settings.

Aims: The current research aimed to judge OHRQoL in older adults searching for dental care in Indian settings.

Methods: In 140 topics, an oral examination to detect any oral situation was completed adopted by filling out a questionnaire for OHRQoL evaluation utilizing the Geriatric Oral Health Assessment Index 12 (GOHAI-12). The remedy wants of every research topic had been ruled by prosthetic and dental standing individually. Statistical analysis of the info collected was completed to formulate the outcomes.

Results: Concerning age, a big affect was seen, the place rising age was related to poor high quality of life (p=0.025). For gender, older females had poor OHRQoL with p-values of <0.001, 0.01, 0.04, and <0.001 respectively for behaviour, psychological, pain and discomfort, and functional limitation. Also, edentulous patients had poorer OHRQoL compared to subjects with >20 tooth

Conclusion: The current research concludes that oral illnesses can considerably have an effect on the OHRQoL, with increased feminine and edentulous state preponderance. Early prognosis and administration can help in bettering QoL in older adults.


Health is the primary concern for healthcare professionals, and it’s all the time taken as the essential proper of human beings. Health can also be a broad social purpose globally, together with in India. Oral well being can also be an important part of the oral well-being and well being of each adults and youngsters. However, dental well being is usually disregarded as an essential facet of general well being. Following the WHO tips and assertion, oral well being goes past simply wholesome dentition. A wholesome oral cavity, in accordance with WHO, is freed from oral cavity problems and illnesses similar to tooth loss, tooth decay, periodontal illnesses, cleft lip and cleft palate start defects, oral sores, throat and oral most cancers, and/or power facial and mouth ache [1].

Diseases affecting dentition are often not self-limiting entities. When not handled, dental conditions can have an effect on the general high quality of life and the general well-being of the affected topics. Regular well being checkups and day by day house oral care are important steps to preserving the well being of the tooth and general dentition. Dental companies will be outlined as the primary reported dental go to inside a go to sequence or dental visits missing in a particular timeframe or annual dental visits per particular person or per individual proportionally visiting a dentist in a yr. In just a few international locations, dental companies are additionally assessed by common bills for routine or emergency dental visits. Assessing these companies additionally helps in implementing and planning oral well being companies on the group degree [1,2].

In creating international locations like India, the generally reported oral well being care considerations, together with oral cancers, periodontitis, and dental caries, pose a excessive concern among the many group. They additionally have an effect on the social lives of the affected topics by imposing restrictions on their house, work, and college lives, leading to a decreased high quality of life in topics of all age teams. The high quality of life is extra severely impacted in topics with low socioeconomic standing. In creating international locations like India, the distinction in oral well being is considerably excessive within the rural and concrete populations. Although numerous advances have been reported in dental applied sciences, procedures, and supplies, there’s restricted entry to oral well being look after the sub-groups of the inhabitants [2,3]. Oral well being is poorer in older adults owing to the cumulative and power nature of assorted situations affecting oral standing. These embody tooth loss, periodontal illnesses, and dental caries, as these are generally encountered oral illnesses. Various situations regarding basic well being similar to diabetes and cardiovascular illnesses may result in elevated oral illnesses in a person, together with periodontal illness, altered style, xerostomia, and others. Tooth loss, widespread in older people, can result in compromised esthetics, phonetics, and chewing difficulties. Difficulty in chewing can result in compromised vitamin uptake, which may proceed to a debilitating stage if extended [1].

The older inhabitants includes a big portion of the general inhabitants globally, owing to elevated life expectancy and improved healthcare constructions worldwide. The aged inhabitants is anticipated to extend by two billion by the tip of 2050. In India, older adults account for 9% (103 billion) of the whole inhabitants. The prevalence of caries in India is 31 to 100% [2]. Promoting oral well being in India is concentrated on diagnosing prevalent oral situations within the focused inhabitants. However, emphasis on particular wants and traits can also be important. Quality of life shouldn’t be precisely judged by illness prevalence. Hence, oral well being evaluation ought to embody oral health-related high quality of life (OHRQoL), which is taken into account an important a part of the worldwide oral well being programme by WHO [3]. OHRQoL will be assessed and measured utilizing numerous indices, with the Oral Health Impact Profile and General Oral Health Assessment Index (GOHAI) being probably the most dependable and generally used. GOHAI can also be accessible in Hindi, which makes it attainable to make use of in India and makes it simpler to make use of [4]. Also, restricted knowledge within the literature has beforehand assessed OHRQoL in older adults within the Indian situation [5-7]. The current research aimed to judge OHRQoL in older adults searching for dental care in Indian settings.

Materials & Methods

The research was carried out after acquiring clearance from Mithila Minority Dental College, Darbhanga, India, and knowledgeable consent from the research members. The research included a complete of 140 topics from each genders with a imply age of 71.46 years and an age vary of 60-87 years. MMDC/2021/102 was the moral quantity. The inhabitants pattern for the current research had been the sufferers from the Outpatient Department of Mithila Minority Dental College and Hospital, Darbhanga, India, who got here for his or her dental care wants. The exclusion was completed for topics who had been terminally ailing, had morbidity, had systemic illnesses, or weren’t keen to take part within the research. A complete of 226 topics had been screened, and 140 topics had been lastly included. After last inclusion, all the topics underwent an oral examination to detect any oral situation, if current. This was adopted by an interview regarding the affect of oral situations on OHRQoL. All oral examinations and interviews had been taken by a single examiner with experience within the area. Oral/mucosal lesions, prosthetic standing, and the Decayed, Missing, Filled (DMF) Index for caries had been used for assessing oral wants, and the Community Periodontal Index (CPI) for periodontal wants evaluation was used. Individual remedy wants had been additionally assessed.

This was adopted by filling out the questionnaire. The questions of the questionnaire had been supplied in each Hindi and English for higher understanding. The questionnaire was comprised of questions relating to demographic traits, socioeconomic standing, household historical past, academic historical past, private habits, medical historical past, dental issues, oral well being, and dental consciousness. GOHAI-12 was used for assessing OHRQoL. The OHRQoL evaluation utilizing GOHAI-6 targeted on 9 gadgets and had 12 questions assessing speaking, swallowing, and consuming for G1, G2, G3, and G4. There are 5 responses to every query, together with 0 = by no means, 1 = seldom, 2 = generally, 3 = usually, 4 = fairly often, and 5 = all the time. G6, G7, G9, G10, and G11 assessed psychological features, together with oral well being worries, social withdrawal, and shallowness. G5, G8, and G12 assessed using pain-relieving medication and discomfort. The general scores ranged from 0 to 60, the place 60 was the utmost rating exhibiting good oral well being. The affect of oral well being standing on health-related high quality of life (HRQoL) was assessed based mostly on the scores of the questionnaire. These scores evaluated the psychosocial and useful penalties of oral well being on HRQoL.

The knowledge data had been assessed statistically with IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States) and evaluation of variance (ANOVA) take a look at. The degree of significance was stored at a p-value of 0.05. The knowledge had been expressed as a imply, quantity, and proportion, and the outcomes had been calculated.


The research included a complete of 140 topics from each genders with a imply age of 71.46 years and an age vary of 60-87 years. The demographic knowledge of the topics from the current research is listed in Table 1. The research included 83.57% (n = 117) topics from the age vary of 60-70 years, 12.14% (n = 17) from 71-80 years, and 4.28% (n = 6) above 80 years. There had been 75.71% (n = 106) females and 24.28% (n = 34) males. 41.42% (n = 58) of topics had been employed and 58.57% (n = 82) of topics had been unemployed. 29.28% (n = 41) had been people who smoke and 70.71% (n = 99) had been non-smokers. A BMI of >19 was seen in 62.14% (n = 87) of topics. A complete of 62.85% (n = 88) used a toothbrush with toothpaste for oral hygiene.

Characteristics Subgroups % n
Mean age (years)   71.46±4.94
Age vary (years) 60-70 83.57 117
  71-80 12.14 17
  Above 80 4.28 6
Gender Females 75.71 106
  Males 24.28 34
Occupational standing Employed 41.42 58
  Unemployed 58.57 82
Educational standing Primary/much less 62.14 87
  Undergraduate 24.28 34
  Postgraduate 13.57 19
Smoking behavior Smokers 29.28 41
  Non-smokers 70.71 99
BMI <19 37.85 53
  >19 62.14 87
Oral hygiene strategies Toothbrush with paste 62.85 88
  Finger 9.28 13
  Toothpowder 27.85 39
Tobacco chewing historical past Present 68.57 96
  Not current 31.42 44

On assessing the oral well being and remedy wants, it was seen that 65.71% (n = 92) of topics had no caries and >2 carious lesions had been present in 30% (n = 42) of the topics. Leukoplakia, ulcerations, oral submucous fibrosis (OSMF), candidiasis, and lichen planus had been seen in 3.57% (n = 5), 0.71% (n = 1), 42.14% (n = 59), 30% (n = 42), and a pair of.85% (n = 4) topics, respectively. Clinical attachment loss (CAL) of >5mm was seen in 25% (n = 35) of the topics. Buccal mucosa, lip, palate, tongue, and ground of mouth lesions had been seen in 40% (n = 56), 3.57% (n = 5), 0.71% (n = 1), 30% (n = 42), and a pair of.84% (n = 4) of the topics, respectively. Concerning remedy wants, emergency care was wanted by 18.57% (n = 26) of topics. Intervention was wanted by 45.71% (n = 64) topics, preventive care by 34.28% (n = 48) topics, and 1.42% (n = 2) wanted referral to a specialist (Table 2).

Condition Parameters % N
Teeth current Edentulous 42.85 60
  <20 40 56
  >20 17.14 24
Caries None 65.71 92
  <2 4.28 6
  >2 30 42
Oral lesions None 20.71 29
  Leukoplakia 3.57 5
  Ulcers 0.71 1
  OSMF 42.14 59
  Candidiasis 30 42
  Lichen planus 2.85 4
Clinical attachment loss (CAL) None 29 41
  <5mm 46 64
  >5mm 25 35
Sites of lesions Buccal mucosa 40 56
  Lip 3.57 5
  Palate 0.71 1
  Tongue 30 42
  Floor of mouth 2.84 4
  Others 22.85 32
Treatment required Immediate intervention (abscess/ache) 18.57 26
  Intervention wanted 45.71 64
  Only preventive measures 34.28 48
  Referred 1.42 2

The GOHAI evaluation based mostly on age, gender, and dentition was used to evaluate the OHRQoL. It was seen that, regarding age, there was a big affect, the place rising age was related to poor high quality of life (p = 0.025). For gender, older females had poor OHRQoL with p-values of <0.001, 0.01, 0.04, and <0.001 respectively for behaviour, psychological, pain and discomfort, and functional limitation. Also, edentulous patients had poorer OHRQoL compared to subjects with >20 tooth (Table 3).

GOHAI part n=117 n=17 n=6 P-value
Age-based 60-70 years 71-80 years >80 years  
Behaviour affect 3.58±1.67 3.24±1.82 4.82±2.49 Not vital
Psychological impacts 6.72±2.24 6.89±2.34 8.9±1.68 Not vital
Pain and discomfort 5.25±1.85 5.11±1.95 4.9±2.37 0.025
Functional limitation 5.4±2.21 5.11±1.95 4.9±2.37 N.S  
Gender-based Females (n=106) Males (n=34)    
Behaviour Impact 3.166±1.399 4.90±1.988   <0.001
Psychological impacts 6.48±2.408 7.75±2.789   0.01
Pain and discomfort 5.12±1.822 5.88±2.060   0.04
Functional limitation 4.84±1.962 7.34±1.681   <0.001  
Dentition-based Edentulous (n=60) <20 (n=56) >20 (n=24)  
Behaviour Impact 3.8±1.90 3.21±1.52 3.4±1.56 0.00
Psychological impacts 6.92±2.41 3.92±1.91 7.03±2.28 Not vital
Pain and discomfort 5.35±2.15 5.06±1.73 5.76±58 Not vital
Functional limitation 6.19±2.47 4.64±1.67 5.37±1.82 0.00


Dental companies are utilised by a restricted inhabitants in a restricted method, particularly within the inhabitants visiting group healthcare centres, notably in creating international locations like India. Also, medical health insurance companies in India are nonexistent. And after they exist, they aren’t utilised by nearly all of the inhabitants as they reside in rural areas or areas with restricted entry to and consciousness of those companies [8]. In the current research, OHRQoL was utilised. OHRQoL assesses the consolation of the topics throughout social interplay, engagement, sleeping, and consuming. OHRQoL additionally assesses the satisfaction of the topics with their oral well being and associated wants. Various advances have been made within the recording of OHRQoL and associated instruments and scales [9,10].

One such scale is GOHAI, which assesses the patient-centred definition of well being, which diverges from disease-centred epidemiological measures of well being. GOHAI was initially developed in 1990 by Atchinson and Dolan and was utilised for the geriatric inhabitants of North America. It is taken into account a dependable software as it’s broadly used, steady, and accessible in lots of languages, together with Hindi, which was advantageous for Indian topics’ use. Atchinson in 1996 additionally reported that the Oral Health Assessment Index was assessed for numerous races, ages, genders, and communities and was discovered to be dependable following its renaming as GOHAI [11,12]. The current research assessed 140 aged topics with a imply age of 71.46 years. The majority of the research topics had been within the age vary of 60-70 years with 83.57% (n =117) topics and the least in >80 years with 4.28% (n =6) topics. In the current research, extra females had been the research topics in comparison with males. The majority of the research topics had been non-smokers and practised good oral hygiene. These demographic knowledge had been the identical as what was discovered by Chahar et al. [13] in 2019 and Bhat et al. [14] in 2010 after they checked out related knowledge.

For analysis of remedy wants and oral well being, no caries was seen within the highest proportion of research topics with 65.71% (n = 92) topics, and in 30% (n = 42) topics, greater than 2 carious lesions had been seen. Lichen planus, candidiasis, OSMF, ulcerations, and leukoplakia had been seen in 2.85% (n = 4), 30% (n = 42), 42.14% (n = 59), 0.71% (n = 1), and three.57% (n = 5) topics, respectively. Involvement of the ground of the mouth, tongue, palate, lip, and buccal mucosa was seen within the research topics. For the remedy required, 1.42% (n = 2) wanted referral to a specialist, 34.28% (n = 48) topics wanted preventive care, and 45.71% (n = 64) topics wanted intervention. These outcomes had been in step with the outcomes of Bhatt et al. [15] in 2011 and Kumar et al. [16] in 2009, the place authors reported related remedy wants and oral well being standing.

OHRQoL was assessed utilizing dentition, gender, and age, and it was seen that poor high quality of life was related to rising age (p = 0.025). Functional limitation, ache and discomfort, psychological, and behavioural p-values had been 0.001, 0.04, 0.01, and 0.001, respectively for poor OHRQoL in older females. Poorer OHRQoL was seen in edentulous topics in comparison with dentate topics. These findings had been related and akin to the outcomes of Lolita et al. [17] in 2015 and Joseph et al. [18] in 2016, as authors of their respective research described feminine preponderance and the edentulous state as a motive for poor OHRQoL.


Within its limitations, the current research concludes that oral illnesses can considerably have an effect on OHRQoL, with a better feminine and edentulous state preponderance. Early prognosis and administration can help in bettering QoL in older adults, thereby selling higher basic well being. Specific programmes must be made to display and consider oral well being on the early levels of life in geriatric topics. However, the restrictions of the current research had been cross-sectional design, a smaller pattern measurement, and a smaller follow-up interval. Hence, extra potential research are warranted to succeed in a decisive conclusion.


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