The prevalence of denture wearing and the impact on by gui72988


									Archives of Orofacial Sciences (2008), 3(1): 17-22


The prevalence of denture wearing and the
impact on the oral health related quality of life
among elderly in Kota Bharu, Kelantan
S. Zainab a, N.M. Ismail b*, T.H. Norbanee c, A.R. Ismail b
    Dept. of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia , 16150
    Kubang Kerian, Kelantan, Malaysia.
    School of Dental Sciences, Universiti Sains Malaysia , 16150 Kubang Kerian, Kelantan, Malaysia.
    Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains
    Malaysia , 16150 Kubang Kerian, Kelantan, Malaysia.

(Received 17 March 2008, revised manuscript accepted 10 June 2008)

Keywords                              Abstract This study aims to determine the prevalence of denture
                                      wearing among elderly and to compare the oral health related quality of
Denture wearing,                      life (OHRQoL) between elderly with dentures and those without
elderly,                              dentures. This cross sectional study involved 506 randomly selected
oral health related quality           edentulous elderly in the district of Badang, Kota Bharu, Kelantan.
of life.                              Consented participants were interviewed in the Kelantanese dialect at
                                      their homes by a single trained interviewer using the short version Oral
                                      Health Impact Profile [S-OHIP(M)] which had been translated into the
                                      Malay language, tested and validated for use in Malaysian population.
                                      Denture wearing and self rated denture status was noted. The
                                      prevalence of denture wearing was 46.2% (95% CI=41.83, 50.70).
                                      There was a significant difference in sex, smoking status, self
                                      perceived treatment need and self perceived satisfaction between
                                      denture wearers and non denture wearers. Denture wearers reported
                                      better overall OHRQoL compared to non denture wearers (p<0.001).
                                      They reported better OHRQoL in 3 items namely ‘difficulty in chewing’
                                      ‘uncomfortable to eat’ and ‘avoiding food’ compared to non denture
                                      wearers. Thus appropriate measures are required to improve
                                      knowledge among the elderly regarding the use of dentures and the
                                      importance of proper denture care.

Introduction                                                       common prosthesis offered to edentulous
                                                                   people worldwide is complete dentures
The Global Oral Health Programme 2005                              (Roessler, 2003). Dentures play a role in the
revealed that the present oral health of elderly                   nutritional status of the elderly. Elderly people
people were far from optimal (Petersen and                         wearing defective dentures or those who were
Yamamoto, 2005). A large proportion of the                         edentulous but not wearing dentures were
elderly is edentulous with small proportions                       associated with malnutrition (Seman et al.,
having few remaining teeth (Petersen, 2003).                       2007). A study among community-dwelling
Elderly with severe oral health status had                         elderly aged 70-75 years in Italy noted that there
problems       with      social    situations   and                was a close inter-relation between dental status
interpersonal contacts which may lead to                           and nutrient intake. The use of dentures can
depression and affect their well being (Avcu et                    help improve both nutrient intake and the quality
al., 2005). The loss of teeth has been found to                    of life of the elderly (Appollonio et al., 1997).
affect quality of life (Locker, 1988; Locker, 2000;                       A local study among edentulous elderly in
Sheiham et al., 2001; Nuttall et al., 2001; Oral
                                                                   Tumpat, Kelantan, Malaysia, reported 71.2%
Health Division, 2004).
                                                                   complete denture wearers (Seman et al., 2007).
       Dentists         frequently       recommend
removable or fixed prostheses to support                           The National Oral Health Survey of Adults
impaired masticatory function (Dolan et al.,                       (NOHSA) reported 50.8% elderly aged 60 years
2001; Shimazaki et al., 2001). The most                            and older had some form of oral prostheses and
                                                                   majority (31.8%) were females (Oral Health
* Corresponding author. Dr. Noorliza Mastura Ismail, School        Division, 2004). About 86.0% edentulous elderly
of Dental Sciences, Universiti Sains Malaysia, 16150 Kubang        staying in ‘pondok’ Kelantan wore complete
Kerian, Kelantan, Malaysia. Fax: +609-764 2026.
   E-mail address:                              dentures (Seman et al., 2007).

                                               Zainab et al.

       Many older adults have problems with               treatment need and self perceived satisfaction
chewing, pain, difficulty in eating and social            as well as responses to the 14-item
relationships because of oral disorders                   questionnaire were obtained. For each item, the
(Shimazaki et al., 2001; Oral Health Division,            elderly were asked how frequently they had
2004; Ismail, 1996). Due to these reported                experienced the impact in the preceeding 12
problems, researchers have developed interest in          months. Response items were recorded in a 5-
quantifying the consequence of disease which              point Likert scale: 0 = never, 1 = hardly ever, 2 =
affects function, comfort and ability to perform          occasionally, 3 = fairly often, 4 = very often.
daily activity (Tickle et al., 1997; Slade and            Total S-OHIP(M) score ranged from 0 to 56.
Spencer, 1994). The Oral Health Related Quality           Higher scores indicate poor OHRQoL. Oral
of Life (OHRQoL) measure was developed to                 examination was carried out by a single
measure psychosocial impact. One such                     examiner and denture wearing status was
instrument is the short version Malay language            recorded after completion of questionnaire.
Oral Health Impact Profile {S-OHIP(M)} which                      Data were analyzed using SPSS version
was validated and found appropriate for use in            12.0. Descriptive statistics such as mean and
cross-sectional studies in the Malaysian adult            standard deviation (SD) for continuous variables
population (Saub et al., 2005). This study aimed          and frequency and percentages for categorical
to determine the prevalence of denture wearing            variables were calculated. For independent
among the elderly and to compare the OHRQoL               categorical variables, dummy variables were
between elderly with dentures and those without           created with reference category set at zero. In
dentures.                                                 this study, denture wearers were those wearing
                                                          at least one removable denture in a jaw. It
Materials and methods                                     includes those with upper and lower complete
                                                          dentures, upper complete dentures only, lower
A cross sectional study was conducted in the              complete dentures only and those wearing
district of Badang, Kota Bharu, Kelantan from             partial dentures. Non denture wearers were
September 2006 until February 2007. This                  edentulous participants without dentures and
district is situated in the north-east of Kelantan        dentate elderly with less than 20 remaining teeth
state. It consists of 14 sub districts and within         whereby this criteria had been associated with
each, was several villages. It was one of the             health related quality of life (Akifusa et al.,
most populated district and have about 1887               2005). Elderly people with less than 20 teeth or
(33%) of elderly people aged 60 years and older           not wearing dentures were considered as
(Department of Statistics, Malaysia, 2001). The           having inadequate rehabilitation (Nevalainen,
age of 60 years and older was used to denote              2004).
elderly people (Mat and Taha, 2003). The                          Level of education was recorded as those
reference population was community-dwelling               with formal education and no formal education.
elderly aged 60 years and older in Kota Bharu             Elderly with formal education included those
and the source population was community-                  who attended at least primary level of education.
dwelling elderly aged 60 years and older in the           As for general health, independent elderly were
abovementioned district during the study period.          those who did not require assistance in their
        The inclusion criteria were Malaysian             daily activities. Those who ever smoke were
elderly aged 60 years and older. Sample size              elderly who currently smokes and past smokers.
was calculated prior to the study using PS                In this study, the responses of ‘fairly often’ and
Power and Sample Size Calculation Program®,               ‘very often’ were considered as the cut off point
version 2.1.31 (Dupont and Plummer, 1990).                to identify those who experienced oral health
The edentulous and dentate elderly formed the             impacts on a relatively frequent basis (Saub et
two groups. The standard deviation of quality of          al., 2005). The overall impact experienced by
life was σ=2 (Slade and Spencer, 1994). This              participants over S-OHIP(M) items were
reference was chosen for calculating sample               described. The difference in S-OHIP(M) score
size because of the similarity of the population          between denture wearers and non denture
of interest. With anticipation of 20% non                 wearers was determined by independent t test.
response rate, the final sample size was 557              The level of significance was set at 0.05. Simple
subjects. Study participants was selected by              logistic regression analyses were undertaken to
systematic random sampling with sampling                  determine the relationship of impacts between
interval of 1:2 from a list of names of                   denture wearers and non denture wearers in
community-dwelling elderly aged 60 years and              each of the 14-items of the S-OHIP(M). The
older in the district. The sampling interval was          dependent variable was the denture wearing
determined based on the estimate of elderly               status. Ethical approval was obtained from the
population aged 60 years and older in Badang              USM Research and Ethics Committee in August
to the estimated sample size required                     2006.
(Department of Statistics, Malaysia, 2001).
        Consented participants were interviewed           Results
by a single trained interviewer in the
Kelantanese dialect at their homes. Socio-                Out of 557 randomly selected participants, 506
demographic factors, life styles and behaviour,           (90.8%) consented and participated in the study.
self perceived oral health, self perceived                Non-participants (51, 9.2%) were those not

                   Prevalence of denture wearing and the impact on quality of life among elderly

available during data collection, too ill or outright            characteristics between sex, smoking status,
refusals. The prevalence of prosthesis                           self perceived treatment need and satisfaction
wearing was 46.2% (95%CI=41.83,                                  between denture wearers and non denture
50.70). There was a significant difference in                    wearers (Table1).

Table 1   Characteristics of denture wearing and non denture wearing elderly, (n=443)
                                      Denture wearing               Non denture wearing        χ (df)          p-value
 Characteristics                        (n=234)                          (n=209)
                                      Mean        Freq               Mean       Freq
                                      (SD)          (%)               (SD)       (%)

 Age (years)                          71.0 (8.25)                   71.1 (8.00)
  60-69                                             113 (48.1)                    105 (50.2)    1.005 (2)         0.605
  70-79                                              79 (33.5)                     61 (29.2)
   >80                                               43 (18.4)                     43 (20.6)

  Male                                           56 (24.0)                        104 (48.8)   31.573 (1)        <0.001*
  Female                                        178 (76.0)                        105 (50.2)

 Educational level
  No formal education                               162 (69.2)                    133 (63.6)        1.472 (1)     0.224
  With formal education                              72 (30.8)                     76 (36.4)

  Unemployed                                        162 (69.2)                    145 (69.4)        0.004 (1)     0.949
  Employed/ Self employed/                           72 (30.8)                     64 (30.9)

 Living status
   Alone                                         32 (13.7)                          20 (9.6)        1.841 (1)     0.175
   With others                                  202 (86.3)                        189 (90.4)

 General health
  Independent                                   187 (79.9)                        172 (82.3)        0.436 (1)     0.509
  Dependent                                      47 (20.1)                         37 (17.7)

 Presence of chronic disease
  Yes                                           110 (47.0)                         96 (45.9)        0.072 (1)     0.788
   No                                           124 (53.0)                        113 (54.1)

 Dental visit
   At least once in the past year                31 (13.2)                         29 (13.9)        0.031 (1)     0.861
   None in the past year                        203 (86.8)                        180 (86.1)

 Smoking status
   Smoke                                         59 (25.2)                         96( 45.9)   20.555 (1)        <0.001*
   Never smoke                                  175 (74.8)                        113 (54.1)

 Dental fear
   Yes                                           58 (30.7)                         52 (35.4)        0.765 (1)     0.382
    No                                          131 (69.3)                         95 (64.6)

 Self perceived oral health
     Good                                       176 (75.2)                        149 (71.3)        2.577(2)      0.278
     Moderate                                    55 (23.5)                         53 (25.4)
     Poor                                          3 (1.3)                          78 (3.3)

 Self perceived treatment need
     Yes                                            51 (21.8)                      66 (31.6)        5.316(1)      0.021*
     No                                             83 (78.2)                     143 (68.4)

 Self perceived satisfaction
     Yes                                        182 (77.8)                        144 (68.9)    4.366 (1)         0.037*
     No                                          52 (22.2)                         65 (31.1)
    Note: * = p <0.05

                                                        Zainab et al.

      Table 2 described the prosthesis status of                   wearers (p<0.001). This indicated that they had
denture wearers.                                                   less impact and better OHRQoL than non
                                                                   denture wearers.
Table 2 Distribution of prosthesis status among                            Table 4 described the impact on S-
denture wearer (n=234)                                             OHIP(M) items. Majority of denture wearers and
                                                                   non denture wearers reported having impact in
Prosthesis status                         Denture wearer           the first 4 domains of S-OHIP(M) which were
                                                Freq (%)           functional limitation, physical pain, physical
                                                                   discomfort, and physical disability. The most
Upper and lower complete denture                  82 (77.7)
                                                                   common impact reported by denture wearers
Upper complete denture only                       34 (14.5)
Lower complete denture only                         9 (0.4)
                                                                   were ‘food stuck in mouth’ while for non denture
Upper partial                                       7 (0.3)        wearers were ‘avoiding food’. Simple logistic
Both upper + lower partial denture                  2 (0.1)        regression     analysis    showed      significant
                                                                   associations in the aspects of ‘difficulty in
                                                                   chewing’ with odds ratio (OR) 0.3 (95%CI=0.2,
      There was a significant difference in the                    0.4), ‘uncomfortable to eat’ OR 0.5 (95%CI=0.3,
mean score of S-OHIP(M) between denture                            0.7), ‘avoiding food’ OR 0.2 (95%CI=0.2, 0.4)
wearers and non denture wearers (Table 3).                         and ‘food stuck in mouth’ OR 2.2 (95%CI=1.4,
Denture wearers had significantly lower mean                       3.5) between denture wearers and non denture
S-OHIP(M) score compared to non denture                            wearers towards OHRQoL.

Table 3 Comparison of S-OHIP(M) score between denture wearers and non denture wearers (n=443)

Characteristics                    n(%)               Mean(SD)          95%CI of mean       t stats(df)    p- value*

Denture wearers                234(52.8)               6.85 (5.75)         1.947, 4.372      5.124 (442)   0.001

Non denture wearers            209(47.2)              10.01 (7.06)

Note: *=p<0.05

Table 4 Association between reported impact on S-OHIP(M) items by denture wearers and non denture wearers

Items                                Denture Wearers          Non denture      Odds Ratio        95%        p value
                                         (n=234)               Wearers           (OR)         Confidence
                                          n (%)                 (n=209)                        Interval
                                                                 n (%)                           (CI)
Functional limitation
Q1. Difficulty in chewing                 73 (36.3)           128 (67.3)           0.3        0.2, 0.4     <0.001*
Q2. Breadth stale                         4 (30.8)              9 (69.2)           0.4        0.2, 1.3      0.120
Physical pain
Q3. Uncomfortable to eat                  63 (40.9)           91 (59.1)            0.5        0.3, 0.7     <0.001*
Q4. Ulcer in mouth                        10 (52.6)            9 (47.4)            0.9        0.3 2.5      0.994
Psychological discomfort
Q5. Discomfort due to food stuck           70(67.3)           34 (32.7)            2.2        1.4, 3.5      0.001*
Q6. Feeling shy                               0               5 (100.0)             0            0          0.995
Physical disability
Q7. Avoid food                            101(39.0)           158 (61.0)           0.2        0.2, 0.4     <0.001*
Q8. Avoid smile                               0               11 (100.0)            0            0          0.995
Psychological disability
Q9. Disturb sleep                             0                    0                0             0          0
Q10.Disturb concentration                     0                    0                0             0          0
Social disability
Q11. Avoid social                          4 (50.0)             4 (50.0)            0             0         0.995
Q12. Affect daily activity                 1(50.0)              1 (50.0)            0             0         0.995
Q13. High expenses                            0                    0                0             0          0
Q14. Affect confidence                        0                    0                0             0          0
Note: 1. Reference level: non denture wearer
      2. CI= Confidence Interval
      *= p< 0.05

                  Prevalence of denture wearing and the impact on quality of life among elderly

Discussion                                                 in chewing’, ‘uncomfortable to eat’ and “avoiding
                                                           food’. This finding was consistent with
The prevalence of elderly denture wearers in               Shimazaki et al. (2001) where elderly people
this study was 46.2% (95%CI=41.83, 50.7). This             using full dentures had significantly less impact
prevalence was lower than those (81.0%) living             on daily functions. Denture wearers had high
in ‘pondok’ (Seman et al., 2007). However the              impact of ‘food stuck in mouth’ compared to non
prevalence was comparable to the findings of               denture wearers. This was most probably due to
Oral Health Division of Malaysia (2004) which              the poor condition of present dentures as some
was 50.8%.                                                 complained of loose and worn out dentures.
        Denture wearers and non denture                            However, a small proportion (20.7%) of
wearers in this study did not differ in terms of           denture wearers were unsatisfied with their
age, socio-economic status, living status and              dentures and perceived they needed treatment,
general health with the exception of gender (p<            while 37.5% of non denture wearers were not
0.001) and smoking status (p<0.001). There                 satisfied with their present oral condition and
were more female denture wearers then males.               perceived they needed treatment. Thus both
Similar findings were also reported by Ismail              denture wearers and non denture wearers
(1996) and Seman et al. (2007) and the Oral                required assistance in oral health intervention
Health Division of Malaysia (2004). This was in            and health promotion. Further research is
agreement with findings of Esan et al. (2004)              needed to evaluate the change in responses to
among patients who were treated in a                       OHRQoL after some form of assistance.
removable prosthetic unit of a teaching hospital           Although denture wearers perceived that they
in the rural south west of Nigeria whereby more            do not need treatment and were satisfied with
females demanded for dentures compared to                  their oral health, a small proportion of denture
males. It is possible that there may be a                  wearers were not satisfied with their dentures.
difference in perception between sex regarding             Thus it is reasonable to intensify efforts in the
the use of dentures. According to Mason et al.             provision of dentures to both groups of elderly
(2006) the life course influences on OHRQoL                people because each had their own set of
differed between men and women. In this study              problems. Community dentists in their
there were more female denture wearers than                domiciliary visits could improve knowledge and
males and the females were more satisfied with             skills regarding use and care of dentures among
their present oral health.                                 elderly and their caretakers to improve
        The most common type of oral prosthesis            OHRQoL.
used among edentulous elderly was complete
dentures. Similar findings were reported by                Conclusion
Seman et al. (2007). A higher proportion of
                                                           A high proportion of elderly in the study area
dentate elderly having less than 20 teeth in this
                                                           were denture wearers (46.2%). They had
study did not use dentures. Similar findings
                                                           significantly better OHRQoL compared to non
were seen in Japan, where more elderly people
                                                           denture wearers with less difficulty in chewing,
who have lost many teeth did not use dentures
                                                           feeling less uncomfortable to eat and less
in spite of coverage by the public health
                                                           avoidance of food. However denture wearers
insurance system (Shimazaki et al., 2001). In
                                                           had significantly more impact in ‘food stuck in
this study, some reasons for not wearing
                                                           mouth’. A small proportion of both denture
dentures included feeling nauseated at the sight
                                                           wearers and non denture wearers perceived the
of dentures, influence by negative experience of
                                                           need of dental treatment.
others and perceived that wearing dentures will
cause discomfort. Some elderly had financial
inability to pay for dentures.                             Acknowledgements
        Overall, the common impacts reported by
both denture wearers and non denture wearers               The author would like to thank the financial
were functional limitation, physical pain,                 support from USM Short Term Grant
psychological discomfort, and physical disability.         304/PPSG/6131406 and the community of
There was a significant difference in the mean             Badang district who participated in this study.
S-(OHIP(M) score between denture wearers
and non denture wearers. Denture wearers
reported lesser impact on OHRQoL compared                  References
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