|Year : 2018 | Volume
| Issue : 6 | Page : 293-298
Oral health-related quality of life and a number of remaining teeth among elderly in Tha-bar-wa center, Thanlyin Township, Yangon, Myanmar
Kyaw Zarni Tun, May Chan Oo, Kyaw Ko Ko, Pyae Linn Aung
Master of Public Health Office, Faculty of Public Health, Mahidol University, Bangkok, Thailand
|Date of Web Publication||24-Dec-2018|
Dr. Kyaw Zarni Tun
Faculty of Public Health, Mahidol University, Bangkok
Dr. Pyae Linn Aung
Faculty of Public Health, Mahidol University, Bangkok
Source of Support: None, Conflict of Interest: None
Objective: This cross-sectional survey is aimed to reveal oral health-related quality of life among the neglected elders, aged 60 years old and older, living in an elderly home. Materials and Methods: Survey was conducted at the elderly home of Tha-Bar-Wa Center, Thanlyin township, Yangon, Myanmar. Study participants (n = 146) were selected using systematic random sampling. Interview questionnaire and standard questionnaire of oral health impact profile (OHIP-14) were used to collect data and measured oral health-related quality of life. Dental status was assessed by visual inspection of one researcher throughout the survey. Descriptive statistics, t-test, or analysis of variance (ANOVA) was analyzed to demonstrate mean difference and multiple regression for statistically relationships. Results: Unacceptable level of oral health knowledge (72, 49.3%) and practice (83, 56.8%) were determined, regardless of the acceptable level of attitude (114, 78.1%). OHIP-14 scores range in 0–40, with mean standard deviation (SD) of 18.7 (9.7). Numbers of remaining teeth range in 0–32, with mean SD of 13.6 (8.6). OHIP-14 scores were significantly different between the age groups (60–64 and ≥70) (P = 0.006), living with partner or alone (P = 0.020), having >19 teeth to those being edentulous and those having ≤19 teeth (P < 0.001) and as of unacceptable or acceptable knowledge levels (P = 0.022). Significant negative relationship between number of remaining teeth and score of OHIP-14 was found when controlled for age in the year (β = −0.558, 95% CI = −0.828–−0.496, P < 0.001). Conclusion: Oral health-related quality of life in this group of neglected elders was averagely low and systematic oral health care is evidently in need.
Keywords: Dental status, elderly, Myanmar, oral health impact profile-14, quality of life
|How to cite this article:|
Tun KZ, Oo MC, Ko KK, Aung PL. Oral health-related quality of life and a number of remaining teeth among elderly in Tha-bar-wa center, Thanlyin Township, Yangon, Myanmar. J Int Oral Health 2018;10:293-8
|How to cite this URL:|
Tun KZ, Oo MC, Ko KK, Aung PL. Oral health-related quality of life and a number of remaining teeth among elderly in Tha-bar-wa center, Thanlyin Township, Yangon, Myanmar. J Int Oral Health [serial online] 2018 [cited 2019 Jun 24];10:293-8. Available from: http://www.jioh.org/text.asp?2018/10/6/293/248430
| Introduction|| |
Oral health well-being is one of the basic needs contributes to the promotion of general health, and sometimes, it has been neglected in consolidated approaches for the improving general health. The World Health Organization (WHO) Oral Health Facts Sheet showed that nearly 3.58 billion people have dental caries, often leading to pain and discomfort, severe periodontal (gum) disease, which may result in tooth loss, is found in 15%–20% of middle-aged (35–44 years) adults. It was 11th most prevalent disease among other noncommunicable diseases. Risk factors for oral diseases include unhealthy diet, tobacco use, harmful alcohol use, and poor oral hygiene.,, According to the global World Health Survey, complete tooth loss affects approximately 30% of old age people 65–74 years, however, prevalence rates are increasing dramatically in low- and middle-income countries, especially among poor and disadvantaged population groups. The interrelationship between oral and general health is proven by evidence. Severe periodontal disease, for example, is associated with diabetes. The strong correlation between several oral diseases and noncommunicable chronic diseases is primarily a result of the common risk factors. Many general disease conditions also have oral manifestations that increase the risk of oral disease which, in turn, is a risk factor for a number of general health conditions.
Oral health status is an integral part of total health because it affects general health by causing several sufferings, such as pain and discomfort and by changing what peoples eating habit, their speech and their quality of life and well-being. The negative impact of poor oral conditions on the quality of life of older adults is an important public health issue, which must be addressed by policy-makers. Increased life expectancy without the enhanced quality of life has a direct impact on public health expenditures and is becoming a key public health issue in the more developed countries. Oral health like general health is strongly influenced by socioeconomic status, behavioral, and community factors. Factors such as race, location, social class, culture, diagnosis, inadequate knowledge, and awareness of health insurance policies and language problems have been investigated as nonfinancial barriers.
Globally, the number of older persons (aged 60 years or over) is expected to more than double, from 962 million people in 2017 to more than 2.1 billion in 2050. Older persons are projected to exceed the number of children for the first time in 2047. At present, about two-thirds of the world's older persons live in developing countries. Being a developing country, Myanmar is also facing the emerging issue of a growing number of older people. The estimated population of Myanmar is 52 million and the population of people over 60 years is estimated to be 4.75 million. Therefore, 9.06% of the population is over 60 years, and it is expected to increase rapidly. As of 2018, life expectancy in Myanmar is 64.6 years for male, 68.9 years for female and average is 66.8 years for both. Caries and periodontal diseases were the two most common and major diseases in Myanmar. DMFT scores were 0.83 for 12 years, 2.94 for 35–44 years, and 6.94 for 65–74 years of age group.
Among various instruments to measure oral health-related quality of life, Oral Health Impact Profile (OHIP) was developed with the purpose of providing comprehensive measure of self-reported dysfunction, discomfort, and disability attributed to oral condition. The original OHIP has 49 questions, and it is based on theoretical model developed by the WHO and adapted for oral health by Locker. Locker model for oral health was used to define seven conceptual dimensions of impact such as functional limitation (e.g., difficulty chewing), physical pain (e.g., sensitivity of teeth), psychological discomfort (e.g., self-consciousness), physical disability (e.g., changes to diet), psychological disability (e.g., reduced ability to concentrate), social disability (e.g., avoiding social interaction), and physically challenged (e.g., being unable to work productively). OHIP-14 is a shorter version of OHIP-49, and its validity was done by Slade. The aim of the study was to assess the associations of oral health-related quality of life and a number of remaining teeth, knowledge, attitude, practice, and demographic characteristics by using OHIP-14 among elderly who are living in Tha-Bar-Wa nursing home, Thanlyin township, Yangon.
| Materials and Methods|| |
The research proposal was submitted and approved by Ethical Committee for Human Research, Faculty of Public Health, Mahidol University, Thailand, with the reference number (COA. No. MUPH 2015-046). Permission to collect data for this study was also asked from administrative of this nursing home. Before data collection, the consent was taken from all respondents as well. There are three buildings for elderly in this nursing home, building A, B, and C. Building A is only for elderly who have severe or serious medical conditions, and so, they were excluded from this study. Elderly who are >60 years of age, able to communicate verbally, able to open mouth were eligible to involve in this study. Required samples were obtained only from two buildings B and C in equal number which is 73 subjects from each building. From building B and C, elderly was picked up as samples by using systematic random sampling. First, the sampling fraction was calculated by dividing the total number of person on the list by the desired sample size. Total number of person on the list for each building is 200, and the desired sample size is 73 in each building, the sampling fraction was 200 divided by 73 = 2.7 = 3. A random number was chosen from between 0 and 9 to select the first person and every 3rd person on the list was selected until the total sample size for each building was obtained.
The research instrument used for data collection was a structured questionnaire that had been developed and modified from the literature reviews by researcher. Pretest was conducted among 30 elderlies in nursing home with similar background, and the values of Cronbach's coefficient of alpha were above the recommended threshold (>0.07). The questionnaire had the following six parts: Part 1-Demographic characteristics, Part 2-Knowledge of tooth loss and prevention, Part 3-Attitude toward oral health and treatment, Part 4-Oral health practice of elderly, Part 5-Teeth status, and Part 6-OHIP-14. Data collection was done by face-to-face interview. First of all, three data collectors who had graduated from University of Dental Medicine (Yangon) were trained for data collection. For the number of remaining teeth, elderly and caretaker were asked for permission in counting remaining teeth. After they had agreed, they were asked to open their mouth and being checked the number of teeth with visual inspection using torchlight and naked eye. At the end of interviewing, short oral health education in tooth brushing, toothbrush, and fluoride toothpaste were provided for each elderly. Researchers had provided special time for them at the end of the interview to avoid bias since some of the elderly wanted to consult about their oral health. Data entry was done by EPIDATA software version 3.1 (Free-ware, EpiData Association, Odense, Denmark) and SPSS version 18.0 (SPSS Inc., Chicago, IL, USA) was used for data analysis. Variables were presented by frequency, percentage, mean, median, and standard deviation (SD) by descriptive analysis. The comparison of means and test for differences of means of OHIP-14 among independent variables was performed t by t-test and analysis of variance (ANOVA) test.
| Results|| |
OHIP consisted of 14 items which measured the oral health-related quality of life. More than half of the elderly reported that they have had an impact occasionally from following items; including item number 3 (had painful aching in mouth), and item number 4 (uncomfortable to eat foods), and item number 6 (felt tense), and item number 7 (diet been unsatisfactory), and item number 10 (been a bit embarrassed). More than half of elderly reported that they never or hardly ever had an oral health impact from following items; including item number 1 (trouble pouncing words), and item number 9 (difficult to relax), and item number 12 (difficulty doing usual jobs), and item number 13 (felt life was less satisfying), and item number 14 (totally unable to function). Overall mean score of OHIP-14 was 18.7 ± 9.7, where median score is 19, the minimum score was 0 and maximum score was 40, respectively [Table 1].
|Table 1: Number and proportion of 146 elderly by report on items of Oral Health Impact Profile-14|
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Results of the study showed the demographic characteristics of elderly; including age, gender, marital status, educational level, and chronic diseases. Total numbers of elderly were 146. Majority of the elderly were 70 years and older (100, 68%). More than half of them were divorced or widowed (78, 53.5%) followed by single (44, 30.1%). Most of the elderly had only finished primary school (56, 38.4%). The majority of the elderly (80, 54.8%) have at least one chronic disease. Detailed data were summarized in the following [Table 2]. For comparison of means across categories, independent t-test was adopted for comparison of two contrasting categories, while one-way ANOVA was adopted for comparing >2 contrasting categories. Tukey HSD method was further adopted after significant result of one-way ANOVA was found, to identify which categories were different from each other. The differences of the mean score of OHIP-14 among different age groups and marital status were significant. Significant difference in OHIP-14 scores was found between different age groups (P = 0.006). The oldest age group of 70 years old and older had the highest mean score (20.2), and this was significantly different from that of the age group of 60–64 years (P = 0.008, Tukey HSD) . The result showed that no statistically significant difference was found between different genders (P = 0.219). There was a significant difference in mean score among marital status (P = 0.020). Elderly who were widowed or divorced had a higher mean score (20.5) than those who were married (P = 0.019, Tukey HSD). No significant differences in mean score of OHIP-14 were found between different educational level (P = 0.264). Mean score of OHIP-14 was also not different among elderly with chronic diseases and those without diseases (P = 0.664, t-test when equal variances were assumed) [Table 2].
|Table 2: Means of score and standard deviation of total Oral Health Impact Profile-14 score by demographic characteristics of elderly in Tha-Bar-Wa nursing home (n=146)|
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About half of the elderly (74, 50.7%) had an acceptable level of knowledge about causes of tooth loss and prevention. For the attitude toward oral health, only about (51, 34.9%) of the elderly had acceptable level of attitude. Up to (63, 43.2%) of elderly had an acceptable level of oral hygiene practice. Among the group of elderly, statistically significant difference was found among different levels of knowledge (P = 0.022, t-test when equal variances were assumed). Elderly with acceptable level of knowledge had lower mean scores 16.9 than 20.5 of those with unacceptable level of knowledge. No significant difference was found among elderly with different attitude level (P = 0.286) and different practice level (P = 0.825, t-test when equal variances were not assumed) [Table 3].
|Table 3: The differences of Oral Health Impact Profile-14 score in mean, standard deviation by level of knowledge, attitude, and practice of elderly in Tha-Bar-Wa nursing home (n=146)|
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The majority of the elderly (102, 69.7%) did not have the ideal number of remaining teeth (>19 natural teeth). There was statistically significant difference in OHIP-14 mean score among elderly with different categories of remaining teeth (P < 0.001). Elderly with >19 natural teeth remaining in their mouths had lowest mean score 10.9, implying better quality of life to those of other categories (P ≤ 0.001, Tueky HSD) [Table 4].
|Table 4: Means of score and standard deviation of total Oral Health Impact Profile-14 score by dental status of elderly in Tha-Bar-Wa nursing home (n=146)|
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Linear regression analysis was used to demonstrate the relationship between numbers of remaining natural teeth and OHIP-14 score when controlling for age. There was a negative significant relationship between numbers of remaining natural teeth and OHIP-14 score; which referred to that when a number of remaining teeth decreased, oral health-related quality of life increased (β = −0.0588: 95% CI = −0.828–−0.496, P < 0.001) [Table 5].
|Table 5: Multiple regression model analysis of Oral Health Impact Profile-14 and dental status|
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| Discussion|| |
Overall mean ± SD of OHIP-14 score was 18.7 ± 9.7 which was lower than the one study in Bangladesh which was 22.33 ± 11.29. The overall mean ± SD score of OHIP-14 was higher than mean ± SD of OHIP-14 (18.63 ± 9.22) score of study among Korea elderly. Again, OHIP-14 score of on study among senior Greek citizens in rural area was 2.4 ± 2.7 which was much lower than the mean score from this study. This might be due to that difference in sociocultural differences and accessibility to the dental service. The result from this study showed that OHIP-14 mean score was higher in elderly, who are in older age group, living alone, with unacceptable level of knowledge about oral health and number of remaining natural teeth. Result in this study was opposite from the study among elderly from Chileans, which stated that youngest age group had the highest mean score of OHIP-14 compared to others. This might be due to that elderly in Chileans elderly might have more concern over their oral health as their age increases. Since elderly in this study were neglected by their families and without social support, they might not have concern over their oral health because of lack of knowledge or other social problems. There was no statistically significant difference in mean scores of OHIP-14 among different gender. This is inconsistent with study in Bangladesh which was found that female had higher mean scores than males.
Also elderly were not allowed to use betel quid, cigarette, and alcohol. This might be one of the reasons for the result from this study because males and females might have the same oral health habits. Result from the study among elderly in Bengaluru stated that female had female experienced greater impact on OHIP-14 domains than male which was inconsistent with the result from this study. This may be due to that females in Bengaluru might have low education and awareness regarding oral health, employed, and might be financially dependent on males which they might have limited access to the dental services. However, in this study, both male and female elderly were living in the same nursing where there is no inequity for anything among different gender. This study showed that there was no significant difference of mean score of OHIP-14 among different educational levels. This result was the same as the result from a study in Norway and study among senior citizens in Greek which both studies stated that there was no significant difference of OHIP-14 score among education levels. However, the result from this study is different from the study in Bangladesh. This might be due to the difference in proportion of education levels of elderly among study in Myanmar and Bangladesh. In a study in Bangladesh, half of the elderly were illiterate while the proportion of education levels of elderly in this research was equal. Another possible reason was that (68.5%) of the elderly in this study were 70 years and older, therefore, the difference in educational levels might not play a role in determining the quality of life since most of the participants might not have concern over oral health.
Among this group of elderly in this study, there were edentulous (4, 2.7%), having 1–19 natural teeth (98, 67%), and >19 natural teeth (44, 30.3%). After testing for the difference in mean scores among these different groups, statistically significant difference was found. The result showed that elderly with >19 natural teeth have a lower mean score than other groups which means that they have a better quality of life than those with <19 natural teeth. This result was the same as the study in some studies which are stated that having >19 natural teeth have better quality of life.,, This result was inconsistent with the one study conducted among elderly citizens living in home for aged (Hnin Si Gone Institution). This study stated that there was no association between number of remaining teeth and oral health-related quality of life. This may be due to difference in structure of Hnin-Si-Gone institution and Tha-Bar-Wa center. Elderly in this home for aged center has better social background than elderly in Tha-Bar-Wa center. Moreover, this institution is supported and funded by government and other organizations, which they can provide much better health-care services than those in the researcher's study site. The result from this study was consistent with the comparative study among two national samples. This comparative study stated that oral health-related quality of life become poorer with the number of remaining teeth decreased. This might be due to that people without acceptable number of teeth will have a problem in tasks such as eating and communication.
| Conclusion|| |
The result from this study found that elderly with acceptable level of knowledge had a better quality of life than those with unacceptable level of knowledge. According to the result, elderly with >19 natural teeth left in their mouth had a better oral health-related quality of life than those who were edentulous and having <19 natural teeth. The result of the study also showed that there was a statistically significant difference of mean scores of OHIP-14 among different age group of elderly. The age group (60–64 years) had the lowest OHIP-14 mean scores which means that they had the better oral health-related quality of life than other age group. There was also a significant difference between elderly who were married and those divorced or widowed. Elderly who were married had a better oral health-related quality of life. Administrative of this center should have consultation with local dental officer for referral system in term of a regular dental checkup and treatment program. Since the result of this survey showed high number of elderly with no teeth, and having teeth <19, this nursing home should have fund from private or government to provide denture for the elderly.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Ansello EF. Oral health and aging. Age Action 2017;32:S44-5. [Doi: 10.2105/AJPH.2017.303835].
Pflipsen M, Zenchenko Y. Nutrition for oral health and oral manifestations of poor nutrition and unhealthy habits. Gen Dent 2017;65:36-43.
Börnigen D, Ren B, Pickard R, Li J, Ozer E, Hartmann EM, et al.
Alterations in oral bacterial communities is associated with risk factors for oral and oropharyngeal cancer. Sci Rep 2017;7:17686.
Poudel P, Griffiths R, Wong VW, Arora A, Flack JR, Khoo CL, et al.
Oral health knowledge, attitudes and care practices of people with diabetes: A systematic review. BMC Public Health 2018;18:577.
Zai SE, Jamayet NB, Alam MK. A study of teeth status and oral health related quality of life among elderly in Bangladesh. Int Med J 2013;20:610-4.
Petersen PE, Yamamoto T. Improving the oral health of older people: The approach of the WHO global oral health programme. Community Dent Oral Epidemiol 2005;33:81-92.
Liu N, Zeng L, Li Z, Wang J. Health-related quality of life and long-term care needs among elderly individuals living alone: A cross-sectional study in rural areas of Shaanxi Province, China. BMC Public Health 2013;13:313.
Alani A, Owens J, Dewan K, Summerwill A. A national survey of oral and maxillofacial surgeons' attitudes towards the treatment and dental rehabilitation of oral cancer patients. Br Dent J 2009;207:E21.
Friedman E. Money isn't everything. Nonfinancial barriers to access. JAMA 1994;271:1535-8.
Ogawa H, Soe P, Myint B, Sein K, Kyaing MM, Maw KK, et al.
A pilot study of dental caries status in relation to knowledge, attitudes and practices in oral health in Myanmar. Asia Pac J Public Health 2003;15:111-7.
Slade GD, Spencer AJ. Development and evaluation of the oral health impact profile. Community Dent Health 1994;11:3-11.
Montero-Martín J, Bravo-Pérez M, Albaladejo-Martínez A, Hernández-Martín LA, Rosel-Gallardo EM. Validation the oral health impact profile (OHIP-14sp) for adults in Spain. Med Oral Patol Oral Cir Bucal 2009;14:E44-50.
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997;25:284-90.
Youn HY, Cho MJ, Hwang YS, Koh KW. Relationship between the subjective-objective oral health status and oral health related quality of life in the elderly. J Dent Hyg Sci 2017;17:447-53.
Papaioannou W, Oulis C, Yfantopoulos J. The oral health related quality of life in different groups of senior citizens as measured by the OHIP-14 questionnaire. Oral Biol Dent 2015;3:1.
Steele JG, Sanders AE, Slade GD, Allen PF, Lahti S, Nuttall N, et al.
How do age and tooth loss affect oral health impacts and quality of life? A study comparing two national samples. Community Dent Oral Epidemiol 2004;32:107-14.
Pushpanjali K, Mohan M, Renuka P. Assessing impact of oral diseases on oral health related quality of life of institutionalized elderly using OHIP-14 in Bengaluru: A cross sectional study. J Dent Med Sci 2013;6:57-64.
Dahl KE, Wang NJ, Holst D, Ohrn K. Oral health-related quality of life among adults 68-77 years old in Nord-Trøndelag, Norway. Int J Dent Hyg 2011;9:87-92.
Aung KM, Maung TT, Oo MM, Soe KM, Naing L. Oral health and the quality of life among elderly citizens of old folks home in Yangon, Myanmar. Myanmar Dent J 2006;7:19-35.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]