Periodontal status of Brazilian elderly

Oral Health and Periodontal Status in Brazilian Elderly

Antonio Carlos PEREIRA1 Roberto Augusto CASTELLANOS2 Silvio Rocha Correa da SILVA2 Marlívia Gonçalves de Carvalho WATANABE2 Dagmar de Paula QUELUZ1 Marcelo de Castro MENEGHIM1 1Faculdade de Odontologia de Piracicaba, Universidade de Campinas, Piracicaba, SP, Brasil 2Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, SP, Brasil

Braz Dent J (1996) 7(2): 97-102 ISSN 0103-6440

A total of 104 elderly persons between the ages of 60 and 89 were examined at the “Geraldo de Paula Sousa” Health Center, São Paulo, State of São Paulo. The state of their oral health was very poor, insofar as 4.29 (71.5%) of the sextants were shown to be null, while 0.12 and 0.13 sextants showed deep periodontal pockets ³ 6 mm in the ages from 60-70 and more than 70 years of age, respectively. The level of knowledge about periodontal disease and dental plaque was very deficient; only about 52% of the population under study reported having visited a dentist in the last two years. We conclude that greater odontological attention is needed for the elderly age group, as there are no large-scale community service centers in Brazil for this population group.

Key Words: oral health, periodontal status, gerodontology.

Introduction

Over the last few years, gerontology has received special attention in many studies with regard to periodontal health conditions (Grytten et al., 1989; Locker et al., 1991; Bergman et al., 1991). In 1986, the Ministry of Health in Brazil carried out an epidemiological survey of periodontal disease, based on the Community Periodontal Index of Treatment Needs (CPITN) (Ainamo, 1982) in which 2,256 elderly between 50 and 59 years of age were examined. This showed that only 1.3% did not need any treatment, 7% were in need of specialized surgical treatment and 49.7% were not examined in any sextant (as fewer than two teeth remained in the sextant). The comparison between the index and economic level of the population examined showed unfavorable periodontal conditions in the lower income groups (Ministério da Saúde, 1988). The development of the CPITN (Ainamo, 1982) helped to standardize diagnostic criteria recommended by international institutions (FDI/OMS, 1985) by providing a better comparison of data from different places, which has made better periodontal planning possible at populational as well as individual levels. Thus, considering the small amount of available information, we decided to investigate the prevalence of periodontal disease using the CPITN, and verify the treatment needs of the elderly over the age of 60 who attended the “Geraldo de Paula Sousa” Health Center in São Paulo, State of São Paulo, Brazil, as well as studying some interesting variables about the knowledge and habits concerning oral health in this age group.

Material and Methods

The target population was 104 elderly, aged 60 to 89 years (mean age, 70), 25 males and 79 females (Table 1) from the “Geraldo de Paula Sousa” Health Center in São Paulo, State of São Paulo, Brazil, who were examined in 1993, and for whom both clinical and questionnaire data were available (Table 1). The population under study was examined according to the standards of the CPITN, which divides the mouth into six sextants with their respective tooth indices (17-16, 11, 26-27, 37-36, 31, 46-47). The examination involved probing the six sextants with the aid of WHO periodontal probes. Each sextant received a grade, on the basis of which tooth showed the worst situation, according to the criteria of Pinto (1989) (Table 2). The treatment needs of a person were standardized according to the following criteria: 0 = no treatment required (code 0); I = instructions about oral health (code 1); II = I + periodontal instrumentation (code 2 and 3); III = I + II + complex treatment (code 4). Clinical examinations were carried out by graduate students at the Dental Clinic of the Health Center, using a sharp number 5 dental explorer, dental mirror and WHO periodontal probe. After the clinical examination the population under study answered a questionnaire with questions about knowledge of periodontal disease, dental plaque, presence of bleeding, size and type of toothbrush bristles, how to perform oral hygiene and information about the last visit to the dentist.

Results

Periodontal health condition

The population under study was divided into two age groups to provide a better understanding of the data in relation to periodontal health condition. The first age group comprised 57% of the sample, including the elderly from 60 to 70 years of age, and the second comprised elderly over 71 years of age. Results are presented with respect to the clinical findings and knowledge and attitudes of the elderly towards periodontal disease, dental visits and oral hygiene. It was found that the percent of the null sextants (less than two teeth per exam) ranged from 45.7% to 84.5%. The age group over 71 years showed a slightly greater percent. These percents are close to those observed in Brazil for the 50-59 year age group, ranging from 53.2% to 76.9% (Ministério da Saúde, 1988). The anterior mandibular sextant showed the lowest percent of null sextants (45.7% and 59.9% of sextants in age group 60-70 and 71 or +, respectively). A possible explanation for this is that due to the presence of salivary ducts in the region, which provide better irrigation, mechanical cleaning is permitted, which favors maintaining the teeth in the mouth for a longer time. (Table 3). The healthy sextants (code 0) showed very small percents, ranging from 0.0 to 8.5%, showing the poor condition of periodontal health in the elderly, which is in agreement with the data from the Ministry of Health (1988) for the 50-59 year age group, which ranges from 1.7 to 8.5%. With regard to code 4 (³ 6 mm periodontal pocket depth) the percent of individuals with the largest score varied between 0.0 to 6.7% (Table 3). In terms of the average number of sextants (Table 4) in the 60-70 year age group, the average was 4.29 null sextants, less than two teeth able to be examined, while there were only 0.29 healthy sextants and 0.12 sextants showing ³ 6 mm pocket depth (code 4). In the 71 or + year age group, the average number of healthy sextants fell to 0.16, while only 0.13 showed periodontal pockets of ³ 6 mm and 4.71 sextants showed null. These low values in relation to the diagnosis should be attributed to the absence of sextants for examination (71-78% of the total sextants). It may also be possible for the loss of teeth to be the result of periodontal problems or caries. Periodontal treatment needs are shown in Table 5. The results indicate that an average of 1.33 and 1.13 sextants in the 60-70 year and 71 or + year age group, respectively, are in need of oral hygiene, while 0.12 and 0.13, for the age groups mentioned, require surgical treatment. Thus, the need for treatment was concentrated on instruction in oral hygiene and prophylaxis, which can be developed by dental hygiene staff, as yet not frequently used in Brazil, which would provide improvement in public oral health aid at a more accesible cost-benefit relationship.

Knowledge about periodontal disease

Table 6 shows the results of a questionnaire to which the elderly were submitted concerning their level of knowledge about periodontal disease. In the over 60 year age group, this was very deficient, 43.3% having no idea about periodontal disease, while the remainder associated the disease with inflammation, infection, tooth looseness, acute inflammation, aphtha and gingivitis.

Knowledge about dental plaque

A summary of the questionnaire on knowlwdge about dental plaque is shown in Table 7. Ignorance about dental plaque was impressive, 86 (79.8%) had no knowledge, while the remainder had a vague notion, associating it with dirt, remains of food retained on the teeth, calculus and bacteria.

Oral hygiene

Table 8 shows how the elderly performed oral hygiene, which was mainly done with tooth brushing (43.3%) or mouthrinse + tooth brushing (36.5%), the use of dental floss not being a usual practice. However, it was observed that only one of the elderly answered that no oral hygiene was practiced and five used mouthrinse with water or other liquid, which means that, at least in this regard, the interviewed showed that they knew how to perform oral hygiene. It only remains to be known whether it was done well, which was not evaluated by any index, as a positive relationship is known to exist between plaque and periodontal disease (Lindhe, 1985). There are many data concerning the prediction of dental caries in the elderly. In these studies, factors such as oral hygiene, past caries experience, the use of fluorides, saliva, socio-economical status, educational level, and so on have been related to caries development (Krasse, 1988). With regard to the kind of tooth brush used by the population under study, 25% used soft bristle and 33.8% hard bristle, while the size of the toothbrush head (small, medium or large) was shown to be 16.0%, 41.3% and 14.4%, respectively. The high proportion of elderly using hard bristle is surprising, as this is not recommended by dentists because it can lead to tooth erosion, especially if radicular caries are prevalent. This could aggravate the clinical picture, which is already seriously affected by the great loss of teeth previously mentioned.

Last visit to the dentist

Table 9 shows the answers given by the population under study about the last visit to the dentist. Observe that 52% of those that went to the dentist during the last 2 years, 11.5% visited the dentist during the year of the interview, which should have shown better oral health. The previously shown clinical facts indicate either that the dentists are not diagnosing periodontal disease or that the attention/treatment model is not obtaining the desired effects.

Conclusions

The state of oral health of the population examined is very deficient, with 4.29 of the sextants (60-70 year group) shown to be null, having fewer than two teeth per examination. Periodontal health was also deficient. In spite of the average number of sextants with ³ 6 mm periodontal pockets being only 0.12 (60-70 yr) and 0.13 (71 or + yr), few sextants were found that were not in need of treatment. The level of knowledge about periodontal disease and dental plaque was very inadequate. Tooth brushing was the procedure most used by those interviewed. About 52% of those interviewed affirmed having visited the dentist in the last two years, but this was apparently not reflected in a significant improvement in the oral health of the populaton under study.

References

Ainamo J: Development of the World Health Organization (WHO) Community Periodontal Index of Treatment Needs (CPITN). Int Dent J 32: 281-291, 1982

Bergman JD, Wright FAC, Hammond RH: The oral health of the elderly in Melbourne. Austr Dent J 36: 280-285, 1991

FDI/OMS: Changing patterns of oral health and implications for oral health man power; Part I. Report of the Joint FDI/WHO Working Group. Int Dent J 35: 135-151, 1985

Grytten J, Holst D, Gjermo P: Validity of CPITN’s hierarchical scoring method for describing the prevalence of periodontal conditions. Community Dent Oral Epid 17: 300-303, 1989

Krasse B: Biological factors as indicators of future caries. Int Dent J 38: 219-225, 1988

Lindhe J: Tratado de Periodontologia Clínica. 1st ed. Ed. Interamericana, Rio de Janeiro, 1985

Locker D, Leake JL, Hamilton M, Hicks T, Lee J, Main PA: The oral health status of older adults in four Ontario communities. J Can Dent Assoc 57: 727-732, 1991

Ministério da Saúde: Levantamento Epidemiológico em Saúde Bucal. Centro de Documentação do Ministério da Saúde, Brasília, 1988

Pinto VG: Saúde Bucal: Odontologia Social e Preventiva. 1st ed. Ed. Santos, São Paulo, 1989

Correspondence: Antonio Carlos Pereira, Departamento de Odontologia Social, Faculdade de Odontologia de Piracicaba, UNICAMP, Av. Limeira 901, 14414-018 Piracicaba, SP, Brasil.

Accepted May 14, 1996
Electronic publication: February, 1997

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