ORIGINAL Hsu ARTICLE et al
Impact of Oral Health Behaviours and Oral Habits on the Number of Remaining Teeth in Older Taiwanese Dentate Adults Kun-Jung Hsua/Yea-Yin Yenb/Shou-Jen Lanc/Yi-Min Wud/Huey-Er Leee Purpose: To evaluate the impact of oral health behaviours and oral habits on the number of remaining teeth in older Taiwanese dentate adults. Subjects and Methods: Subjects comprised dentate patients (mean age, 60.0 ± 9.9 years) in Taiwan. Information on demographic data, oral health behaviours, oral habits and self-perceived health status was collected via self-administered questionnaires and dentition status was assessed by oral examination. Multiple logistic regression analyses were used to determine variables correlated with the low dentition group (subjects with less than 20 natural teeth or 8 functional tooth units). Results: The analysis showed that the low dentition group was more likely to be older and to exhibit low educational levels, less frequent use of dental floss, more common smoking habits, poor self-perceived dental health and to be exbetel-nut chewers. In addition, the low dentition group was less likely to be current betel-nut chewers. Conclusions: These results underscore the importance of the use of dental floss and confirm the adverse effects of smoking on dental health. Hence, the dental profession should continue to encourage proper oral health behaviours and oral habits. Key words: functional tooth units, natural tooth, oral habit, oral health behaviour, tooth retention Oral Health Prev Dent 2013;11:121-130 doi: 10.3290/j.ohpd.a29360
D
entition status, especially in terms of the number of natural teeth (Ueno et al, 2008; Hsu et al, 2011) and number of functional tooth units (FTUs) (Ueno et al, 2008; Ueno et al, 2010; Hsu et al, 2011), strongly influences chewing ability. In a statement issued in 1992, the World Health Organa
Dentist, Department of Family Dentistry, Kaohsiung Medical University Hospital; PhD Student, School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
b
Associate Professor, Faculty of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
c
Professor, Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan.
d
Periodontist, Kaohsiung Medical University Hospital; Associate Professor, Faculty of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
e
Prosthodontist, Kaohsiung Medical University Hospital; Professor, Faculty of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Correspondence: Professor Huey-Er Lee, Department of Prosthodontics, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd, San Ming District, Kaohsiung 807, Taiwan. Tel: +886-7-312-1101 Ext.7003, Fax: +886-7-321-0637. Email:
[email protected]
Vol 11, No 2, 2013
Submitted for publication: 05.01.12; accepted for publication: 13.06.12
isation (WHO) argued that the objective of any dental treatment is to maintain functional and a esthetic dentition in the person by retaining at least 20 teeth. The purpose of the statement is to seek improvement in the dental condition of the elderly to avoid deterioration of masticatory ability due to tooth loss. Dental health is affected by a person’s oral health behaviours and oral habits, including toothbrushing, use of dental floss, regular dental visits, smoking, chewing betel nuts and self-perceived general health condition (Fukuda et al, 1997; Norton, 1997; Kressin et al, 2003; Vyšniauskaité et al, 2005; Imazato et al, 2006; Chatrchaiwiwatana, 2007). In a longitudinal study, Kressin et al (2003) claimed that many oral health behaviours, including brushing, flossing, and prophylactic dental visits can help retain more natural teeth. Additionally, to improve dental health, the American Dental Association (ADA) recommends that a person brush his or her teeth at least twice a day, use dental floss at least once a day and make regular visits to the dentist.
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In recent years, medical advances have extended life expectancy, resulting in increased demand for oral health care in the elderly. To effectively reduce tooth loss in this population due to poor oral health behaviours and oral habits, it is important to specify systematic oral health guidelines and to encourage compliance with the guidelines. Ueno et al (2008) found that older people aged between 40 and 75 years need at least 20 natural teeth (NT) and 8 FTUs to avoid self-assessed chewing difficulty. Given the treatment goal of 20 or more NT and at least 8 FTUs for good masticatory ability in older adults, an epidemiologic database of oral health behaviours and oral habits would advance the goal of helping older adults maintain good masticatory ability. Therefore, the purpose of this study was to investigate the relationships between oral health behaviours/oral habits and dental status (ie, whether or not the subject has at least 20 NT and 8 FTUs) while considering the effects of age, gender, educational level and self-perceived general health status. We hypothesised that people who have at least 20 NT and 8 FTUs demonstrate better oral health behaviours and oral habits than those who do not.
SUBJECTS AND METHODS Subjects Between March and December 2006, dentate patients aged 45 years and over were recruited from Taiwanese dental clinics in accordance with the population structure of Taiwan in 2005. With the support of the Taiwan Dental Association, 319 dental clinics in 23 counties and cities of Taiwan participated in the study. Participation was voluntary. Subjects who could not complete the questionnaire were excluded. All subjects signed an informed consent form before data collection.
Questionnaire The questionnaire documented basic demographics (gender, age, and educational level). Other questions assessed oral health behaviours (frequency of tooth brushing, use of dental floss and regular prophylactic dental visits) and oral habits (smoking and betel-nut chewing). Finally, subjects reported self-perceived dental health and self-perceived general health.
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Dental examination Subjects underwent clinical dental examinations by trained and certified dentists at participating dental clinics in accordance with the WHO format (1997). Each subject sat in a dental chair, and a dental operatory light, dental mouth mirror and dental probe were used for the examination. No radiographs were taken. To avoid discrepancies in clinical judgements, only the simple and easy-to-perform dental examinations were included in the study. Research workshops at local dental associations of 23 counties and cities of Taiwan were conducted before the study; two standard cases as gold standards were provided in the research workshops. All participating dentists attended a workshop and completed the 2 standard case records as part of the research workshop. Dentists also received a dental examination manual describing the detailed criteria for the study. Dentists with a g coefficient of agreement of less than 0.70 were excluded. The records of clinical dental examinations included the locations, numbers and types of natural and prosthetic teeth. In addition, caries status and tooth mobility were recorded for all subjects. Teeth that were sound, decayed, filled or filled but decayed were scored as natural teeth (NT). Teeth with grade III mobility, retained roots, and extensive crown destruction (i.e. at least 3/4 of the clinical crown was destroyed) were excluded. Functional tooth units (FTUs) were defined as pairs of occluding posterior natural teeth or fixed artificial teeth, including abutment teeth, pontics and implant-supported prostheses. Fixed artificial teeth with grade III mobility were excluded. The number of FTUs was defined as 1 unit for premolars and 2 units for molars. Third molars were not included; thus, 28 NT or 12 FTUs indicated an intact dentition.
Statistical analysis Subjects were categorised as those with 20 and more NT and at least 8 FTUs (normal dentition group) and those with less than 20 NT or 8 FTUs (low dentition group). Chi-square tests were used to compare distributions of means with regard to age, educational level, oral health behaviours, oral habits, self-perceived dental health and self-perceived general health as they pertained to gender and groups classified by dentition status. Multiple logistic analyses were performed to determine the predicted variables associated with dentition status. A
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P-value of 0.05 was considered significant. All statistical analyses were performed using JMP 8 statistical software (SAS Institute; Cary, NC, USA).
RESULTS Our study population consisted of 2071 subjects (1013 men and 1058 women; mean age 60.0 ± 9.9 years). The mean age in the normal and low dentition groups was 56.9 ± 8.6 and 64.4 ± 9.9 years (P < 0.0001), respectively. The mean number of NT in the normal and low dentition groups was 26.1 ± 2.0 and 15.5 ± 6.9 (P < 0.0001), respectively, and the mean number of FTUs was 10.8 ± 1.5 and 2.7 ± 2.7 (P < 0.0001), respectively. Table 1 shows demographic data and dentition status of
the subjects by gender. Females tended to have a lower educational level. Since the implementation of Taiwan’s National Health Insurance in 1995, 1433 subjects in the study had experienced tooth loss. Among those subjects, 1164 subjects (81.2%) had tooth loss due to periodontal disease or decay, 35 subjects (2.4%) had tooth loss due to trauma and 89 subjects (6.2%) had tooth loss due to other causes, such as anomalies of tooth position, radiotherapy, etc. Distribution of oral health behaviours, oral habits and self-perceived health status by gender are presented in Table 2. Females were more likely to report toothbrushing at least twice a day. Males were apt to report smoking and betel-nut chewing habits. Over 40% of the subjects exhibited low dentition status; 897 (43.3%) were in the low dentition group
Table 1 Distribution of demographic data and dentition status by gender (N = 2071) Male
Female
Total
n
%
N
%
45–54
719
350
34.6
369
34.9
55–64
592
282
27.8
310
29.3
65+
760
381
37.6
379
35.8
Elementary school or less
949
353
34.9
596
56.3
Junior high school
291
145
14.3
146
13.8
Senior high school
425
247
24.4
178
16.8
College
406
268
26.4
138
13.1
Yes
505
237
23.4
268
25.3
No
1566
776
76.6
790
74.7
0–14
351
168
16.6
183
17.3
15–19
224
121
11.9
103
9.7
20–28
1496
724
71.5
772
73.0
0–3
560
280
27.6
280
26.5
4–7
307
166
16.4
141
13.3
8–12
1204
567
56.0
637
60.2
P*
Age (years)
0.6524
Education
