[Dental health among the elderly].
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Biomedical subjects
Publications and source records attributed to T Osterberg.
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The aim was to describe and analyze changes in dental status in Sweden over a 6-yr period, and to establish a baseline for a subsequent investigation. Representative samples of the Swedish population in 1975, 1977, and 1981 were investigated by means of interviews. The participation rate varied between 81 and 86% and the number of participants between 11,582 and 14,964. Dental status, based on a question about natural teeth and/or removable denture(s), was analyzed in relation to demographic, socio-economic, social support and life style factors. The prevalence of edentulism in the age group 16-74 years decreased during the observation period from 12.7% to 9.9% in men and from 15.5% to 11.2 in women. Besides age, urbanization, occupation and tobacco smoking had the highest explanatory value for edentulism. The findings are discussed with respect to the increasing life expectancy and possible changes in the need and demand for dental care.
Functional ageing, including dental health, was studied in the gerontological population study in Gothenburg. This study was based on three 70-yr-old cohorts, born in 1901-2, 1906-7, and 1911-12 (n = 1380). The Eichner index was used as a measurement of deterioration in dental state and dental functional impairment. This impairment was significantly associated with a lower capacity in cognition, visual ability, hearing ability, lung volume, heart volume, muscle strength, and bone mineral content as well as a lower self-assessment of health. A multiple regression model showed that an index of seven functional capacities was the most predictive factor for dental status independent of confounding factors such as socioeconomic factors, tobacco smoking, and the most incapacitating diseases. These associations were more marked in men and the survival rate between 70 and 79 years of age was higher among men with a well preserved dental state of the age of 70. The co-variation between impairment in dental function and other functional variables and survival indicate a common functional ageing.
A longitudinal population study of 1462 women, aged 38-60, was started in Gothenburg, Sweden, in 1968-69. In univariate analysis of the results from 1968-69, smokers were found to have a significantly lower number of remaining teeth than non-smokers had. The differences between smokers and non-smokers with respect to edentulousness and number of remaining teeth was further accentuated 12 yr later. The mean number of teeth lost during the 12-yr follow-up period was 3.5 among smokers and 2.1 among non-smokers, i.e. 67% higher among smokers than among non-smokers. The associations were independent of age, education, socio-economic group, marital status, frequency of toothbrushing, and frequency of visits to a dentist. It is concluded that smoking seems to play an important role as far as tooth loss is concerned.
Oral cancer was studied in a population of 3435 which constituted all persons who were operated upon because of peptic ulcer in Gothenburg 1952-61. This population formed a data base which was coordinated with the National Cancer Register and the Register of Causes of Deaths in Sweden. The expected number of oral cancers was 7.7 and the observed number was 17 (P less than 0.01). In gerontologic population studies of the elderly in Gothenburg it was shown that 70-yr-old men with a history of peptic ulcer surgery more often were tobacco smokers, edentulous and more often had sideropenic and megaloblastic anemia and also had a lower bone mineral content.
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In three cohorts of 70-yr-olds in Gothenburg, Sweden, born in 1901/02, 1906/07 and 1911/12, the relationship between oral health and parity was studied in 713 women and between oral health and the reported number of children in 660 men of the same cohorts. For women in all three cohorts, the number of teeth decreased in relation to increasing number of children that they had given birth to. Significantly more women with high parity were edentulous in one or both jaws compared to the other groups. Among parous compared to nulliparous women the age for becoming edentulous occurred earlier. The number of intact teeth was lower in parous compared to nulliparous women. Among the men no relation was found between oral health and the number of their children. When socioeconomic factors were taken into consideration the above described relations between declining dental health and increasing parity remained on about the same level of significance. Although pronounced cohort differences were found, a relationship between parity and dental health was found in all cohorts, indicating a general biological influence of repeated pregnancies.
Oral health was examined in a random sample of 1377 people in three 70-year-old cohorts studied within 5-yr intervals. During the studied period 1971-1983 the prevalence of toothlessness decreased from 52 to 34%. Toothlessness in men was more common in smokers, 48%, and ex-smokers, 32%, than in non-smokers, 20%. Eichner's index was used as a measurement of dental invalidity. This index showed a worse dental state among smokers and ex-smokers compared to non-smokers. Multivariate analyses indicated that tobacco smoking was a major independent risk factor for tooth loss in elderly men.
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A representative systematic selection of 30% of all 70-year-olds (1148 persons) in Göteborg were invited to a population study. The participation rate was 85%. Sixteen per cent of the men and 25% of the women reported dryness in the mouth (sex. diff. P less than 0.01). There was a significant correlation between the number of drugs consumed by the subjects and subjective dryness (in both sexes P less than 0.001). Intake of drugs from the groups of anticholionergics, antihistamines, sedatives, hypnotics or phenothiazines respectively seemed to have the highest predicative value for dryness in the mouth (men P less than 0.05 and women P less than 0.01). There was also a positive correlation between subjective dryness and number of definable diseases in both sexes (P less than 0.01). In a consecutive sample (fifty-eight men and fifty-three women) a study of salivary flow, direct pH and buffer effect were performed. The mean value of unstimulated salivary secretion was in men 0.25 and in women 0.18 ml/min. Corresponding figures for stimulated secretion was 1.65 and 1.04 ml/min (sex. diff. P less than 0.01). A significantly lower unstimulated secretion was noted in women with subjective dryness (P less than 0.01). A negative significant correlation were found between dental invalidity, according to Eichner's classification, and stimulated secretion when drug treatment had been considered (men P less than 0.05 and women P less than 0.01). Only weak relations were noted between salivary secretions and drug treatment. Only intake of drugs with diuretic effect were negatively correlated to stimulated secretion (P less than 0.01). Diseases of the circulatory system were correlated to subjective dryness (P less than 0.01).
Within the framework of an epidemiological, initially cross-sectional and subsequently longitudinal, population study of 70-year-old people, a representative sample of 386 subjects were subjected to odontological investigation. Forty six per cent of the men and 55% of the women were edentulous in both jaws and 20% of the men and 19% of the women were edentulous in one jaw. In dentulous subjects the mean number of teeth was 13.6 (men) and 13.5 (women). The tooth mortality rate was higher in the upper than in the lower jaw and higher in the lateral segments of the jaws than in the frontal region. The mean number of carious teeth was 3.2 for men and 2.4 for women and the mean number of intact teeth was 4.8 in men and 3.4 in women (p less than or equal to 0.05). Fifty four per cent of remaining teeth had been restored in men and 73% in women (p less than or equal to 0.01). Significantly more upper teeth were restored than lower teeth. Half of the dentulous subjects had worn their dentures for more than 10 years and only 14% had satisfactorily functioning dentures and acceptable occlusion. Poor retention and poor stability were very common in unsatisfactory dentures, more so in the upper than in the lower jaw. The proportion of dentures with these faults increased with increasing age of the dentures. The degree of dental invalidity was classified according to Eichner's index. This index was strongly correlated to the number of teeth and tooth contacts (p less than or equal to 0.001). The Eichner index covaried with frequency of visits to the dentist and special background factors such as income, education, marital status and past and present smoking habits. Married men tended to have a better level of dental health than other men (p less than or equal to 0.01), while the reverse was true for women. About half of the dentulous subjects were in need of prosthetic treatment and slightly less than half of them needed conservative dental treatment. Sixty per cent of edentulous subjects needed new dentures. The longitudinal comparisons between the ages of 70 and 75 showed small changes in dental invalidity. In a new cohort of 70-year-olds examined 5 years later the proportion of edentulous was significantly lower than in the first 70-year-old cohort.
A representative sample of 368 70-year-old males and females in Göteborg, Sweden, participated in an odontological examination and a dietary interview. The aim of the study was to relate dental state to dietary habits and, furthermore, to study the possible influence of some social factors on these relations. The degree of dental invalidity was measured with Eichner's index. There was a highly significant correlation between this index and the number of teeth and tooth contacts. Dietary interviews were performed by a dietitian according to the dietary history method. Intake of several food items was significantly inversely related to the degree of dental invalidity in males but less so in females. The proportion of probands with insufficient intake of nutrients was in one or more respects higher among the edentulous than in the dentate and highest in the female edentulous probands with only one or no denture. Insufficient intakes of some nutrients were significantly related to the degree of dental invalidity. These relations remained unchanged in males but not in females when some socio-economic factors were introduced as confounding factors in a multivariate relation analysis; which might be due to the fact that these social factors play a more important role in females than in males.
A representative systematic selection of 30% of all 70-year-olds in Gothenburg were invited to a population study. Forty percent of the sample (384 persons) were subjected to a comprehensive dental examination. The participation rate was 84%. The aim of the present study was to describe the function and dysfunction of the masticatory system of the 70-year-olds. 41% reported no symptoms of dysfunction while 46% had severe dysfunction according to HELKIMO'S Anamnestic Dysfunction Index. The clinical examination revealed that only 14% had no signs of dysfunction. 32% had moderate or severe dysfunction according to Helkimo's Index. In more than half of the subjects the masticatory muscles were tender to palpation and in 37% TMJ sounds were diagnosed. Several of the clinical findings were more common in the women than in the men but only concerning tenderness of the TMJ and the masseter muscle were the differences significant. The degree of dental invalidity was measured by Eichner's Index. The Index showed no or only weak relation to the Anamnestic and Clinical Dysfunction Indices. Neither did the degree of dysfunction in complete denture wearers vary with the condition of their prostheses.
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