Aðalheiður Svana Sigurðardóttir¹

Ólöf Guðný Geirsdóttir²

Inga B. Árnadóttir¹

Alfons Ramel²

¹School of Health Sciences, Faculty of Odontology, University of Iceland, ²School of Health Sciences, Faculty of Food Science and Nutrition, University of Iceland.

Correspondence: Aðalheiður Svana Sigurðardóttir, adalhsvana@hi.is

Key words: Oral Care, Nursing homes, Geriatric care, Health care, Oral health, Quality of life.

INTRODUCTION: Prevalence of oral health problems among nursing home residents is common, they suffer from oral diseases and need dental service. The aim of this study was to examine clinical oral health of Icelandic nursing home residents and their oral health quality of life.

MATERIAL AND METHODS: Total (N=82) residents in two nursing homes in Reykjavik gave their consent to be involved in this descriptive cross-sectional study. Residents participated in a clinical oral health examination at site and answered oral health quality of life questionnaire.

RESULTS: Total 89% (N=73) residents completed the study, mean age 86.8 years (SD=5.7, range 73-100 years), of whom third had their own teeth and like had teeth, and partial dentures, while 41.1% were completely edentulous. The clinical oral health examination showed high prevalence of untreated oral health problems (67%).

Residents with the worst oral health scored significantly higher than those who were better dentate, affecting their oral health quality of life (p=0.014), functional limitation (p=0.002) and physical disability (p=0.000). Most oral health problems interrelated to chewing, eating and limited ability to eat certain foods affecting their capability of food intake.

CONCLUSION: Current administration of oral health care in nursing home needs alteration and the qualification in geriatric oral health and oral health care must be guaranteed among nursing staff in these settings. The public and health professions should work together in oral care matters in nursing homes to maintain oral health and lifelong oral health quality of life among residents.

Table I. Socio-demographic profile of study participants (N= 73) living in nursing home A or B.

		Nursing home
Background		A (N=38)		B (N=35)		Total (N=73)		P valuea
		n	(%)	n	(%)	n	(%)
Gender	Male	13	(34.2)	15	(42.9)	28	(38.4)
	Female	25	(65.8)	20	(57.1)	45	(61.6)
	Total	38		35		73		0.448
Age groups	<80 years	5	(13.2)	3	(8.6)	8	(11.0)
	80-89 years	23	(60.5)	14	(40.0)	37	(50.7)
	≥90 years	10	(26.3)	18	(51.4)	28	(38.4)	0.027b
	Total	38		35		73		0.088
Residency°	Reykjavik	26	(70.3)	29	(82.9)	55	(76.4)
	Town	9	(24.3)	4	(11.4)	13	(18.1)
	Village	0	(0.0)	1	(2.9)	1	(1.4)
	Rural	2	(5.4)	1	(2.9)	3	(4.2)
	Total	37		35		72		0.338
Education	Compulsory education	24	(68.6)	18	(51.4)	42	(60.0)
	College secondary education	11	(31.4)	10	(28.6)	21	(30.0)
	Vocational education	0	(0.0)	7	(20.0)	7	(10.0)
	Total	35		35		70		0.019
Marital status	Unmarried	2	(5.4)	2	(5.7)	4	(5.6)
	Married	2	(5.4)	2	(5.7)	4	(5.6)
	Widow(er)	27	(73.0)	23	(65.7)	50	(69.4)
	Separated	6	(16.2)	1	(2.9)	7	(9.7)
	Married, spouse living elsewhere	0	(0.0)	7	(20.0)	7	(9.7)
	Total	37		35		72		0.028

Note: ^aChi-squared test, ^bTwo-sided significant test of proportion between nursing homes. °Place of residency before moving to a nursing home

Table II. Oral health and quality of life related to the length of stay of resident in the nursing home (N=60).

Scales	Length of stay	N	M ±	(SD)	(%)	P-valuea
OHIP – 49	<1 year	27	33.3	(20.3)		0,159
	1 year or more	33	40.6	(19.6)
Functional limitation	<1 year	27	9.0	(5.8)		0,056
	1 year or more	33	11.6	(5.7)
Physical pain	<1 year	27	5.4	(4.6)		0,507
	1 year or more	33	6.1	(3.8)
Psychological discomfort	< 1 year	27	5.4	(4.2)		0,499
	1 year or more	33	4,8	(3.6)
Physical disability	<1 year	27	7.7	(6.2)		0,061
	1 year or more	33	10.8	(6.2)
Psychological l disability	<1 year	27	2.1	(2.6)		0,513
	1 year or more	33	2.5	(2.5)
Social disability	<1 year	27	0.9	(1.4)		0,158
	1 year or more	33	1.6	(2.3)
Handicap	< 1 year	27	2.7	(2.6)		0,471
	1 year or more	33	3.3	(3.3)
Oral health						P-valueb
DFMT 28c	<1 year	27			(48.1)	0.148
	1 year or more	33			(66.7)
Dry mouth (very often)	<1 year	27			(74.1)	0.881
	1 year or more	33			(75.8)
Oral mucosa (normal)	<1 year	27			(81.5)	0.768
	1 year or more	33			(84.4)
Need of dental service	<1 year	27			(51.9)	0.028
	1 year or more	33			(78.8)
Dental visit	<1 year	27			(48.0)	0.113
	1 year or more	33			(68.8)
Wearing complete dentures	<1 year	27			(29.6)	0.087
	1 year or more	33			(51.5)
Oral health (good)	< 1 year	27			(50.0)	0.221
	1 year or more	33			(40.6)

Note: ^aT-test, ^bChi-squared test. ^cTotal number of decayed, missed or filled teeth = 28 teeth.

Table III. Comparison of mean score^° on quality of life and sub-scales by number of decayed, filled and missed teeth (N=73).

Quality of life scales	DFMT groups	M*	±	(sf)	P-gildi
OHIP 49	< 23 (n = 20)a	26.5	±	(4.4)	0.014
	24-27 (n = 12)b	34.7	±	(5.7)	0.425
	28 (n = 41)c	39.8	±	(3.1)	ref. #
Functional limitation	<23a	7.0	±	(1.2)	0.002
	24-27b	9.4	±	(1.6)	0.185
	28c	11.8	±	(0.9)	ref.
Physical pain	<23a	4.2	±	(0.9)	0.078
	24-27b	5.7	±	(1.2)	0.711
	28c	6.2	±	(0.6)	ref.
Psychological discomfort	<23a	5.4	±	(0.8)	0.359
	24-27b	5.8	±	(1.1)	0.278
	28c	4.4	±	(0.6)	ref.
Physical disability	<23a	4.8	±	(1.3)	0.000
	24-27b	8.2	±	(1.7)	0.191
	28c	10.7	±	(0.9)	ref.
Psychological l disability	<23a	2.1	±	(0.6)	0.551
	24-27b	2.1	±	(0.8)	0.635
	28c	2.5	±	(0.4)	ref.
Social disability	<23a	1.0	±	(0.4)	0.727
	24-27b	1.5	±	(0.5)	0.595
	28c	1.2	±	(0.3)	ref.
Handicap	<23a	2.0	±	(0.6)	0.172
	24-27b	2.0	±	(0.8)	0.291
	28c	3.0	±	(0.5)	ref.

Note: ^°Groups defined by DMFT status and mean scores compared to reference group with no teeth, controlled for gender and age. ^aDMFT < 23: Residents with 12-23 decayed, missed or filled teeth, (5-16 healthy teeth). ^bDMFT 24-27: Residents with 24-73 decayed, missed or filled teeth (1-4 healthy teeth). ^cDMFT 28: Residents with 28 decayed, missed or filled teeth (0 healthy teeth). ^#ref: Reference group having no teeth, using dentures in both jaws.

Table IV. Comparison of mean score on quality of life and sub-scales^° between dentate (n=43) and complete denture wearers (n=30).

Quality of life scales	Oral health	M	±	sf	P-gildi
OHIP – 49	Dentate with prosthesisa	31,9	±	(3,1)	0,083
	Complete denturesb	40,2	±	(3,6)
Functional limitation	Dentate with prosthesisa	8,7	±	(0,9)	0,011
	Complete denturesb	12,1	±	(1,0)
Physical pain	Dentate with prosthesisa	4,9	±	(0,6)	0,118
	Complete denturesb	6,5	±	(0,7)
Psychological discomfort	Dentate with prosthesisa	5,7	±	(0,6)	0,022
	Complete denturesb	3,7	±	(0,7)
Physical disability	Dentate with prosthesisa	6,8	±	(0,9)	0,002
	Complete denturesb	11,3	±	(1,1)
Psychological l disability	Dentate with prosthesisa	2,4	±	(0,4)	0,744
	Complete denturesb	2,2	±	(0,5)
Social disability	Dentate with prosthesisa	1,4	±	(0,3)	0,303
	Complete denturesb	0,9	±	(0,3)
Handicap	Dentate with prosthesisa	2,0	±	(0,4)	0,027
	Complete denturesb	3,5	±	(0,5)

Note: ^°Groups defined by teeth and prosthesis status, mean scores compared to reference group being edentulous using complete dentures, controlled for gender and age. ^aResidents with own teeth, fixed prosthesis (dental crown, bridge) and/or removable partial dentures. ^bResidents having no teeth, using dentures in both jaws.

Supplement

Table V. Number of residents having own teeth, fixed prosthesis, partial dentures and complete dentures.

			Male			Female		Total
Oral health		n	%a	%b	n	%a	% b	n	%b
	Own teeth, fixed prosthesis	8	(28,6)	(11,0)	15	(33,3)	(20,5)	23	(31,5)
	Own teeth and removable prosthesisc	8	(28,6)	(11,0)	12	(26,7)	(16,4)	20	(27,4)
	Complete dentures	12	(42,9)	(16,4)	18	(40,0)	(24,7)	30	(41,1)
	Total	28	(100,0)	(38,4)	45	(100,0)	(61,6)	73	(100,0)

Note: ^aTwo sided proportion test between columns. ^bPercent of total. ^cHaving complete or partial dentures in one jaw opposite their own natural teeth with or without partial dentures