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Year : 2019  |  Volume : 30  |  Issue : 3  |  Page : 332-336
Prevalence of dental caries, oral health awareness and treatment-seeking behavior of elderly population in rural Maharashtra

1 Health System Support Unit, Public Health Foundation of India, Pune, India
2 Chairman, Janaseva Foundation, Pune, India
3 Department of Community and Family Medicine, Duke University Medical Centre, Durham, North Carolina, USA
4 Department of Dental Surgery, Poona Hospital and Research, Pune, India
5 Department of Research, Poona Hospital and Research, Pune, India
6 Department of Research, Janaseva Foundation, Pune, India

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Date of Web Publication9-Aug-2019


Background and Objective: There have been numerous studies of oral health status of school children and young population; however, similar studies in elderly population in India are lacking. With advances in medical science and consequent increase in life expectancy, elderly population is on the rise and is a subject of growing concern for public health policy. Hence, an attempt was made to study factors influencing decayed, missing, and filled teeth (DMFT) index, oral health awareness, and dental treatment-seeking behavior of elderly population. Methods: A cross-sectional community-based survey was conducted between September 2014 and December 2014 in villages in rural Maharashtra. Sociodemographic and health-related information were collected from 352 participants 60 years of age and above in 10 villages. Results: Prevalence of dental caries was 76.4% in a study population with median DMFT score of 12 with interquartile range of 7–22. The majority of the participants cleaned their teeth with fingers using charcoal and mishri. Only 17.2% participants used toothbrush. About 39% participants had experienced dental pain, of which majority did not visit dentist. The median DMFT index who used toothbrush and toothpaste was significantly less when compared with participants who did not use tooth brush and tooth paste. The majority of the participants had one or more missing teeth, but only 2.2% were using dentures. Conclusion: There is an urgent need for comprehensive oral health educational programs, and accessible and affordable oral health services to be provided to rural community.

Keywords: Decayed, missing, and filled teeth index, dental treatment-seeking behavior, elderly population, oral health awareness

How to cite this article:
Salunke S, Shah V, Ostbye T, Gandhi A, Phalgune D, Ogundare MO, Sable V. Prevalence of dental caries, oral health awareness and treatment-seeking behavior of elderly population in rural Maharashtra. Indian J Dent Res 2019;30:332-6

How to cite this URL:
Salunke S, Shah V, Ostbye T, Gandhi A, Phalgune D, Ogundare MO, Sable V. Prevalence of dental caries, oral health awareness and treatment-seeking behavior of elderly population in rural Maharashtra. Indian J Dent Res [serial online] 2019 [cited 2023 Oct 2];30:332-6. Available from:

   Introduction Top

India is the second most populous country in the world, with a population of more than 1.2 billion. Of this, geriatric population is 7.7%, that is, about 92 million.[1] Approximately 72% of people reside in rural areas under unfavorable socioeconomic conditions. According to World Health Organization,[2] 80% of the global population suffering from oral diseases live in developing countries, indicating that oral diseases are strongly correlated with low income.

Poor oral health adversely affects dietary intake and nutrition and has an effect on general health of a person. Fight against oral diseases such as dental caries, periodontal diseases, and oral cancer makes a significant contribution toward improving quality of life of population.[3],[4] In India, there are several challenges in delivering oral healthcare services to the rural population, including poor accessibility, lack of manpower, poverty, and illiteracy. For instance, the dentist-to-population ratio in urban areas is 1:10,000, whereas it is 1:150,000 in rural areas.[5] Moreover, there is lack of substantial data related to the oral health status of rural population of India, which is fundamental for planning oral health services. Therefore, it is necessary to assess oral health status and treatment needs in rural population.

While there have been numerous studies of oral health status of school children and the young population,[6],[7] similar studies in elderly in India are lacking. With advances in medical science and consequent increase in life expectancy, the elderly population is on the rise,[8] and this vulnerable population is a subject of growing concern for public health policy. To address this concern, it is necessary to undertake studies specifically targeted toward elderly population. Hence, an attempt was made to study factors influencing the total number of decayed, missing, and filled teeth (DMFT) index, oral health awareness, and dental treatment-seeking behavior of the elderly population in rural area around Pune, Maharashtra.

   Methods Top

A cross-sectional community-based study was conducted between September 2014 and December 2014 in villages in rural Maharashtra. The overall study has been described previously;[9] 10 villages were selected by purposive sampling within a radius of 35 km from Janaseva Rural Hospital, Ambi, Haveli Taluka, Pune district. Based on previously published study,[10] setting an alpha error at 0.05, and power at 80%, sample size of 352 was calculated for the present cross-sectional study.[11] Sociodemographic and health-related information were collected from elderly 60 years of age and above from 10 villages. Elders were selected using stratified random sampling from Janaseva Foundation registry list of elders. Each elderly person was approached at their home and enrolled after giving informed consent. Elders who could not communicate at all were excluded from the study. Permission was obtained from the Institutional Ethics Committee and Scientific Advisory Committee of the institution and Duke University School of Medicine. Funding was provided by the Doris Duke Charitable Foundation and the Duke Global Health Institute, Durham, North Carolina, USA.

The survey was conducted in local language (Marathi) and included dental examination and verbal interview. Study participants were explained the objectives of study, and written informed consent was taken. Dental examination was conducted by a trained dentist who recorded DMFT, with the help of mouth mirror and dental explorer, under good light. The interview included questions to assess oral health status, oral hygiene practices, awareness and utilization of healthcare services, economic status, and risk factors such as tobacco habits.

Data are presented as median and interquartile range (IQR). Group comparisons were made using Chi-square test for qualitative variables. Differences between the medians of the groups was analyzed by Mann–Whitney U-test. Analyses were carried out using STATA (version 12.0).

   Results Top

Of 352 participants, 174 were males with a median age of 70 years (IQR 65–76 years), and 178 were females with a median age of 70 years (IQR 65–75 years). The median age of all (males + females) the participants was 70 years (IQR 65–75 years).

Dental caries

Dental examination showed that the prevalence of dental caries was 76.4%. The median DMFT score of study population was 12 (IQR 7–22). The decayed teeth component, the missing teeth component, and the filled teeth component had medians of 3 (IQR 1–6), 7.5 (IQR 3–15), and 0, respectively.

As depicted in [Table 1], there were no statistically significant differences in the DMFT index related to monthly income. The median DMFT index for those who used toothbrush and toothpaste was significantly less when compared with participants who did not use tooth brush and tooth paste. However, there was no statistically significant difference in the DMFT index by frequency of cleaning teeth and median DMFT index. There was no statistically significant difference in median DMFT in those participants who visited dentist and those who did not visit dentist in the past 1 year. Tobacco consumption and the duration of habit were also not significantly associated with DMFT index.
Table 1: Factors influencing median DMFT index

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Oral hygiene practices

It was found that 351 of 352 (99.7%) participants cleaned their teeth daily, of whom 178 of 352 (50.6%) cleaned once and 173 of 352 (49.1%) cleaned twice a day, whereas one person did not clean the teeth at all. In all, 63 of 351 (17.9%) participants used toothbrush, and 288 of 351 (82.1%) participants cleaned their teeth with fingers. In all, 137 of 351 (39.0%) participants used tooth paste, whereas 214 (61.0%) used other means such as charcoal and mishri.

Dental problems and dental-care-seeking behavior

In all, 161 of 352 (45.7%) rated themselves as having good dental health, 128 of 352 (36.4%) rated themselves as having average dental health, whereas 63 of 352 (17.9%) rated themselves as having poor dental health.

As shown in [Table 2], 135 of 352 (38.4%) had experienced some dental pain in the past 1 year. Among these, only 21 participants (15.6%) visited dentist in the past 1 year, and the remaining 114 (84.5%) had not visited dentist in the past 1 year in spite of having dental pain.
Table 2: Dental problems and treatment-seeking behavior

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In terms of the overall chewing ability, 174 of 352 (49.4%), 120 (30.1), and 58 (16.5%) were able to chew pretty well, fairly well, and not well, respectively. In this study, 314 (89.2%) participants had one or more missing teeth. Of those, only 7 (2.2%) participants were using dentures, while 307 (97.8%) were not using dentures.

   Discussion Top

Dental caries

The prevalence of dental caries in the elderly population worldwide is very high.[12] Papas et al.[13] and Slade and Spencer [14] reported that the dental caries prevalence in old age population in developed countries was the mean number of decayed and filled teeth ranging from 22 to 25. Doifode et al.[10] reported that the prevalence of dental caries was 43.2% in the elderly population of urban Nagpur. Goel et al.[15] reported 100% caries prevalence in rural Delhi, whereas the national health survey conducted by Dental Council of India (DCI)[16] stated that caries prevalence was 85%. In our study, the prevalence of dental caries was 76.4%, which is higher than that reported by Doifode et al.[10] and less than that of rural Delhi, and the national survey conducted by DCI. Available data worldwide show that dental caries is a major public health problem in older people and that is closely linked with social and behavioral factors.[12],[17]

Beck [18] and Vehkalahti and Paunio [19] reported that there was a strong correlation between dental caries and low income, tobacco habits, infrequent visits to dentist, and those who brush their teeth less than once a day. However, in our study, no statistically significant difference was found between DMFT index by income categories. This is possibly because there was not much variation in income range of study population.

Oral health awareness

Effective oral hygiene practices are well established in developed countries. In developing countries, there is still often a lack of awareness and knowledge about good oral hygiene. It has previously been observed that oral hygiene is the most ignored aspect of health in India. According to a study in 2010 conducted on the basis of consumer usage, almost half of the population of India did not use toothbrush to clean their teeth.[20] Oral hygiene practices, especially in rural India, are still based on tradition and culture like use of charcoal, mishri, miswak/chew sticks, and use of fingers.

In our study, 173 of 352 (49.15%) participants cleaned their teeth twice a day, but only 63 of 352 (9%) used tooth brush, and 137 of 352 (38.9%) used tooth paste, which is similar to the findings of a study conducted by Jain et al.[21] Kaur also reported that awareness of oral health practices was low especially in rural communities in India.[22] Studies conducted to correlate the socioeconomic status and education to oral hygiene practices showed that subjects with higher education and socioeconomic status had significantly better oral hygiene practices.[23],[24]

The self-rated oral health status in our study group was pretty good, fairly good, and poor in 49.4%, 34.1%, and 16.5%, respectively. This finding shows lack of congruence in self-perception and actual status and needs, since the DMFT index was quite high in all the three groups. This finding is similar to a study conducted by Heft et al.[25]

Treatment-seeking behavior

Utilization of the dental services is limited in developing countries. Fédération Dentaire Internationale (FDI) has classified the barriers to seeking dental services as follows:[26]

  1. The individual themselves (financial problems, inaccessibility, fear, or anxiety)
  2. The dental profession (inappropriate manpower sources, training not at par for changing needs and demands, attitude of dentist toward patient's needs)
  3. Society (inadequate dental healthcare facilities, inadequate oral health manpower planning, insufficient support for research)

Studies on dental-care-seeking behavior are also scarce in India. In this research, DMFT index of participants showed high levels of decayed teeth [3] and missing teeth (7.5), whereas the median number of filled teeth was 0, which indicates that very little priority was given to treatment of decayed teeth, leading to increased number of extractions, further resulting in more number of participants with partial edentulism. Of 352, 324 (89.2%) had one or more missing teeth. Only seven (2.2%) were using dentures for missing teeth; this also shows lack of awareness and limited inclination toward seeking treatment.

In this study, we identified numerous factors that influenced treatment-seeking behavior of participants. Pain was the main reason for a visit to dentist. This has also been reported in other studies.[24],[26] Dental pain leads to problems of eating and chewing, thereby affecting normal functioning and adversely affecting the daily life of the person. Therefore, most of the people with dental pain visit a dentist only in case of extreme discomfort. Of the 135 elderly who had visited a dentist, 79 (58.5%) visited for pain, and only 2 (1.5%) visited for general consultation and advice. These results are similar to those in study conducted by Jain et al., where 54% subjects visited dentist only when they were in severe pain.[21] This shows the overall lack of awareness in this population about dental health. Delay in visiting the dentist till pain becomes extreme can be the cause of extraction of tooth. This may explain why most of the study participants had one or more missing teeth in mouth.

However, periodontal disease can also be the cause of tooth loss in old age, which can influence the missing teeth component and it is not necessarily only due to painful decayed tooth. On the other hand, DMFT index is not the true indicator of dental health in the aging population, and study of periodontal health status is more important in old age. This can be a limitation of this research.

A common reason for not visiting dentist can be negligence, since dental problems are not life-threatening, and therefore less priority is given for the same. Because of lack of awareness about effects of poor dental health on general health, most of the people do not feel the need of visiting a dentist.[27],[28] Other reasons for not seeking dental treatment are unaffordability,[29] fear of dental treatment,[27] and inaccessibility. Therefore, understanding the treatment-seeking behavior of the population is a complex process, and more studies are necessary with a larger sample size at community level.

The limitations of the study were that we have not collected information regarding systemic diseases such as diabetes mellitus, hypertension, and cardiovascular diseases. These systemic diseases may have an effect on oral health.

   Conclusion Top

The prevalence of dental caries was 76.4%. The median DMFT score of study population was 12. The median DMFT index for those who used toothbrush and toothpaste was significantly less when compared with participants who did not use tooth brush and tooth paste. Only 2.2% participants were using dentures. Awareness about good oral hygiene practices was found to be low among the study participants.

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Conflicts of interest

There are no conflicts of interest.

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijdr.IJDR_356_17

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