The dental status, needs and demands of the elderly in three communities
An age stratified random sample of 2280 adults over the age of 60 years, from three different areas of England, were interviewed and examined by a dentist in order to assess their dental status needs and demands. The towns of Salisbury (representing an urban community in the South of England), Darlington (representing an urban community in the North of England) and Richmondshire in North Yorkshire (representing a rural community) were the areas used. This allowed Salisbury and Darlington, the two towns used in one of the original population studies of adult dental health in 1962, to be revisited after 30 years. Response rates were around 55%, and a postal follow up of refusers allowed the influence of sampling bias on key dental factors to be established. The final sample was mostly ambulant and severe disability was rare, except in the oldest subjects (75^). Four dentists conducted the examinations, but one examiner (the author) undertook half of the examinations in each area. Geographical location, age and social class were strongly related to edentulousness. The percentage edentulous ranged from 11% in the younger (age 60-64) Salisbury non-manual workers to 90% in the oldest (age 75^) Darlington unskilled manual workers. A further 10% of the total sample in all three areas was edentulous in one arch. Complete dentures were rarely free of faults, but the relationships between denture faults, as assessed by the dentist, and reported dissatisfaction were weak. In the dentate sample, partial dentures were worn by 40%. Most of these were made of acrylic and were of a simple tissue supported design. Around 20% had had a partial denture made in the past which they were unable or unwilling to wear. Decay, periodontal attachment loss and tooth wear increased with age, but geographical variations were small. The most important influence on the dental health of the dentate was dental attendance pattern. Subjects who only attend the dentist when driven by pain had about six fewer teeth, six fewer filled teeth, and about twice as much decay (taking into account the number of teeth left) as those who attend for check-ups. 40-50% of the sample had some moderate periodontal attachment loss, but signs of more severe disease were found in only 10-25%. CPITN was an inappropriate measure of periodontal disease in an elderly population; loss of attachment and tooth mobility were preferable. Some moderate tooth wear affected about 40% of the sample, but did not seem to be closely related to functional problems. Most of the teeth with root surface decay, advanced periodontal disease and severe wear were concentrated in a minority of the sample. Demands and attitudes in the dentate varied with geography, gender and social class. Dental non-attenders were more common among men (particularly in the North) and people from manual backgrounds. A perceived lack of need for treatment was the major reason given for non-attendance. Fear of edentulousness and a preference to have restorative treatment were more common in the south. Few subjects reported difficulty with access to dental care. The risk factors for dissatisfaction and difficulty with eating were analysed using a model of the factors contributing to oral health and well being. The presence of unfilled anterior spaces and social and demographic variables were the major risk factors for dissatisfaction with aesthetics. Symptoms and the number of missing teeth were the most important factors leading to eating difficulties and dissatisfaction with masticatory function. Partial dentures are much more likely to be worn when there are less than 20 teeth, and where there is an anterior space. Number of posterior contacts and dental attendance pattern were the other major determinants of partial denture wearing. Partial dentures were a major risk factor for having root surface decay and fillings. Oral health goals for the elderly, taking into account the need to retain sufficient teeth to function through life, are presented. The absence of partial dentures, 20-24 teeth and 2-4 posterior contacts are seen as the desirable minimum, although these requirements may reduce with age.