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ЕVALUATION OF THE ORAL HEALTH STATUS IN GERIATRIC PATIENTS
ЕVALUATION OF THE ORAL HEALTH STATUS IN GERIATRIC PATIENTS
ORAL HEALTH
ЕVALUATION OF THE ORAL HEALTH
STATUS IN GERIATRIC PATIENTS
Аneta Mijoska1, Gordana Kovacevska1, Sasho Jovanovski1, Emilija Bajraktarova Valjakova1, Blago-
ja Dastevski1, Marjan Petkov1, Efka Zabokova Bilbilova2 , Daniela Srbinoska3, Vesna Trpevska3
1
Faculty ofDental Medicine, Department for Prosthodontics, Ss. Cyril and Methodius University in Skopje, Republic of North
Macedonia
2
Faculty of Dental Medicine,Department of Children and Preventive Dental Medicine, Ss. Cyril and MethodiusUniversity in
Skopje, Republic of North Macedonia
3
University Dental Clinical Center “St. Panteleimon” - Skopje
Abstract
Citation: Mijoska A, Kovacevska G, Jovanovski S, The geriatric population in R. Macedonia presents a specific group that needs continuous evaluation
Bajraktarova Valjakova E, Dastevski B, Petkov M, of their oral health. According to WHO data in 2010, 12 % of the population was aged 65+ years in
Zabokova Bilbilova E, Srbinoska D, Trpevska V. Eval-
uation of the oral health status in geriatric patients. Macedonia. Aging is the process with different specific changes in all systems and organs, including
Arch. Pub Health 2022; 14 (1) 114:125. the orofacial system. The most common conditions associated with age in the geriatric population
doi.org/10.3889/aph.2022.6023 are teeth loss, parodontopathy, precancerous lesions and oral carcinomas, xerostomia, resorption
Key words: geriatric, oral health, soft oral tissues, of the residual alveolar ridge, and overall dysfunction of the orofacial system. There is a great
screening influence of the performed prosthodontic therapy in geriatric patients on the overall and general
*Correspondence: Аneta Mijoska, Faculty of Den- health. The aim of this study was to evaluate the condition of the soft tissues in geriatric patients,
tal Medicine, Department for Prosthodontics, Ss. especially in patients with prosthodontic treatments, their oral health, and the influence of oral
Cyril and Methodius University in Skopje, Republic health on life quality. Мaterial and methods: Оbservational cross-sectional study was conducted in
of North Macedonia. Е-mail: amijoska@yahoo.com
geriatric patients and Geriatric Oral Health Assessment Index (GOHAI) was used for self-assessment
Received: 27-Nov-2021; Revised: 25-Jan-2022;
Accepted: 5-Feb-2022; Published: 23-Jun-2022 of their oral health and the impact of oral conditions and performed dental treatment on quality
Copyright:© 2022. Аneta Mijoska, Gordana Ko- of life. Results: Participants witha mean age of 72.88 years reported several general and systemic
vacevska, Sasho Jovanovski, Emilija Bajraktarova diseases, and the main risk factors for their oral mucosal changes were smoking and drinking
Valjakova, Blagoja Dastevski, Marjan Petkov, Efka alcohol. Total anodontiа was observed in 37.5% of respondents and partial anodontia in 62.5%.
Zabokova Bilbilova, Daniela Srbinoska, Vesna Trpe- The average period of wearing dentures was 7.8 years. The total scoreof the quality of life and oral
vska. This is an open-access article distributed un-
der the terms of the Creative Commons Attribution health of the respondents varied in the interval 1.93 ± 0.65, and the average value in the subjects
License, which permits unrestricted use, distribu- with prosthetic constructions for p> 0.05 (p = 0.19) was slightly higher in relation to the subjects
tion, and reproduction in any medium, provided without any prosthodontic device. Conclusion: GOHAI-12 score in the study had a low value, less
the original author(s) and source are credited.
than 50 indicated that the respondents were in poor oral health. According to the results of the
Competing Interests: The author have declared self-assessment, there was a weak to moderate perception of oral health. An integrated approach is
that no competing interests
needed to achieve a critical positive level of general and oral health in geriatric patients.
ОРАЛНО ЗДРАВЈЕ
ПРОЦЕНКА НА ОРАЛНОТО ЗДРАВЈЕ КАЈ ГЕРИЈАТРИСКИ ПАЦИЕНТИ
Анета Мијоска1, Гордана Ковачевска1, Сашо Јовановски1, Емилија Бајрактарова Валјакова1, Благоја
Даштевски1, Марјан Петков1, Ефка Жабокова – Билбилова2, Даниела Србиноска3, Весна Трпевска3
1
Стоматолошки факултет Скопје, Катедра за стоматолошка протетика Универзитет „Св. Кирил и Методиј”
Скопје, Северна Македонија
2
Стоматолошки факултет Скопје, Катедра за детска стоматологија Универзитет „Св. Кирил и Методиј”
Скопје, Северна Македонија
3
Универзитетски Стоматолошки Клинички Центар “ Св. Пантелејмон” Скопје
Извадок
Цитирање: Мијоска А, Ковачевска Г, Јованов- Геријатриската популација во Македонија претставува специфична група која има потреба од кон-
ски С, Бајрактарова Валјакова Е, Даштевски Б, тинуирана евалуација на нивното орално здравје. Според податоците на СЗО во 2010 година, 12 % од
Петков М, Жабокова Билбилова Е, Србиноска Д,
Трпевска В. Проценка на оралното здравје кај населението во Македонија било на возраст 65+ години. Стареењето е процес со различни специфич-
геријатриски пациенти. Арх. Ј Здравје 2022;14 ни промени во сите системи и органи, вклучувајќи го и орофацијалниот систем. Најчестите состојби
(1) 114:125. поврзани со возраста кај геријатриската популација се губење на забите, пародонтопатија, преканце-
doi.org/10.3889/aph.2022.6023 розни лезии и орални карциноми, ксеростомија, ресорпција на резидуалниот алвеоларен гребен и
целокупна дисфункција на орофацијалниот систем. Големо е влијанието на извршената протетичка
Клучни зборови: геријатрија, орално здравје, терапија кај геријатриските пациенти врз нивното целокупно и општо здравје. Целта на оваа студија
меки орални ткива, скрининг
беше да се процени состојбата на меките ткива кај геријатриските пациенти, особено кај пациентите
*Кореспонденција: Анета Мијоска, Стома- со протетички третмани, нивното орално здравје и влијанието на оралното здравје врз квалитетот
толошки факултет Скопје, Катедра за сто-
матолошка протетика Универзитет „Св. Ки- на животот. Материјал и методи: Спроведовме опсервациона студија на пресек кај геријатриските
рил и Методиј” Скопје, Северна Македонија пациенти, а геријатрискиот индекс за проценка на оралното здравје (GOHAI) беше употребен за да
E-mail:amijoska@yahoo.com се изврши евалуација на нивното орално здравје и влијанието на оралните состојби и извршениот
Примено: 27-ное-2021; Ревидирано: 25-јан-2022; дентален третман врз квалитетот на животот. Резултати: Испитаниците со просечна возраст од 72,88
Прифатено: 5-фев-2022; Објавено: 23-јун-2022 години пријавиле повеќе општи и системски заболувања, а главните фактори на ризик за промените
на оралната мукоза биле пушењето и пиењето алкохол. Вкупна анодонција е забележана кај 37,5% од
Печатарски права: ©2022 Анета Мијоска, Гор-
дана Ковачевска, Сашо Јовановски, Емилија испитаниците и делумна анодонција кај 62,5%. Просечниот период на носење протези изнесуваше 7,8
Бајрактарова Валјакова, Благоја Даштевски, години. Вкупната оценка за квалитетот на животот и оралното здравје на испитаниците варираше во
Марјан Петков, Ефка Жабокова – Билбилова, интервалот 1,93 ± 0,65, а просечната вредност кај субјектите со протетички конструкции за p> 0,05 (p
Даниела Србиноска, Весна Трпевска. Оваа ста- = 0,19) беше нешто повисока во однос на субјектите без било каква протетичка изработка. Заклучок:
тија е со отворен пристап дистрибуирана под
условите на нелокализирана лиценца, која овоз- Резултатот на GOHAI-12 во студијата имаше ниска вредност, помалку од 50 што покажа дека испи-
можува неограничена употреба, дистрибуција таниците беа со слабо орално здравје. Според резултатите од самооценувањето, имаше слаба до
и репродукција на било кој медиум, доколку се умерена перцепција за нивното оралното здравје. Потребен е интегриран пристап за да се постигне
цитираат оригиналниот(ите) автор(и) и изворот.
критично позитивно ниво на општото и оралното здравје кај геријатриските пациенти.
Конкурентски интереси: Авторот изјавува
дека нема конкурентски интереси.
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ment of oral hygiene, and proper Clinic for dental prosthetics with
diet are very important factors for prosthetic constructions and 40 re-
proper assessment of the quality of spondents without prosthetic con-
life of the geriatric population relat- structions.
ed to oral health12. All participants completed a ques-
The aim of this study was to assess tionnaire with anamnestic data on
the condition of oral status in ge- their general health status - medical
riatric patients with and without history and oral health status - dental
prosthetic devices, their general and history, as well as data from the anal-
dental health, and the impact of oral ysis of risk factors and oral hygiene,
health on quality of life. and completed a GOHAI - question-
naire (Global / General Oral Health
Assessment Index).The GOHAI ques-
Material and methods tionnaire for self-assessment of oral
The data for the paper was ob- health and the impact of oral condi-
tained by clinical and epidemio- tions on quality of life consists of 12
logical examination, observational questions such as functional limita-
cross-sectional study conducted in tion, aesthetic dissatisfaction, dis-
the geriatric population - patients comfort during chewing, avoidance
over 65 years of PHI UDCC “St. Pan- of certain types of food, avoidance of
teleimon”, Skopje (Picture 1). Eighty social contacts, and more. The ques-
respondents who were included in tionnaire covers the problems of the
the study signed an informed con- elderly in three dimensions: physical
sent form. The examination was ap- functioning such as eating, speaking,
proved by the Ethics Committe for and swallowing; mental functioning
examination at the Faculty of Den- such as oral health concerns, dissat-
tistry, UKIM in Skopje. isfaction with appearance and avoid-
ance of social contacts; pain and dis-
comfort, use of pain medication or
discomfort in the mouth.The ques-
tions are written positively or nega-
tively, to stimulate the respondents
to give their assessment of their oral
health. The answers are evaluated
with number 1-5 where 1 = never, 2 =
rarely, 3 = sometimes, 4 = often and
5 = always. The overall score on the
scale is the sum of all the values for
each question, and the low value in-
dicates the presence of an oral health
Figure 1. Epidemiological survey and
clinical examination
problem. A higher GOHAI score indi-
cates better oral health status. The
values also show three levels of sub-
Respondents were divided into 2 jective perception of respondent’s
groups according to the presence or oral health: poor, moderate, and good
absence of prosthetic construction perception. At the Clinic for prosth-
in the mouth: 40 respondents at the odontics, a clinical examination (ex-
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Vol. 14 No.1 2022
numberpercent
GENDER
male 34 42,5%
female 46 57,5%
AGE/years
65-69 24 30%
70-74 25 31,25%
75-79 26 32,5%
80-84 4 5%
85-90 1 1,25%
Over 90 / /
language
Macedonian 72 90%
Albanian 3 3,75%
other 5 6,25%
education
without / /
4 grade / /
primary 18 22,5%
secondary 46 57,5%
university 16 20%
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Respondents also had several gen- and some behaviors (smoking, exces-
eral and systemic diseases, mostly sive alcohol consumption, drug use,
cardiovascular diseases such as hy- tattooing and piercing, and HPV-16
pertension (47.5%), rheumatic cardio- virus infection).
myopathy and angina pectoris (15%), Data were analyzed and the results
hypotension (12.5%), and arrhythmias obtained are displayed in Table 2.
(7.5%). Prevalence of the eye diseases Respondents did not provide infor-
and cataracts was registered in 12.5% mation that any of them used ille-
and reduced vision in 22.5%of respon- gal substances, got a tattoo, or had
dents. Diseases of the gastric mu- a piercing. Risk factors were smok-
cosa and ulcer were present in 20%, ing and alcoholconsumption, and
20%had diseases of the bones and there were no data on HPV infec-
joints, and 12.5% of female patients tion. Forty-five percents smoke or
were diagnosed with osteoporosis, smoked, of which 61.1% werw men
for which they received therapy with and 38.8%women. On average, every-
bis-phosphonates. Of the endocrine one smoked 1-2 packs a day, and 40%
diseases, the most common were di- stopped more than three years ago, or
abetes mellitus (25%) for which the about 10 years ago. Regarding alcohol
patients most often used therapy as a risk factor, 47.5% drank alcoholic
with Glucophage tablets or insulin beverages 6-11/week, and 5% drank
ampouleс, and 12.5% of patients suf- 1-5 drinks/week, most of the respon-
fered from thyroid disease. dents still drink some beer or brandy
Risk factors for oral disease are he- when they have the opportunity, and
reditary predisposition and condi- only 20% gave data that they no lon-
tions or risks that depend on lifestyle ger consume alcoholic beverages.
36(45%)
SMOKING
22(61,1%)
male
14(38,8%)
female
38(47,5%)
ALCOHOL / AVERAGE AMOUNT OF
6-11 drinks/week
ALCOHOL
TATTOOS / PIERCINGS no
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Vol. 14 No.1 2022
Most of the respondents did not know fractures of the teeth. The periodon-
the exact reasons for the extraction tal status of the patinets with partial
of the largest number of their teeth, edentulousness was noted by record-
so fractures, a large dental caries ing the presence/absence of gingival
process, and periodontitis were most bleeding, the presence/absence of
often mentioned. Total anodontiа or periodontal pocket, and the lost at-
no teeth in the upper and lower jaw tachment from 0-3mm to 12mm. In-
were observed in 37.5% of patients, flammation and gingival bleeding, at
while partial anodontia had 62.5%. least one periodontal pocket 4-5 mm
More than 53.33% of patients with deep and a lost 0-3mm attachment to
complete anodontiawere women. Of at least one tooth were observed in
the patients with partial anodon- all patients with residual teeth.
tia, 72% were females and 28% were Prosthodontic constructions pres-
males. The average age of patients ent in the mouth are total prosthe-
with total anodontiawas 72.63 rang- sis, partial prosthesis, skeletal pros-
ing from 65 to 80 years. The average thesis, crowns, bridge, and combined
age of patients with partial anodon- prosthetic rehabilitation (bridge/
tiawas 72.66 ranging from 65to 80 prosthesis). Of all respondents 93.33%
years. hadtwo total prostheses, 6.66% had
Regarding the number of remain- one total prosthesis in the upper
ing teeth as an important indicator jaw and partial edentulousness with
of the oral healthstate, the average lower partial acrylic prosthesis and
number of remaining teeth in the up- in 3.33% prosthetic rehabilitation
per and lower jaw in patients was 14.5 was performed in combination with
ranging between 4and 23 teeth. The a lower total prosthesis, and partial
most common cause of tooth extrac- edentulousness in the upper jaw with
tion was loosening or periodontitis, a visceral skeletal prosthesis (Table 3).
followed by large carious lesions and
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Patients had a total of 60 total acryl- tures time was 7.8 years ranging in an
ic prostheses and 26 partial acrylic interval of 3-20 years (Figure No. 2).
prostheses. The average wearing den-
Calculation and results of the ques- or dentures?); T11(How often did you
tionnaire for the GOHAI index feel uncomfortable eating in front
of people because of problems with
your teeth or dentures?); T12(How of-
The GOHAI Questionnaire consists of ten were your teeth or gums sensitive
12 items/questions: T1(How often do to heat, cold or sweets?).
you limit the amount of food you eat
because of problems with your teeth Responses to the questions are scored
or dentures?); T2(How often do you according to the Likert scale and a
have problems with biting or chew- GOHAI score is obtained, according
ing any kind of food (solid meat or ap- to which the oral health is divided
ples)?); T3(Do you have difficulty swal- into three categories: high - good
lowing?); T4 (How often have your oral health 57-60; moderate - second-
teeth or dentures prevented you to ary oral health 51-56; low - poor oral
speakthe way you wanted?); T5 (How health less than 50.
often you were able to eat without The obtained score can be catego-
feeling discomfort?); T6(How often rized for easier and faster determi-
have you avoided contact with peo- nation of the level of psychometric
ple because of the condition of your characteristics according to the oral
teeth or dentures?); T7(How satisfied health self-perception: less than 50
are you with the look of your teeth, as “low perception, 51-56 as” moder-
gums or dentures?); T8(How often ate perception ”for oral health, 57-
have you used medication to relieve 60 as“ high perception ”. Table 4 and
pain or discomfort from around your Figure 3 show descriptive statistics of
mouth?); T9(How often have you been the total score and the average score
concerned about the condition of your for the quality of life and oral health
teeth, gums or dentures?); T10(How of respondents.
often do you feel nervous or aware
of problems with your teeth, gums
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Table 4. Quality of life and oral health/total, average score / Descriptive statistics
Std.Dev.
Average
Median
Confidence Confidence
Max.
Min.
Sum
GOHAI
No
-95,00% +95,00%
Sum
80 15,48 14,32 16,63 14,50 1238 6 32 5,19
Total
Average 80 1,93 1,79 2,08 1,81 154,75 0,75 4,00 0,65
The total score that refers to the score referring to the quality of life
quality of life and oral health in re- and oral health of the respondents
spondents from group 1 varied in from group 1 varied in the interval
the interval 15.48 ± 5.19; ± 95.00% CI: 1.93 ± 0.65; ± 95.00% CI: 1.79-2.08; the
14.32-16.63; the median was 14.50; median was 1.81; the sum of average
the sum of the total score was 1238; score was 154.75; the minimum score
the minimum value was 6 and the was 0.75 and the maximum score was
maximum value was 32. The average 4.00.
Figure 3.
Std.Dev.
Valid N
Valid N
Female
Female
Female
t-value
Mean
Mean
Male
Male
Male
Variable
df
Average*
2,05 1,85 1,40 78 0,17 34 46 0,63 0,66
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There was an insignificant correla- the quality of life and oral health de-
tion between the average value of creases insignificantly by 0.03 units.
quality of life and oral health and The average value of quality of life
their age (72.48-5.25). For r = -0.21 (p> and oral health in the respondents in
0.05) a moderately weak negative in- peri-urban environment (x = 2.27) for
significant correlation was found. t = - 2.17 and p <0.05 (p = 0.03) is signif-
Namely, with a single increase in the icantly higher than in respondents in
age of the respondents by one year, urban environment (x = 1.86).
Periurban
Std.Dev.
Std.Dev.
Valid N
Valid N
Female
t-value
Urban
Urban
Urban
Mean
Mean
Variable
df
p
Average*
1,86 2,27 -2,17 78 0,03 66 14 0,58 0,84
No smokers
Nosmokers
Smokers
Smokers
Smokers
Std.Dev.
Std.Dev.
Valid N
Valid N
t-value
Mean
Mean
Variable
df
Average*
2,15 1,76 2,74 78 0,008 36 44 0,72 0,53
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Vol. 14 No.1 2022
teeth and have reduced function and tion in the rate of toothlessness from
quality of life13. The average life expec- 14% in 1973, to 8% in 1993 and only 1%
tancy of people is constantly increas- in 200319. This confirms that the atti-
ing due to better living conditions, ed- tude towards age and the number of
ucation, and better health care. Life remaining teeth have changed, and
expectancy in 1900 was 45 years, and today it is known that regular main-
in 2000 it was twice higher(85 years). tenance of oral hygiene, proper diet,
Aging, on the other hand, is associat- and visit to the dentist give positive
ed with higher rates of morbidity, dis- results in preserving natural teeth.
ability, and lower quality of life. Oral Prosthetic constructions (total and
diseases and the reduced number partial dentures) successfully restore
of teeth affect the orofacial system mastication, phonetics, and aesthetic
and its functions in elderly patients14. function, but also contribute a lot to
They have problems with chewing, the improvement of social life. Prop-
decreased sense of taste, bad breath er chewing function is of great im-
(fluoride), dry mouth (hyposalivation portance because it also affects the
and xerostomia), burning syndrome, effect of digestion. During aging, the
speech and communication prob- secretion of gastric juice decreases,
lems, pain in TMЈ, etc.15. Age is not al- and proper preparation of the bolus
ways directly related to tooth loss and is especially important, because the
is most likely the result of periodon- masticatory efficiency of dentures is
titis, caries, poor general health, and 16-50% compared to chewing with
socioeconomic factors16. However, natural teeth20.
the number of elderlywith anodontia Health-related quality of life (HRQoL)
in different countries is quite high (6- and оral health-related quality of
78%), and this has a negative impact life represent the condition of the
on the quality of life related to oral teeth and mouth and general health
health (OHRQoL)17. According to the of patients, and their assessment
WHO, anodontia is a severe physical is performed using several indices.
disability that causes several clinical, The GOHAI General Oral Health As-
functional, and psychological difficul- sessment Index measures people’s
ties. In this study, partial anodontia perceptions of the social impact of
was recorded in all patients missing oral disorders on their general well-
more than one tooth. Studies in some being21. The index specializes in the
Western European countries show evaluation of oral functional prob-
a higher number of remaining teeth lems in elderly patients and the ef-
than data obtained from our geriatric fects of dental treatment22. It con-
respondents (37.5% partial and 62.5% sists of 12 questions related to the
total edentulousness). А study con- ability to do social activities and
ducted in Germany gives data on an lack of pain and infection. If the pa-
average of 14 remaining teeth in sub- tient does not answer more than 3
jects from the age group 60-65, and questions, his data are invalid and
only 3 remaining teeth on average in are not used for statistical analysis.
the group 75-79 years18. A study con- The total points are 0-60, and the
ducted in Sweden after the continu- validity of the index was checked in
ous implementation of measures to a study conducted on a sample of
improve oral health showed a reduc- 1775 patients, which showed great
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