Level of education and incidence of caries in the elderly: a 5-year follow-up study.

OBJECTIVE: This study aimed to examine the possible association between level of education and 5-year caries increment in the elderly inhabitants of Helsinki. BACKGROUND: Low salivary flow and high numbers of salivary microorganisms are associated with the presence of caries, but cannot predict the increment in caries in the elderly. MATERIALS AND METHODS: This study group was derived from a population-based Helsinki Aging Study, which consisted of a random sample of elderly born in 1904, 1909 and 1914. The 71 dentate elderly who underwent clinical oral examinations at baseline (1990-91) and 5 years later (1995-96) were included in the study group. Decayed, Missing or Filled Tooth (DMFT) and Root Caries Index (RCI) indexes were used to study subjects' caries experience. Data on subjects' education came from questionnaire studies. The subjects were divided into four groups according to their level of education and occupation. Bivariate and multivariate analyses were used to evaluate relationships between subjects' caries experience and level of education. RESULTS: At baseline the elderly with high level of education had more teeth and more root surfaces at risk than those with low level of education. Number of teeth decreased (-1.085, p < 0.0001), while both DMFT (1.164, p < 0.0001) and RCI (0.081, p < 0.0001) indices increased during follow-up. The increments in DMFT and RCI were not directly associated with the level of education. Multivariate analysis in which subjects' gender, number of teeth, level of education, frequency of eating and frequency of brushing were taken into consideration, showed no significant association with caries increment. CONCLUSIONS: Within the limitations of this study it can be concluded that the level of education of the elderly is not directly associated with the increment in caries.

Salivary findings, daily medication and root caries in the old elderly.

Root caries is one of the main dental problems among the dentate old elderly. The aim of our study was to evaluate the occurrence of root caries in 196 dentate elderly (mean age 79.3) in relation to their salivary flow rate, buffering capacity and salivary microbial counts. These subjects participated in the oral health component of the Helsinki Aging Study in 1990-1991. Clinical oral examinations included assessment of the state of root surfaces and salivary flow rates, both paraffin-wax-stimulated and unstimulated. Salivary buffering capacity and the growth of salivary mutans streptococci, lactobacilli and yeasts were determined by means of commercially available kits. Root caries occurred in 52% of men and in 35% of women (p < 0.05). Number of decayed (DRS) and decayed or filled (DFRS) root surfaces correlated (r = 0.16 to 0.26) with salivary microbial counts. No correlation appeared between DRS and subjects' salivary flow rates. Basic estimates on the association between DRS and salivary findings showed that microbial counts only produced significant odds ratios, from 2.0 to 3.5. However, in a log-linear model high salivary mutans streptococci and yeast counts together with male gender were associated with greater occurrence of root caries.

Prosthetic rehabilitation in the elderly inhabitants of Helsinki, Finland.

The aim of this study was to document the number of remaining natural teeth, to examine the prosthetic rehabilitation and to evaluate further prosthetic treatment needs among a representative sample of 76-86-year-old inhabitants of Helsinki. The edentulous made up 46% (168) of the subjects, 40% of the men and 48% of the women. Of these edentulous, 94% (158) wore complete dentures in both jaws, 2% wore only a maxillary denture, and 4% wore no dentures at all. One edentulous subject had an implant-supported overdenture in the lower jaw. More than half (54%) of all subjects had 1-32 natural teeth left. These dentate subjects had 47% (mean 13.2, excluding the wisdom teeth) of their natural teeth remaining. Of the remaining teeth, 13% (mean 1.8) were crowned and 5% (mean 0.6) were indicated to be extracted. Among the dentate, 37% (mean 10.4) of their natural teeth were missing and replaced by some type of fixed or removable prosthesis. Eleven per cent (mean 3.1) of missing teeth had not been replaced and were considered not to need prosthetic replacement. However, 5% (mean 1.3) of the missing teeth without prosthetic replacement were judged to need a prosthesis. Among the dentate, 37% wore a complete denture in one jaw; 34% of the dentate subjects used acrylic removable partial dentures (ARPD), and 19% used metallic removable partial dentures (MRPD). Of the dentate, 45% had crowns and fixed bridges. Altogether, 25% wore some kind of combination of fixed and removable prosthesis, whereas 14% had no type of prosthetic rehabilitation at all. The age of the current prosthesis varied from less than one year to over 50 years. Of all the subjects, 37% (6% of the edentulous and 63% of the dentate) had experienced inadequate prosthetic rehabilitation.

Factors related to the non-attendance in a clinical oral health study on the home-dwelling old elderly.

OBJECTIVE: To evaluate how elderly home-dwelling subjects' background factors, state of health, functional capacity and edentulousness related to their attendance in a comprehensive clinical dental study. DESIGN: Cross-sectional population study; interview and clinical dental data. SETTING: The City of Helsinki; clinical dental examinations at the Institute of Dentistry, University of Helsinki. SUBJECTS: 600 elderly aged 76, 81 and 86 years, participants in the medical examinations in the Helsinki Ageing Study one year earlier, 81% being home-dwelling. MEASURES: Age, gender, marital status, family structure, educational level, former line of work, self-perceived general health, dentulousness, ability to move, sense of hearing, state of memory, clinical findings of dementia, other medical diagnoses, and intake of drugs. OUTCOME MEASURE: Participation in clinical dental examinations. RESULTS: The overall participation was 63% being reduced by high age and female gender, 75% of the 76-year-olds, but only 53% of those aged 81 or 86 years were clinically examined, figures were for men 72% and for women 60%. As shown by a multifactorial logit model, the strongest factors related to non-participation were the home-dwelling subjects' old age (OR = 3.6), deteriorated ability to move (OR = 5.3), clinically diagnosed symptoms of dementia (OR = 4.1), or edentulousness (OR = 2.5). CONCLUSION: Non-participation selectively by those edentulous will lead to prevalence figures on numbers of teeth being too optimistic for the entire elderly population.

Dental radiographic findings in the elderly in Helsinki, Finland.

A total of 169 dentate persons, aged 76, 81, and 86 years, living at home in Helsinki, Finland, were examined by means of panoramic radiography supplemented by intraoral radiographs. The older the age group, the fewer teeth remained. Altogether 75% of the subjects had radiographically detectable caries. A high proportion of the carious teeth (62%) was found in a relatively small number (24%) of subjects. The number of carious teeth and their percentage of the total number of teeth were greater in the older age groups. The proportion of endodontically treated teeth was 19% in the 76-year-olds and 26% in the 86-year-olds. Of the subjects 41% had periapical periodontitis, which was commoner in root-filled teeth (18%) than in other teeth (4%). Caries and periapical radiolucent and radiopaque findings were commoner in men. Vertical bone pockets (3 mm or deeper) were found in 51% and furcation lesions in 28% of the subjects. Compared with earlier Finnish studies, the results indicate an improving oral health status among elderly Finns.

Association between salivary flow rate and the use of systemic medication among 76-, 81-, and 86-year-old inhabitants in Helsinki, Finland.

The aim of this study was to examine salivary flow rate and its association with the use of medication in a representative sample of 76-, 81-, and 86-year-old subjects, totaling 368. In this study, 23% (n = 80) of the subjects were unmedicated. From one to three daily medications were used by 47% (n = 168) and more than four medications by 30% (n = 104). The most commonly used medications were nitrates, digitalis or anti-arrhythmic drugs (47.7%), analgesics and antipyretics (32.6%), and diuretics (29.5%). The mean number used daily was significantly higher in 86-year-olds than in the two younger age groups (p < 0.01). No significant differences in this respect were found between genders. Among the unmedicated subjects, 76-year-olds had significantly higher stimulated salivary flow rates than did the 81-year-olds (p < 0.05). Unmedicated women showed significantly lower unstimulated (p < 0.01) and stimulated flow rates than did men (p < 0.05). Stimulated salivary flow rate was also significantly higher in the 76-year-old medicated subjects than in the medicated 86-year-old subjects (p < 0.05). No statistically significant differences were found in unstimulated salivary flow rates among the three age groups. Medicated women showed significantly lower unstimulated salivary flow rates than men (p < 0.001), although the difference in stimulated saliva flow was not significant. A statistically significant difference in unstimulated and stimulated salivary flow rates was found between unmedicated persons and those who took from four to six, or more than seven, prescribed medications daily.