|Year : 2012 | Volume
| Issue : 2 | Page : 129-132
High burden of dental caries in geriatric population of India: A systematic review
Rahul Srivastava1, Baridalyne Nongkynrih2, Vijay Prakash Mathur3, Anil Goswami4, Sanjeev Kumar Gupta5
1 Senior Resident, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Additional Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Associate Professor, Department of Community Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
4 Supervising Medical Social Service Officer, All India Institute of Medical Sciences, New Delhi, India
5 Professor, Center for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||21-Aug-2012|
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi
| Abstract|| |
Oral health is an essential component of health throughout life. Poor oral health and untreated oral diseases can have a significant impact on the quality of life of the elderly. The objective of this study was to estimate the burden of dental caries among the elderly persons in India in the past two decades. A systematic review from available literature was carried out. Six community-based articles were included in this review. The selected studies were screened by using STROBE checklist for observational studies. All studies were found to contain the required essentials of observational studies. Weighted prevalence of dental caries experience was calculated. Trend was generated using Microsoft Excel program. The prevalence of dental caries experience ranged from 31.5 to 100%. Weighted prevalence of dental caries experience was 83.6% and 82.3% for 2000-2004 and 2005-2009, respectively. There is a high burden of dental caries in the elderly population. Treatment and restorative services need to be provided to alleviate this problem.
Keywords: Dental caries, Elderly, Geriatric, India
|How to cite this article:|
Srivastava R, Nongkynrih B, Mathur VP, Goswami A, Gupta SK. High burden of dental caries in geriatric population of India: A systematic review. Indian J Public Health 2012;56:129-32
|How to cite this URL:|
Srivastava R, Nongkynrih B, Mathur VP, Goswami A, Gupta SK. High burden of dental caries in geriatric population of India: A systematic review. Indian J Public Health [serial online] 2012 [cited 2014 Dec 19];56:129-32. Available from: http://www.ijph.in/text.asp?2012/56/2/129/99903
| Introduction|| |
Dental diseases are among the most widespread diseases around the globe.  Although not an important cause of mortality, these may adversely affect the general health of people, especially in old age. Poor dental health and untreated dental conditions can have a significant impact on quality of life, and increase the risk of other chronic ailments such as cardiovascular diseases. ,, Poor oral health leads to poor nutrition, and both these factors create a vicious cycle, which may lead to the overall deterioration of health.
The age distribution of the world's population is changing. With advances in technology and medicine, and with prolonged life expectancy, the proportion of older people will continue to rise worldwide. Projected elderly population will increase in both the absolute and relative size of the elderly population in many third world countries, and is a subject of growing concern for public health policy. ,, Five basic dimensions are included in any overall assessment of elderly individuals, namely, activities of daily living, mental health, physical health, social functioning, and economic functioning.  Of these, physical health is directly related to good oral health. It has also been reported that majority of the elderly suffer from diseases like respiratory problems, poor vision, anemia, and dental problems.  Though oro-dental health problems are rarely life threatening, they do impact the quality of life. Dental diseases are expensive to treat, but simple to prevent. Oral disease is the fourth most expensive ailment to treat in most industrialized countries.  Limited studies are available from the community to estimate the burden of dental caries in elderly population in India. Keeping this in mind, the present review was undertaken to estimate the burden of dental caries among elderly population in India.
| Materials and Methods|| |
The review of literature was done electronically as well as manually. Search strategy for the review of literature is depicted in [Figure 1]. For electronic search, various scientific journals and web-based search engine were used for the literature related to oral health problems in elderly in India, with definite search strategy or keywords. Experts were contacted for literature by sending emails or making personal visits to the authors. Articles were manually retrieved from BB Dikshit Library of All India Institute of Medical Sciences, New Delhi, India and National Medical Library, New Delhi. Cross references of the relevant articles were also retrieved.
The inclusion criteria for this review were: studies conducted in elderly population in India, i.e. aged 60 years or above, and articles in English language. The period was limited from January 1990 through December 2009 since we assume that data over the last two decades would provide the trend of prevalence of dental caries over the years.
Electronic search for dental caries in the elderly yielded 26 references, of which 6 were retained. The rest of the studies were excluded because they were hospital based, or were carried out in children or adults below 60 years. Full text of all these six references were retrieved by electronic (Internet and intranet) and manual search from BB Dikshit Library and National Medical Library. Selected studies were screened by using STROBE checklist for observational studies. 
Two of the authors (RS and BN) screened the shortlisted studies and independently categorized and extracted data from the full text of the articles. Any kind of disagreement between the authors regarding article screening and data extraction was sorted by the other two authors (VM, SKG).
In order to estimate the secular trend, the 10-year period, i.e. from 2000 to 2009, was divided into two intervals, i.e. 2000-2004 and 2005-2009. Point estimates (weighted prevalence) were then calculated for each time period. Point estimate was calculated using the formula: ∑PiWi/∑Wi, where Pi denotes prevalence of dental caries in an individual study and Wi denotes weight assigned to that individual study. Weight of the individual study was calculated by using the formula: 1/square of SD. , Maximum weight was given to the multicentric studies, since they had maximum sample size.
| Results|| |
Six articles were found to be relevant to the elderly with dental caries, and hence were included in this review. ,,,,, On screening by STROBE checklist, all six studies were found to contain the required essentials of observational studies.
The review comprised a total of four published articles and two reports of multicentric surveys, three of which were conducted in Delhi and two were multicentric studies. Two studies defined elderly to be aged 65 years and above, while the remaining studies defined elderly age group to be 60 years and above. All these studies used the DMFT Index for diagnosing the prevalence of dental caries. Therefore, even though the studies were carried out in different time periods, the diagnostic criteria remained the same. In all the studies, the investigators were trained in carrying out oro-dental examination according to standard procedures.
It was seen [Table 1] that the prevalence of dental caries experience ranged from 31.5% in Nagpur  to 100% in Delhi.  The Dental Council of India (DCI) in collaboration with Ministry of Health and Family Welfare in 2002-2003 conducted a multicentric study in 20 states of the country and reported the average prevalence of dental caries to be 85%.  Another multicentric study conducted in eight states of the country, by the Government of India and the WHO collaborative program on oral health, reported the prevalence to be 67.8%.  These two were the major surveys on dental caries in India. The studies also showed similar distribution among males and females. ,,,,,
|Table 1: Summary of studies reviewed for prevalence of dental caries in the elderly in India (2000– 2009)|
Click here to view
Secular trend analysis showed an increasing trend of dental caries from 2000 to 2009 [Figure 2]. Weighted prevalence of dental caries experience was 83.6% in 2000-2004 and 82.3% in the period 2005-2009.
|Figure 2: Trend of prevalence of dental caries among elderly population in India (2000-2009)|
Click here to view
The DMFT score in the multicentric study conducted in 2007 was 5.3, which ranged from 2.4 in Rajasthan to 15.5 in Uttar Pradesh.  Similar DMFT score (13.8) was also reported in the study by Patro et al.  and the multicentric study by the DCI (14.9).  Polynomial trend was observed for the average DMFT score.
| Discussion|| |
The present review shows that the burden of dental caries in elderly population in India is high, as seen both from individual studies as well as from weighted prevalence. The prevalence varied in different studies and this may be attributed to different study populations, different study settings, local differences in eating habits, oral cleaning habits, fluoride content of water, etc. Due to the variations in these studies, a pooled estimate was not calculated.
All studies reported the DMFT score according to either the 1997 criteria  or a modified version of 1987 WHO oral health criteria. Patro et al. and multicentric oral health survey 2007  used the modified 2004 WHO criteria for oral health examination.  However, even though these studies used different versions of the WHO criteria, there were no differences in the diagnostic criteria as per these WHO guidelines. All studies used DMFT index for estimating the prevalence of dental caries; therefore, this does not affect the prevalence of dental caries. There is a high score of missing teeth, as revealed from the studies in the review, which indicates that decayed teeth are generally extracted when pain or abscess develops and restorative procedures are rarely performed on the elderly population.
There are certain limitations of this study. It was based on a review of previous studies which were conducted in different time periods by different investigators and in different study settings. Therefore, the generalizability may be inaccurate, though attempts were made to use statistical methods to generate a weighted prevalence giving due weightage to studies with larger sample size. Secondly, since the analysis did not include the two multicentric studies, the actual weighted prevalence calculated here could have been different. Moreover, all the studies were cross-sectional descriptive studies, which by themselves had their own limitations in terms of methodological issues, generalizability, and internal validity.
| Conclusion|| |
The present review shows that the burden of dental caries is high in elderly population in India. Dental caries and its complications can be easily prevented by simple measures like good oral hygiene and early treatment. Therefore, there is a need to address the problem of dental caries in the community. Besides generating awareness, treatment and restorative services need to be made available and accessible to the elderly population.
| References|| |
|1.||Petersen PE. The World Oral Health Report 2003. Continuous improvement of oral health in the 21st century - the approach of the WHO Global Oral Health Programme. Available from: http://www.who.int/oral_health/media/en/orh_report03_en.pdf. [Last accessed on 2011 Mar 3] |
|2.||DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. BMJ 1993;306:688-91. |
|3.||Joshipura KJ, Rimm EB, Douglass CW, Trichopoulos D, Ascherio A, Willett WC. Poor oral health and coronary heart disease. J Dent Res 1996;75:1631-6. |
|4.||Mendez MV, Scott T, LaMorte W, Vokonas P, Menzoian JO, Garcia R. An association between periodontal disease and peripheral vascular disease. Am J Surg 1998;176:153-7. |
|5.||Kinsella K, Velkoff VA, Victoria A. An Ageing World. International Population Reports. U.S. Department of Health and Human Service and U.S. Department of Commerce; 2001. p. 95-101. |
|6.||India: The Challenge of Old Age Income Security. World Bank 2001. Finance and Private Sector Development: South Asia Region, Report No. 22034-IN.Available from: http://www.silverinnings.com/docs/Finance/Pension/India%20%20Challenge%20of%20Old%20age%20Security.pdf. [Last accessed on 2011 Jan 16]. |
|7.||United Nations. World Population Ageing, 1950-2050, Department of Economic and Social Affairs, Population Division, New York. United Nations (UN)-2002. Available from: http://www.un.org/esa/population/publications/worldageing19502050/index.htm. [Last accessed on 2011 Jan 16]. |
|8.||Fillenbaum GG. The wellbeing of the elderly: Approaches to multidimensional assessment. World Health Organization, Geneva: WHO Offset Publication No. 84; 1984. p. 75-82. |
|9.||Nandal DS, Khatri RS, Kadian RS. Ageing problems in the structural context. In: Shrma ML, Dak TM, editors. Aging in India. New Delhi: Ajanta Publications (India); 1987. p. 106-16. |
|10.||Health care financing administration. National health expenditures, 1998. US Department of Health, Washington DC: Health Care Financing Administration. Available from: http://www.nidr.nih.gov/sgr/sgrohweb/ toc.htm. [Last accessed on 2011 Apr 16] |
|11.||STROBE Statement. Strengthening the reporting of observational studies in epidemiology. Available from: http://www.strobe-statement.org/index.php?id=available-checklists.[Last accessed on 2011 Jan 16]. |
|12.||Misra P, Upadhyay RP, Misra A, Anand K. A review of the epidemiology of diabetes in rural India. Diabetes Res Clin Pract 2011;92:303-11. |
|13.||Terr D. "Weighted Mean." From Math World - A Wolfram Web Resource. Available from: http://mathworld.wolfram.com/WeightedMean.html. [Last accessed on 2011 Apr 15]. |
|14.||Shah N, Pandey RM, Duggal R, Mathur VP, Parkash H, Sundaram KR. Oral Health in India. A report of Multi-centric study. Director General of Health Services, Ministry of Health and Family Welfare, Government of India and WHO collaborative programme. December 2007. Available from: http://www.whoindia.org/en/section20/Section30_1525.htm. [Last accessed on 2011 Jan 16]. |
|15.||Patro BK, Ravi Kumar B, Goswami A, Mathur VP, Nongkynrih B. Prevalence of dental caries among adults and elderly in an urban resettlement colony of New Delhi. Indian J Dent Res 2008;19:95-8. |
|16.||Goel P, Singh K, Kaur A, Verma M. Oral health care for elderly: Identifying needs and feasible strategies for service provision. Indian J Dent Res 2006;17:11-21. |
|17.||Shah N, Sundaram KR. Impact of socio-demographic variables, oral hygiene practices, oral habits and diet on dental caries experience of Indian elderly: A community-based study. Gerodontology 2004;21:43-50. |
|18.||DCI. National Oral Health Survey & Fluoride Mapping. Dental Council of India in collaboration with Ministry of Health and Family Welfare, Government of India;2002-2003. |
|19.||Doifode VV, Ambadekar NN, Lanewar AG. Assessment of oral health status and its association with some epidemiological factors in population of Nagpur, India. Indian J Med Sci 2000;54:261-9. |
|20.||World Health Organization (WHO). Oral health survey: Basic methods. 2 nd ed. Geneva: Oral Health Department, WHO;1997. |
|21.||Parkash H, Duggal R, Mathur VP, Petersen PE. Manual for multi-centric oral health survey. Directorate general of Health Services, Ministry of Health and Family Welfare and World Health Organization. Government of India and WHO India Biennium; 2004-05. |
[Figure 1], [Figure 2]