Background: The global prevalence of oral diseases is increasing at an alarming rate, particularly affecting developing nations such as India. Despite this pressing issue, there is a notable lack of comprehensive data in existing literature regarding the oral health-related quality of life (OHRQoL) among older adults within the Indian context. This gap in knowledge highlights the urgent need for focused research in this area to better understand the implications of oral health on the quality of life in vulnerable populations.
Aims: This study was designed to thoroughly assess the OHRQoL in older adults who are actively seeking dental care in various Indian healthcare settings. By conducting this research, we aim to provide valuable insights that can inform future oral health policies and practices tailored for older populations.
Methods: A total of 140 subjects were recruited for the study, where each participant underwent a detailed oral examination to identify any existing oral conditions. Following this assessment, participants completed a comprehensive questionnaire to evaluate their OHRQoL using the Geriatric Oral Health Assessment Index 12 (GOHAI-12). The treatment requirements for each subject were determined based on their individual prosthetic and dental conditions. Statistical analysis was performed on the collected data to derive meaningful results and conclusions.
Results: The analysis revealed that age has a significant correlation with OHRQoL, indicating that as age increases, the quality of life tends to decline (p=0.025). Additionally, the findings showed that older females experience poorer OHRQoL, with p-values of <0.001, 0.01, 0.04, and <0.001 for various factors including behavior, psychological impacts, pain and discomfort, and functional limitations. Furthermore, edentulous patients reported a notably lower OHRQoL compared to those with more than 20 teeth, emphasizing the importance of maintaining dental health.
Conclusion: This study concludes that oral diseases have a profound impact on OHRQoL, particularly among older adults, with a marked prevalence in females and those who are edentulous. Implementing early diagnosis and effective management strategies can significantly enhance the quality of life for older individuals, underscoring the need for improved oral healthcare access and education.
Understanding the Importance of Oral Health as a Fundamental Aspect of Overall Well-Being
Health is a crucial concern for healthcare professionals worldwide and is recognized as a fundamental human right. This concept extends beyond mere survival to encompass a broad range of social goals, including the promotion of oral health in both adults and children. Unfortunately, dental health is often overlooked as a vital component of overall health. According to the World Health Organization (WHO), oral health encompasses more than just the presence of healthy teeth. A truly healthy oral cavity is free from disorders and diseases, which include but are not limited to tooth loss, dental caries, periodontal disease, congenital anomalies (like cleft lip and palate), oral sores, and cancers of the mouth and throat, as well as chronic facial and oral pain [1].
Untreated dental diseases can have far-reaching consequences, severely affecting individuals’ quality of life and overall well-being. Regular health check-ups, along with diligent daily oral care at home, are essential for preserving the integrity of both teeth and overall dental health. Dental services are defined as the initial dental visit within a series of appointments or the frequency of annual dental visits per individual. In some regions, these services are also evaluated based on the average costs associated with routine or emergency dental visits. Analyzing these services is crucial for planning and implementing effective oral health initiatives at the community level [1,2].
In developing nations like India, prevalent oral health concerns such as oral cancers, periodontitis, and dental caries significantly impact communities. These conditions not only affect physical health but also impose social restrictions, diminishing quality of life across various age groups. The repercussions are often more pronounced among individuals with lower socioeconomic status. Additionally, stark disparities exist in oral health between rural and urban populations in India. Despite advancements in dental technologies and procedures, access to oral healthcare remains limited for certain subgroups within the population [2,3]. Older adults face heightened challenges regarding oral health due to the cumulative effect of chronic conditions, including tooth loss and periodontal diseases. Moreover, systemic health issues such as diabetes and cardiovascular diseases can exacerbate oral health problems, leading to conditions like periodontal disease, altered taste sensations, and xerostomia. The prevalence of tooth loss among older adults can significantly compromise aesthetics, phonetics, and the ability to chew effectively. Such difficulties can ultimately impact nutritional intake, potentially leading to severe health issues if not addressed [1].
The global elderly population is expanding rapidly, largely due to increased life expectancy and improved healthcare systems. By 2050, the number of older adults is projected to reach two billion worldwide. In India, older adults currently make up approximately 9% (103 billion) of the total population, with the prevalence of dental caries ranging from 31% to 100% [2]. Efforts to promote oral health in India must focus on diagnosing prevalent oral conditions within targeted demographics, while also considering the unique needs and characteristics of these populations. Quality of life cannot be solely assessed through the prevalence of diseases; thus, incorporating oral health-related quality of life (OHRQoL) assessments is essential. The WHO recognizes OHRQoL as a critical component of global oral health initiatives. Various indices, including the Oral Health Impact Profile and the General Oral Health Assessment Index (GOHAI), are reliable tools for measuring OHRQoL. The availability of GOHAI in Hindi facilitates its use within India, making it accessible for local populations [4]. Despite its importance, there is still limited research on OHRQoL among older adults in India [5-7]. This study aims to fill that gap by evaluating OHRQoL in older adults seeking dental care in Indian healthcare settings.
Study Design: Comprehensive Materials and Methods to Ensure Robust Findings
The study was conducted following rigorous ethical standards, with approval obtained from Mithila Minority Dental College, Darbhanga, India, and informed consent secured from all participants. The research included a total of 140 subjects from both genders, with a mean age of 71.46 years and an age range spanning from 60 to 87 years. The ethical approval number for this study was MMDC/2021/102. Participants were selected from the Outpatient Department of Mithila Minority Dental College and Hospital, Darbhanga, India, who sought dental care services. Exclusion criteria included individuals who were terminally ill, had significant morbidity, were suffering from systemic diseases, or declined to participate. Out of 226 subjects screened, 140 were ultimately included in the study. Following inclusion, a thorough oral examination was conducted to identify any oral conditions present, followed by an interview addressing the impact of these conditions on OHRQoL. All examinations and interviews were performed by a single examiner with expertise in this area. Oral conditions such as mucosal lesions, prosthetic status, and the Decayed, Missing, Filled (DMF) Index for caries were assessed, alongside the Community Periodontal Index (CPI) for periodontal health assessment. Individual treatment needs were also evaluated based on these findings.
Participants then completed a questionnaire designed to gather comprehensive data. The questions were made available in both Hindi and English to enhance understanding. The questionnaire included inquiries regarding demographic characteristics, socioeconomic status, family and educational history, personal habits, medical history, dental issues, and oral health awareness. The OHRQoL was assessed using the GOHAI-12, which consists of 12 questions focusing on nine key items related to talking, swallowing, and eating, categorized into groups G1, G2, G3, and G4. Each question offered five response options ranging from 0 (never) to 5 (always). Groups G6, G7, G9, G10, and G11 examined psychological factors such as oral health concerns, social withdrawal, and self-esteem, while groups G5, G8, and G12 assessed the use of pain relief medications and discomfort. Overall scores ranged from 0 to 60, with a higher score indicating better oral health. The influence of oral health status on health-related quality of life (HRQoL) was evaluated based on the questionnaire scores, which provided insights into the psychosocial and functional implications of oral health.
The collected data underwent statistical analysis using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States), applying the analysis of variance (ANOVA) test. A significance level of p=0.05 was established, and data were expressed as mean values, counts, and percentages, with outcomes calculated accordingly.
Key Findings: Detailed Results and Demographics of Study Participants
The study successfully included a total of 140 subjects from both genders, with a mean age of 71.46 years, ranging from 60 to 87 years. The demographic characteristics of the participants are outlined in Table 1. Among the subjects, 83.57% (n = 117) were aged between 60 and 70 years, 12.14% (n = 17) were aged between 71 and 80 years, and 4.28% (n = 6) were over 80 years. The gender distribution revealed that 75.71% (n = 106) were females, while 24.28% (n = 34) were males. Employment status showed that 41.42% (n = 58) of subjects were employed, while 58.57% (n = 82) were unemployed. Smoking was reported by 29.28% (n = 41) of the participants, with the remaining 70.71% (n = 99) being non-smokers. A body mass index (BMI) greater than 19 was observed in 62.14% (n = 87) of subjects, and 62.85% (n = 88) reported using a toothbrush with toothpaste for oral hygiene.
Regarding oral health and treatment needs, it was found that 65.71% (n = 92) of subjects had no caries, while >2 carious lesions were detected in 30% (n = 42) of subjects. Additionally, oral lesions such as leukoplakia, ulcerations, oral submucous fibrosis (OSMF), candidiasis, and lichen planus were identified in 3.57% (n = 5), 0.71% (n = 1), 42.14% (n = 59), 30% (n = 42), and 2.85% (n = 4) of subjects, respectively. Clinical attachment loss (CAL) exceeding 5mm was observed in 25% (n = 35) of subjects. Lesions on the buccal mucosa, lip, palate, tongue, and floor of the mouth were recorded in 40% (n = 56), 3.57% (n = 5), 0.71% (n = 1), 30% (n = 42), and 2.84% (n = 4) of subjects, respectively. In terms of treatment needs, 18.57% (n = 26) required emergency care, while 45.71% (n = 64) needed interventions, 34.28% (n = 48) required preventive care, and 1.42% (n = 2) were referred to a specialist (Table 2).
The GOHAI assessment was utilized to evaluate OHRQoL based on parameters such as age, gender, and dentition. The results indicated a significant association between increasing age and lower quality of life (p = 0.025). In terms of gender differences, older females exhibited poorer OHRQoL, with p-values of <0.001, 0.01, 0.04, and <0.001 for behavioral impact, psychological aspects, pain and discomfort, and functional limitations, respectively. Additionally, edentulous patients reported significantly poorer OHRQoL compared to those with more than 20 teeth, as detailed in Table 3.
| GOHAI component | n=117 | n=17 | n=6 | P-value |
| Age-based | 60-70 years | 71-80 years | >80 years | Â |
| Behaviour impact | 3.58±1.67 | 3.24±1.82 | 4.82±2.49 | Not significant |
| Psychological impacts | 6.72±2.24 | 6.89±2.34 | 8.9±1.68 | Not significant |
| Pain and discomfort | 5.25±1.85 | 5.11±1.95 | 4.9±2.37 | 0.025 |
| Functional limitation | 5.4±2.21 | 5.11±1.95 | 4.9±2.37 | N.S  |
| Gender-based | Females (n=106) | Males (n=34) | Â | Â |
| Behaviour Impact | 3.166±1.399 | 4.90±1.988 |  | <0.001 |
| Psychological impacts | 6.48±2.408 | 7
Sienna Blake
Sienna Blake is a licensed aesthetic consultant and beauty writer specializing in cosmetic surgery advancements and non-invasive treatments. With a background in dermatology and over eight years of industry experience, Sienna is passionate about helping people achieve confidence through informed beauty decisions. She holds a Bachelor's degree in Health Sciences and regularly collaborates with top plastic surgeons to stay at the forefront of aesthetic innovations. Outside of her work, Sienna enjoys traveling, skincare research, and practicing Pilates.
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