Tooth Loss, Sociodemographic Conditions and Oral Health-Related Quality of Life in the Elderly

Adriana Drummond de Aguiar Elizabeth Regina Araújo de Oliveira Maria Helena Monteiro de Barros Miotto About the authors

Abstract

Objective:

To verify the association between impacts produced by tooth loss and sociodemographic variables in the oral health-related quality of life (OHRQoL) in the elderly.

Material and Methods:

This is an analytical cross-sectional study carried out in the municipality of Vitória/ES, Brazil, which sample was composed of 402 older adults. The Oral Health Impact Profile (OHIP-14) was used to measure the individuals' OHRQoL. For data analysis, descriptive and bivariate analyses were performed using the Fisher's exact test and the Mantel-Haenzsel test to assess the effects of combined dimensions. The significance level adopted was 5%. To assess the strength of association between independent variables and dimensions, Odds-Ratio (OR) with 95% confidence interval (CI) was calculated.

Results:

The prevalence of negative impact on OHRQoL in the elderly was 32.6%. The greatest impact perception was found in individuals with up to 10 years of schooling (p=0.021 and OR=1.602), with need for removable partial dentures (p=0.000 and OR=2.873) and those who did not accept the loss of dental elements (p=0.000 and OR=3.064).

Conclusion:

Older female adults with socioeconomic class C/D-E, with up to 10 years of schooling, who lost 11 or more teeth, who declared the need for removable partial dentures, suffered greater impacts caused by tooth loss on OHRQoL.

Keywords:
Quality of Life; Oral Health; Aged; Health Status Indicators; Sickness Impact Profile

Introduction

A broader view of health includes objective aspects based on the professional's clinical assessment and subjective aspects, such as quality of life. Thus, with the expansion of the health concept, Dentistry started to consider the absence or cure of oral diseases and the effect of these problems on people's quality of life [1[1] Miotto MHBM, Barcellos LA, Almeida CS. The impact of oral conditions in the quality of life municipal civil servants. Ciên Saúde Colet 2014; 19(9):3931-40. https://doi.org/10.1590/1413-81232014199.12912013
https://doi.org/10.1590/1413-81232014199...
].

The Oral Health Impact Profile (OHIP) is a subjective indicator developed and tested by Australian researchers to complement traditional epidemiological indicators, as it provides a comprehensive measure of self-perception of oral disorders that may or may not affect quality of life [2[2] Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dent Health 1994; 11(1):3-11.]. In addition, a Brazilian study emphasized the importance of using subjective indicators to assess the population's oral health needs as a complement to normative clinical needs [3[3] Ilha L, Martins AB, Abegg C. Oral impact on daily performance: need and use of dental prostheses among Brazilian adults. J Oral Rehabil 2016; 43(2):119-26. https://doi.org/10.1111/joor.12351
https://doi.org/10.1111/joor.12351...
].

Providing the elderly population longevity with quality of life has become a major challenge for the Brazilian public health system, mainly because Brazil is experiencing a period of accelerated demographic aging, with important implications for individuals and society [4[4] Brasil. Instituto Brasileiro de Geografia e Estatística. Relações entre as alterações históricas na dinâmica demográfica brasileira e os impactos decorrentes do processo de envelhecimento da população. Rio de Janeiro: IBGE; 2016. [In Portuguese].]. For example, projections indicate that by 2030, approximately 19% of the Brazilian population will be composed of individuals aged 60 years and over [5[5] Brasil. Instituto Brasileiro de Geografia e Estatística. Projeção da população do Brasil e das Unidades da Federação. Available from: https://www.ibge.gov.br/apps/populacao/projecao. [Accessed on July 10, 2018]. [In Portuguese].
https://www.ibge.gov.br/apps/populacao/p...
].

Thus, successful and healthy aging emerges in different contexts and raises concerns about how to maintain general and oral health in the elderly [6[6] Milagres CS, Tôrres LHN, Neri AL, Sousa MLR. Self-perceived oral health status, chewing ability and longevity in the elderly. Ciên Saúde Colet 2018; 23(5):1495-506. https://doi.org/10.1590/1413-81232018235.14572016
https://doi.org/10.1590/1413-81232018235...
]. Benefits are generated by social groups for older individuals who seek life with more autonomy and quality, as the encouragement of some changes in habits and attitudes intensifies the search for results of healthy and active aging [7[7] Schoffen LL, Santos WL. The importance of living groups for the elderly as instrument for health maintenance. Rev Cient Sena Aires 2018; 7(3):160-70.].

Senior Citizens' Care Centers (CCTIs) belong to the Companionship and Bond Strengthening Service to offer spaces through their activities that favor healthy aging, quality of life and strengthening of social bonds [8[8] Brasil. Ministério do Desenvolvimento Social e do Combate à Fome. Perguntas Freqüentes: Serviço de Convivência e Fortalecimento de Vínculos. Available from: http://www.mds.gov.br/webarquivos/publicacao/assistencia_social/perguntas_e_respostas/PerguntasFrequentesSCFV_032017.pdf. [Accessed on September 15, 2018]. [In Portuguese].
http://www.mds.gov.br/webarquivos/public...
]. In Brazil, the offer of public dental services to this population is still incipient, so it is believed that knowing the perception of these people about their oral condition should be the first step to planning programs and services that can prioritize this age group.

Given the scarce literature in the national context addressing this issue, this study aimed to verify the association between impacts produced by tooth loss and sociodemographic variables on the oral health-related quality of life (OHRQoL) in the elderly. The hypothesis of this study was to detect the negative impact on the OHRQoL in the elderly population.

Material and Methods

Study Type and Site

This is an analytical study with a cross-sectional design carried out in the four CCTIs of the municipality of Vitória, capital of the state of Espírito Santo, Brazil. According to data from the IBGE Census, the municipality has 327,801 inhabitants, with 39,505 people over 60 years of age [9[9] Brasil. Instituto Brasileiro de Geografia e Estatísitica. Censo Demográfico 2010. Available from: https://www.censo2010.ibge.gov.br/. [Accessed on July 2, 2018]. [In Portuguese].
https://www.censo2010.ibge.gov.br/...
].

Sample Size and Selection

The sample universe was composed of all older adults attending CCTIs. The sampling unit was composed of 2,416 individuals. Sample size calculation was performed using the formula of the Epi Info statistical software, which considered 50% prevalence, 95% confidence interval, and 5% sampling error. This calculation generated the amount of 332 users that, with an increase of 20% for probable losses, resulted in a minimum sample of 398 individuals. Researchers visited CCTIs every day of the week and in all shifts so that users had the same opportunity to participate in the research. Therefore, the number of respondents by CCTI was proportional to the number of users attending each unit.

Selection Criteria

Inclusion criteria were individuals of both sexes aged 60 years or over, registered and attending activities offered by CCTIs during the collection period. Exclusion criteria were individuals who did not understand or, for some health reason, were unable to answer the interview questions.

Study Variables and Data Collection

  • Dependent Variable

    The dependent variable in this study was OHRQoL assessed using the OHIP instrument. A previous study performed the cross-cultural translation to adapt to the Brazilian reality. It was found that the instrument has psychometric properties similar to the original instrument, demonstrating validation for the Brazilian Portuguese language [10[10] Nadanovsky P, Oliveira BH. Psycometric properties of the Brazilian version of the Oral Health Impact Profile-short form. Community Dent Oral Epidemiol 2005; 33(4):307-14. https://doi.org/10.1111/j.1600-0528.2005.00225.x
    https://doi.org/10.1111/j.1600-0528.2005...
    ]. The "Oral Health Impact Profile" script was used in the OHIP 14 - short version for oral health self-perception questions, addressing the seven dimensions: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability and social disability. Participants answered the questions on a frequency scale (Lickert) with five options: never, rarely, sometimes, often and always. The expression of OHIP results was given in a dichotomous way: impact on the quality of life for answers “always and often” and no impact on the quality of life for answers “sometimes, rarely and never”.

  • Independent Variables

    For independent variables, scripts that collected information on sociodemographic characteristics such as gender, age and socioeconomic class were used. The latter was categorized according to the possession of consumer goods and respondent’s schooling - class A, B1, B2, C1, C2, D-E - using the Brazil Economic Classification Criteria [11[11] Brasil. Associação Brasileira de Empresas de Pesquisa (ABEP). Critério de Classificação Econômica do Brasil-2016. Available from: https://www.abep.org. [Accessed on August 3, 2018]. [In Portuguese].
    https://www.abep.org...
    ]. Another independent variable was oral condition – dentate and edentate. Characteristics related to perceived need were also identified. Tooth loss was assessed using a script in which individuals had the opportunity to declare the number of missing teeth, region (anterior and posterior), type of extracted dental elements (incisors, canines, premolars and molars), expectation for replacement treatment, probable causes that led to tooth extractions, feelings regarding extraction, acceptance or not regarding tooth loss and factors that contributed to dental losses. A participant with at least one missing tooth was considered tooth loss. Data collection was carried out from February to April 2019 by three duly calibrated researchers through training to apply the questionnaires used.

Statistical Analysis

Statistical analysis was performed using the IBM Social Package Statistical Science (SPSS) Version 20 statistical package. Descriptive data analysis was organized in tables. Association between impact, sociodemographic variables and oral health was tested by the Fisher's Exact Test. Significance level adopted in tests was 5%.

To assess the strength of association between independent variables and dimensions, the Odds-Ratio (OR) with 95% confidence interval (CI) was calculated. To analyze the effect of combined dimensions, the Mantel-Haenszel test was used.

Ethical Clearance

The study was approved by the Research Ethics Committee of the Municipal Social Welfare Secretariat of Vitória/ES, on September 26, 2018, and by the Research Ethics Committee of the Health Sciences Center, Federal University of Espírito Santo, on October 30, 2018, according to Resolution No. 466/12 of the National Health Council. All research participants signed the Free and Informed Consent Form (FICF).

Results

The final sample consisted of 402 older adults, and there was no loss. The prevalence of general impact observed was 32.6%, where 131 individuals reported a negative impact on OHRQoL caused by tooth loss. The demographic profile of the population under study shows a predominance of women, with the participation of 83.8% and predominance of the age group of 70 – 79 years (41.3%). As for socioeconomic class, classes D-E had the highest representation in the study (29.4%). Regarding the schooling declared by participants, the majority (63.3%) reported having complete high school/incomplete higher education (over 10 years of study).

Regarding gender (Table 1), statistical significance was observed for the following dimensions: physical pain (95%CI= 1.229 - 10,000 and OR= 3.506), psychological discomfort (95%CI= 1.089 - 6.326 and OR= 2.625), physical disability (95%CI= 1.031 - 56.856 and OR=7.654) and psychological disability (95%CI= 1.114 - 12.191 and OR=3.685).

Table 1
Analysis of the impact, by dimension, according to the gender of individuals attending Senior Citizens' Care Centers.

When analyzing schooling (Table 2), considering the impact dimensions, statistical significance was observed for functional limitation (95%CI=1.206–4.81 and OR=2.410), physical disability (95%CI=1.015–3.951 and OR=2.02) and psychological disability (95%CI=1.543–4.961 and OR=2.767).

Table 2
Analysis of the impact, by dimension, according to the schooling of individuals attending Senior Citizens' Care Centers.

Regarding the need for a removable partial denture (RPP), considering the general impact (Mantel-Haenszel), statistical significance was found between this variable and impact (95%CI= 1.861-4.438 and OR =2.873), that is, individuals who need RPP were 2.83 times more likely of being impacted on OHRQoL (Table 3).

Table 3
Analysis of the impact, by dimension, according to the need for the use of removable partial dentures (RPP) of individuals attending Senior Citizens' Care Centers.

In the analysis of the socioeconomic condition (Table 4), considering the impact dimensions alone, statistical significance was found for functional limitation (95%CI=1.156–12.864 and OR=3.856), physical disability (95%CI=1.474–26.462 and OR=6.245) and psychological disability (95%CI=1.037–5.448 and OR=2.377).

Table 4
Analysis of the impact, by dimension, according to the socioeconomic status of individuals attending Senior Citizens' Care Centers.

In Table 5, it is possible to observe, considering the total score (Mantel-Haenszel), statistical significance between acceptance of tooth loss and impact (95%CI=1.851–5.071 and OR=3.064), as individuals who did not accept tooth loss were 3.06 more likely of being impacted on OHRQoL.

Table 5
Analysis of the impact, by dimension, according to acceptance of tooth loss among individuals attending Senior Citizens' Care Centers.

Discussion

Dentistry today seeks to achieve health in a broader way, where objective and subjective aspects must be considered, focusing on the relationship between oral conditions and quality of life [1[1] Miotto MHBM, Barcellos LA, Almeida CS. The impact of oral conditions in the quality of life municipal civil servants. Ciên Saúde Colet 2014; 19(9):3931-40. https://doi.org/10.1590/1413-81232014199.12912013
https://doi.org/10.1590/1413-81232014199...
]. In this context, this study found an association between impacts produced by tooth loss and sociodemographic variables on the OHRQoL of older adults attending CCTIs in the municipality of Vitória, Brazil.

The greatest perception of impact on OHRQoL in this research was found in individuals with up to 10 years of schooling, belonging to socioeconomic class C/DE, who had lost 11 teeth or more, needed RPP and did not accept the loss of dental elements. These factors lead to reflections and critical analyses with regard to aspects related to the physical, mental and social well-being of the most disadvantaged individuals.

The prevalence of general impact observed was 32.6%, where 131 individuals reported a negative impact on OHRQoL caused by tooth loss. This finding is similar to that found in research carried out in the adult and older adult population of a municipality in the state of Espírito Santo, in which prevalence of 35% was identified, in which 83 participants suffered impact caused by oral problems [12[12] Miotto MHMB, Barcellos LA, Velten DB. Evaluation of the impact on quality of life caused by oral health problems in adults and the elderly in a southeastern Brazilian city. Ciên Saúde Colet 2012; 17(2):397-405. https://doi.org/10.1590/S1413-81232012000200014
https://doi.org/10.1590/S1413-8123201200...
]. Furthermore, the result of this study is similar to that found in research developed in Fortaleza, Brazil, where 30.5% of subjects had a negative impact on oral health in their daily lives [13[13] Nogueira CMR, Falcão LMN, Nuto SAS, Saintrain MVL, Vieira-Meyer APGF. Self-perceived oral health among the elderly: a household-based study. Rev Bras Geriatr Gerontol 2017; 20(1):7-19. https://doi.org/10.1590/1981-22562017020.160070
https://doi.org/10.1590/1981-22562017020...
].

On the other hand, the impact frequency of 7.8% observed in the study developed with workers of a mixed-economy company in the capital of Espírito Santo can be considered low [14[14] Miotto MHMB, Gomes LMM, Velten DB, Barcellos LA. Impact produced by oral conditions on the quality of life of Brazilian workers of a mixed-economy company. Pesqui Bras Odontoped Clín Integr 2018; 18(1):3769. https://doi.org/10.4034/PBOCI.2018.181.75
https://doi.org/10.4034/PBOCI.2018.181.7...
]. It is believed that the high schooling and purchasing power of these individuals provided access to private and free choice dental services agreed upon by the company, which were preponderant for the result obtained.

An even lower impact frequency was verified in workers from a Brazilian public university who had completed high school [15[15] Guerra MJC, Greco RM, Leite ICG, Ferreira EF, Queiroz de Paula MV. Impact of oral health conditions on the quality of life of workers. Ciên Saúde Colet 2014; 19(12):4777-86. https://doi.org/10.1590/1413-812320141912.21352013
https://doi.org/10.1590/1413-81232014191...
]. It is suggested that the participants' schooling is the cause of the percentage found in this study, as higher schooling would likely generate more information and self-care.

The demographic profile of the population surveyed shows a predominance of women, with 83.8% of the 402 participants. This result is similar to the study carried out at the Reference Center for Elderly Care in João Pessoa, Brazil, in which the sample consisted of 84.9% of women [16[16] Silva MA, Batista AUD, Abreu MHNG, Forte FDS. Oral Health Impact Profile: need and use of dental prostheses among Northeast Brazilian independent-living elderly. Ciên Saúde Colet 2019; 24(11):4305-12. https://doi.org/10.1590/1413-812320182411.32472017
https://doi.org/10.1590/1413-81232018241...
]. A similar situation was found in other studies [13[13] Nogueira CMR, Falcão LMN, Nuto SAS, Saintrain MVL, Vieira-Meyer APGF. Self-perceived oral health among the elderly: a household-based study. Rev Bras Geriatr Gerontol 2017; 20(1):7-19. https://doi.org/10.1590/1981-22562017020.160070
https://doi.org/10.1590/1981-22562017020...
,17[17] Costa MJF, Lins CAA, Macedo LPV, Sousa VPS, Duque JA, Souza MC. Clinical and self-perceived oral health assessment of elderly residents in urban, rural, and institutionalized communities. Clinics 2019; 74:e972. https://doi.org/10.6061/clinics/2019/e972
https://doi.org/10.6061/clinics/2019/e97...
]. This higher prevalence of females can be attributed to the phenomenon called in studies of the feminization of old age, which is the predominance of women in the elderly population [18[18] Fleury L. Feminização da velhice: uma questão masculina. Rev Aptare. 2019. Available from: https://revistaaptare.com.br/2019/03/08/feminizacao-da-velhice-uma-questao-masculina/. [Accessed on January 20, 2020]. [In Portuguese].
https://revistaaptare.com.br/2019/03/08/...
]. In addition, women are proactive and participate more in group activities; in the case of the present work, they attend Senior Citizens' Care Centers.

Also, regarding the sociodemographic variables under study, in the analysis between gender and impact on OHRQoL, it was observed that women were more likely to be impacted on some isolated dimensions. The finding of this research corroborates another Brazilian study, which reports women suffering a greater impact on the performance of their daily activities when compared to men [19[19] Bulgareli JV, Faria ET, Cortellazzi KL, Guerra LM, Castro M, Ambrosano GM, et al. Fatores que influenciam o impacto da saúde bucal nas atividades diárias de adolescentes, adultos e idosos. Rev Saúde Pública 2018; 52:44. https://doi.org/10.11606/s1518-8787.2018052000042.
https://doi.org/10.11606/s1518-8787.2018...
]. This characteristic may be associated with women showing greater concern with aesthetics and social interaction [20[20] Soares SLB, Rodrigues RA, Ribeiro RA, Rosendo RA. Assessment of full dentures users addressing functional, social and psychological aspects. Rev Saúde Colet 2015; 4(2):19-27. https://doi.org/10.35572/rsc.v4i2.248
https://doi.org/10.35572/rsc.v4i2.248...
]. In addition, some authors emphasize the more critical oral health self-perception among women [21[21] Agostinho ACMG, Campos ML, Silveira JLGC. Edentulism, denture wearing and self-perceived of oral health among elderly. Rev Odontol. UNESP 2015; 44(2): 74-9. https://doi.org/10.1590/1807-2577.1072
https://doi.org/10.1590/1807-2577.1072...
]. This may be related to the fact that they take more care of themselves, seek more for health services and often do not have their expectations met, as they find it difficult to access public health services, which can result in worse self-assessment for females regarding the impact on OHRQoL.

Regarding schooling, in this study, considering the general impact and the psychological disability dimension, it was found that individuals with up to 10 years of schooling were more likely of suffering impact on OHRQoL. Other studies have also reported low schooling related to a negative impact on oral health [22[22] Mejia G, Armfield J, Jamieson L. Self-rated oral health and oral health-related factors: the role of social inequality. Aust Dent J 2014; 59(2):226-33. https://doi.org/10.1111/adj.12173
https://doi.org/10.1111/adj.12173...
,23[23] Ribeiro AE. Desigualdades relacionadas à autopercepção da saúde bucal entre idosos do município de São Paulo entre 2000 e 2010. (Tese de doutorado). São Paulo: Faculdade de Saúde Pública; 2018. [In Portuguese].]. These data show that the level of knowledge influences the oral health perception, considering that less educated individuals had a greater impact on OHRQoL. Thus, it is believed that the greater the access to information, the greater the adherence to prevention measures, resulting in better oral conditions. Thus, it is understood that high schooling would be a protective factor for oral diseases.

In the analysis of the socioeconomic condition variable of the present research, considering the physical disability dimension, it was observed that individuals from socioeconomic classes C/D-E were much more likely of suffering impact on OHRQoL. Similar results were reported in previous studies, where less favored economic classes suffered greater impact of oral health on daily activities [19[19] Bulgareli JV, Faria ET, Cortellazzi KL, Guerra LM, Castro M, Ambrosano GM, et al. Fatores que influenciam o impacto da saúde bucal nas atividades diárias de adolescentes, adultos e idosos. Rev Saúde Pública 2018; 52:44. https://doi.org/10.11606/s1518-8787.2018052000042.
https://doi.org/10.11606/s1518-8787.2018...
,23[23] Ribeiro AE. Desigualdades relacionadas à autopercepção da saúde bucal entre idosos do município de São Paulo entre 2000 e 2010. (Tese de doutorado). São Paulo: Faculdade de Saúde Pública; 2018. [In Portuguese]., 24[24] Cohen-Carneiro F, Souza-Santos R, Rebelo MAB. Quality of life related to oral health: contribution from social factors. Ciên Saúde Colet 2011; 16(Suppl 1):1007-15. https://doi.org/10.1590/S1413-81232011000700033
https://doi.org/10.1590/S1413-8123201100...
, 25[25] Martins AB, Dalberto CS, Hugo FN. Association between tooth root remains and self-reported oral health among the elderly. Ciên Saúde Colet 2015; 20(12):3669-79. https://doi.org/10.1590/1413-812320152012.00822015
https://doi.org/10.1590/1413-81232015201...
]. In a study carried out in Porto Alegre/RS, the authors identified that older adults whose family income was sufficient exhibited prevalence of positive oral health self-perception 31% higher than those without sufficient income, allowing for health expenses, choice of type of service (public or private) and access to health care, considering that socioeconomic status interferes with treatment options [25[25] Martins AB, Dalberto CS, Hugo FN. Association between tooth root remains and self-reported oral health among the elderly. Ciên Saúde Colet 2015; 20(12):3669-79. https://doi.org/10.1590/1413-812320152012.00822015
https://doi.org/10.1590/1413-81232015201...
].

Regarding the variable need to use RPP, not considering dimensions in isolation, individuals who declared need for this type of prosthesis were more likely of suffering impact on OHRQoL. The SB Brasil 2010 project, the last national epidemiological survey, shows that 68% of adults who were interviewed claimed need for some type of prosthesis, and the partial prosthesis in a dental arch was the main claim [26[26] Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Coordenação Nacional de Saúde Bucal. Projeto SB Brasil 2010: Condições de Saúde Bucal da População Brasileira, Resultados Principais. Brasília: Ministério da Saúde; 2011. [In Portuguese].]. Previous studies have demonstrated that individuals in need of prostheses have greater negative impacts on OHRQoL [3[3] Ilha L, Martins AB, Abegg C. Oral impact on daily performance: need and use of dental prostheses among Brazilian adults. J Oral Rehabil 2016; 43(2):119-26. https://doi.org/10.1111/joor.12351
https://doi.org/10.1111/joor.12351...
,14[14] Miotto MHMB, Gomes LMM, Velten DB, Barcellos LA. Impact produced by oral conditions on the quality of life of Brazilian workers of a mixed-economy company. Pesqui Bras Odontoped Clín Integr 2018; 18(1):3769. https://doi.org/10.4034/PBOCI.2018.181.75
https://doi.org/10.4034/PBOCI.2018.181.7...
,16[16] Silva MA, Batista AUD, Abreu MHNG, Forte FDS. Oral Health Impact Profile: need and use of dental prostheses among Northeast Brazilian independent-living elderly. Ciên Saúde Colet 2019; 24(11):4305-12. https://doi.org/10.1590/1413-812320182411.32472017
https://doi.org/10.1590/1413-81232018241...
,27[27] Rosendo RA, Sousa JNL, Abrantes JGS, Cavalcante ABP, Ferreira AKTF. Self-perception of the oral health and its impact in elderly people’s life quality: a literature review. Rev Saúde Colet 2017; 6(1):89-102. https://doi.org/10.35572/rsc.v6i1.157
https://doi.org/10.35572/rsc.v6i1.157...
]. Thus, the relevance of these findings is understood, considering that deficiencies in the stomatognathic system can cause chewing, speech and aesthetics problems [28[28] Bitencourt FV, Corrêa HW, Toassi RFC. Tooth loss experiences in adult and elderly users of Primary Health Care. Ciên Saúde Colet 2019; 24(1):169-80. https://doi.org/10.1590/1413-81232018241.09252017
https://doi.org/10.1590/1413-81232018241...
], leading to negative oral health self-perception.

The analysis of the impact caused by tooth loss according to the number of lost teeth, considering the functional limitation dimension, showed that individuals who lost 11 teeth or more were more likely of suffering impact on OHRQoL. This finding may be related to the fact that this population has the greatest accumulated needs throughout life, resulting in numerous tooth losses. Through the OHIP-14 indicator, a study showed that among people with a greater number of missing teeth, most manifested influence of oral health on daily life [29[29] Santillo PMH, Gusmão ES, Moura C, Soares RSC, Cimões R. Factors associated with tooth loss among adults in rural areas in the state of Pernambuco, Brazil. Ciên Saúde Colet 2014; 19(2):581-90. https://doi.org/10.1590/1413-81232014192.20752012
https://doi.org/10.1590/1413-81232014192...
]. Furthermore, research carried out in the southern region of Brazil found that the presence of 1 to 19 teeth can reduce the prevalence of favorable oral health self-perception [25[25] Martins AB, Dalberto CS, Hugo FN. Association between tooth root remains and self-reported oral health among the elderly. Ciên Saúde Colet 2015; 20(12):3669-79. https://doi.org/10.1590/1413-812320152012.00822015
https://doi.org/10.1590/1413-81232015201...
]. These data reflect the precariousness of the oral condition of the Brazilian population, which is a legacy of curative and mutilating dentistry.

When evaluating the impact caused by tooth loss according to the acceptance of tooth loss, statistical significance was found in all dimensions, both for the general impact and for isolated dimensions, except for the social disability dimension. For the psychological disability dimension, individuals who did not accept tooth loss were more likely of suffering impact in this dimension. Other studies with the elderly population showed a greater impact of tooth loss in the psychological discomfort dimension and was associated with a greater chance of compromised quality of life in its physical and mental domains [30[30] Martins AMEBL, Jones KM, Souza JGS, Pordeus IA. Association between physical and psychosocial impacts of oral disorders and quality of life among the elderly. Ciên Saúde Colet 2014, 19(8):3461-78. https://doi.org/10.1590/1413-81232014198.16202013
https://doi.org/10.1590/1413-81232014198...
]. Psychological disability was a point highlighted in research carried out with older adults in northeastern Brazil, as it emphasized that tooth loss is directly conditioned to the feeling of humiliation and embarrassment [16[16] Silva MA, Batista AUD, Abreu MHNG, Forte FDS. Oral Health Impact Profile: need and use of dental prostheses among Northeast Brazilian independent-living elderly. Ciên Saúde Colet 2019; 24(11):4305-12. https://doi.org/10.1590/1413-812320182411.32472017
https://doi.org/10.1590/1413-81232018241...
].

The cross-sectional design is considered a study limitation, as it does not allow inference of causal relationships. The interview covers past experiences, a fact that may have caused memory bias. As information on tooth loss was self-reported, the amount and type of tooth loss may have been a bias, as some individuals may not know the name of the lost tooth element. The population surveyed is part of a group with specific characteristics (users of Senior Citizens' Care Centers), and it is not possible to infer results for the elderly population in the municipality of Vitória; for this, a study with a population-based sample design is necessary.

Conclusion

The greatest impact on OHRQoL produced by tooth loss was found in females belonging to socioeconomic class C/DE, with up to 10 years of schooling, who had a loss of 11 teeth or more, who declared the need for removable partial dentures and who did not accept the loss of dental elements. Therefore, the highest prevalence of problems related to tooth loss affects the most disadvantaged individuals, highlighting the lack of public policies to reduce social disparities.

  • Financial Support
    None.
  • Data Availability
    The data used to support the findings of this study can be made available upon request to the corresponding author.

References

  • [1]
    Miotto MHBM, Barcellos LA, Almeida CS. The impact of oral conditions in the quality of life municipal civil servants. Ciên Saúde Colet 2014; 19(9):3931-40. https://doi.org/10.1590/1413-81232014199.12912013
    » https://doi.org/10.1590/1413-81232014199.12912013
  • [2]
    Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dent Health 1994; 11(1):3-11.
  • [3]
    Ilha L, Martins AB, Abegg C. Oral impact on daily performance: need and use of dental prostheses among Brazilian adults. J Oral Rehabil 2016; 43(2):119-26. https://doi.org/10.1111/joor.12351
    » https://doi.org/10.1111/joor.12351
  • [4]
    Brasil. Instituto Brasileiro de Geografia e Estatística. Relações entre as alterações históricas na dinâmica demográfica brasileira e os impactos decorrentes do processo de envelhecimento da população. Rio de Janeiro: IBGE; 2016. [In Portuguese].
  • [5]
    Brasil. Instituto Brasileiro de Geografia e Estatística. Projeção da população do Brasil e das Unidades da Federação. Available from: https://www.ibge.gov.br/apps/populacao/projecao [Accessed on July 10, 2018]. [In Portuguese].
    » https://www.ibge.gov.br/apps/populacao/projecao
  • [6]
    Milagres CS, Tôrres LHN, Neri AL, Sousa MLR. Self-perceived oral health status, chewing ability and longevity in the elderly. Ciên Saúde Colet 2018; 23(5):1495-506. https://doi.org/10.1590/1413-81232018235.14572016
    » https://doi.org/10.1590/1413-81232018235.14572016
  • [7]
    Schoffen LL, Santos WL. The importance of living groups for the elderly as instrument for health maintenance. Rev Cient Sena Aires 2018; 7(3):160-70.
  • [8]
    Brasil. Ministério do Desenvolvimento Social e do Combate à Fome. Perguntas Freqüentes: Serviço de Convivência e Fortalecimento de Vínculos. Available from: http://www.mds.gov.br/webarquivos/publicacao/assistencia_social/perguntas_e_respostas/PerguntasFrequentesSCFV_032017.pdf [Accessed on September 15, 2018]. [In Portuguese].
    » http://www.mds.gov.br/webarquivos/publicacao/assistencia_social/perguntas_e_respostas/PerguntasFrequentesSCFV_032017.pdf
  • [9]
    Brasil. Instituto Brasileiro de Geografia e Estatísitica. Censo Demográfico 2010. Available from: https://www.censo2010.ibge.gov.br/ [Accessed on July 2, 2018]. [In Portuguese].
    » https://www.censo2010.ibge.gov.br/
  • [10]
    Nadanovsky P, Oliveira BH. Psycometric properties of the Brazilian version of the Oral Health Impact Profile-short form. Community Dent Oral Epidemiol 2005; 33(4):307-14. https://doi.org/10.1111/j.1600-0528.2005.00225.x
    » https://doi.org/10.1111/j.1600-0528.2005.00225.x
  • [11]
    Brasil. Associação Brasileira de Empresas de Pesquisa (ABEP). Critério de Classificação Econômica do Brasil-2016. Available from: https://www.abep.org [Accessed on August 3, 2018]. [In Portuguese].
    » https://www.abep.org
  • [12]
    Miotto MHMB, Barcellos LA, Velten DB. Evaluation of the impact on quality of life caused by oral health problems in adults and the elderly in a southeastern Brazilian city. Ciên Saúde Colet 2012; 17(2):397-405. https://doi.org/10.1590/S1413-81232012000200014
    » https://doi.org/10.1590/S1413-81232012000200014
  • [13]
    Nogueira CMR, Falcão LMN, Nuto SAS, Saintrain MVL, Vieira-Meyer APGF. Self-perceived oral health among the elderly: a household-based study. Rev Bras Geriatr Gerontol 2017; 20(1):7-19. https://doi.org/10.1590/1981-22562017020.160070
    » https://doi.org/10.1590/1981-22562017020.160070
  • [14]
    Miotto MHMB, Gomes LMM, Velten DB, Barcellos LA. Impact produced by oral conditions on the quality of life of Brazilian workers of a mixed-economy company. Pesqui Bras Odontoped Clín Integr 2018; 18(1):3769. https://doi.org/10.4034/PBOCI.2018.181.75
    » https://doi.org/10.4034/PBOCI.2018.181.75
  • [15]
    Guerra MJC, Greco RM, Leite ICG, Ferreira EF, Queiroz de Paula MV. Impact of oral health conditions on the quality of life of workers. Ciên Saúde Colet 2014; 19(12):4777-86. https://doi.org/10.1590/1413-812320141912.21352013
    » https://doi.org/10.1590/1413-812320141912.21352013
  • [16]
    Silva MA, Batista AUD, Abreu MHNG, Forte FDS. Oral Health Impact Profile: need and use of dental prostheses among Northeast Brazilian independent-living elderly. Ciên Saúde Colet 2019; 24(11):4305-12. https://doi.org/10.1590/1413-812320182411.32472017
    » https://doi.org/10.1590/1413-812320182411.32472017
  • [17]
    Costa MJF, Lins CAA, Macedo LPV, Sousa VPS, Duque JA, Souza MC. Clinical and self-perceived oral health assessment of elderly residents in urban, rural, and institutionalized communities. Clinics 2019; 74:e972. https://doi.org/10.6061/clinics/2019/e972
    » https://doi.org/10.6061/clinics/2019/e972
  • [18]
    Fleury L. Feminização da velhice: uma questão masculina. Rev Aptare. 2019. Available from: https://revistaaptare.com.br/2019/03/08/feminizacao-da-velhice-uma-questao-masculina/ [Accessed on January 20, 2020]. [In Portuguese].
    » https://revistaaptare.com.br/2019/03/08/feminizacao-da-velhice-uma-questao-masculina/
  • [19]
    Bulgareli JV, Faria ET, Cortellazzi KL, Guerra LM, Castro M, Ambrosano GM, et al. Fatores que influenciam o impacto da saúde bucal nas atividades diárias de adolescentes, adultos e idosos. Rev Saúde Pública 2018; 52:44. https://doi.org/10.11606/s1518-8787.2018052000042.
    » https://doi.org/10.11606/s1518-8787.2018052000042
  • [20]
    Soares SLB, Rodrigues RA, Ribeiro RA, Rosendo RA. Assessment of full dentures users addressing functional, social and psychological aspects. Rev Saúde Colet 2015; 4(2):19-27. https://doi.org/10.35572/rsc.v4i2.248
    » https://doi.org/10.35572/rsc.v4i2.248
  • [21]
    Agostinho ACMG, Campos ML, Silveira JLGC. Edentulism, denture wearing and self-perceived of oral health among elderly. Rev Odontol. UNESP 2015; 44(2): 74-9. https://doi.org/10.1590/1807-2577.1072
    » https://doi.org/10.1590/1807-2577.1072
  • [22]
    Mejia G, Armfield J, Jamieson L. Self-rated oral health and oral health-related factors: the role of social inequality. Aust Dent J 2014; 59(2):226-33. https://doi.org/10.1111/adj.12173
    » https://doi.org/10.1111/adj.12173
  • [23]
    Ribeiro AE. Desigualdades relacionadas à autopercepção da saúde bucal entre idosos do município de São Paulo entre 2000 e 2010. (Tese de doutorado). São Paulo: Faculdade de Saúde Pública; 2018. [In Portuguese].
  • [24]
    Cohen-Carneiro F, Souza-Santos R, Rebelo MAB. Quality of life related to oral health: contribution from social factors. Ciên Saúde Colet 2011; 16(Suppl 1):1007-15. https://doi.org/10.1590/S1413-81232011000700033
    » https://doi.org/10.1590/S1413-81232011000700033
  • [25]
    Martins AB, Dalberto CS, Hugo FN. Association between tooth root remains and self-reported oral health among the elderly. Ciên Saúde Colet 2015; 20(12):3669-79. https://doi.org/10.1590/1413-812320152012.00822015
    » https://doi.org/10.1590/1413-812320152012.00822015
  • [26]
    Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Coordenação Nacional de Saúde Bucal. Projeto SB Brasil 2010: Condições de Saúde Bucal da População Brasileira, Resultados Principais. Brasília: Ministério da Saúde; 2011. [In Portuguese].
  • [27]
    Rosendo RA, Sousa JNL, Abrantes JGS, Cavalcante ABP, Ferreira AKTF. Self-perception of the oral health and its impact in elderly people’s life quality: a literature review. Rev Saúde Colet 2017; 6(1):89-102. https://doi.org/10.35572/rsc.v6i1.157
    » https://doi.org/10.35572/rsc.v6i1.157
  • [28]
    Bitencourt FV, Corrêa HW, Toassi RFC. Tooth loss experiences in adult and elderly users of Primary Health Care. Ciên Saúde Colet 2019; 24(1):169-80. https://doi.org/10.1590/1413-81232018241.09252017
    » https://doi.org/10.1590/1413-81232018241.09252017
  • [29]
    Santillo PMH, Gusmão ES, Moura C, Soares RSC, Cimões R. Factors associated with tooth loss among adults in rural areas in the state of Pernambuco, Brazil. Ciên Saúde Colet 2014; 19(2):581-90. https://doi.org/10.1590/1413-81232014192.20752012
    » https://doi.org/10.1590/1413-81232014192.20752012
  • [30]
    Martins AMEBL, Jones KM, Souza JGS, Pordeus IA. Association between physical and psychosocial impacts of oral disorders and quality of life among the elderly. Ciên Saúde Colet 2014, 19(8):3461-78. https://doi.org/10.1590/1413-81232014198.16202013
    » https://doi.org/10.1590/1413-81232014198.16202013

Publication Dates

  • Publication in this collection
    16 Mar 2022
  • Date of issue
    2022

History

  • Received
    22 Aug 2020
  • Reviewed
    26 Mar 2021
  • Accepted
    24 Aug 2021
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