Effect of all previous dental treatment on the current oral health related quality of life in geriatric patients

Aims and Objectives: The objectives of this research were to determine the influence of all previous dental treatment on the current oral health-related quality of life in geriatric patients and to assess the effect of the regularity of dental care in geriatric patients on oral healthrelated quality of life. Materials and Methods: A population-based evaluation was carried out on subjects over the age of 60 who reported to the Department of Prosthodontics for 7 months. Self-perceived oral health was assessed using the Geriatric Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile (OHIP-14). Descriptive statistics were used to analyze data using SPSS version 21. Result: The sample included 75 elderly people, 77% of whom were males and 23% women. The Regular Visit Group had 28 subjects, of which 22 (78%) were males and six (21%) were females. There were a total of 47 subjects in the Irregular Patient Group, of which 36 (76%) were males and 11 (22%) were females. In our study both GOHAI and OHIP-14 showed good reliability for measurement of OHRQoL (Oral Health-related Quality of Life). The GOHAI and OHIP-14 Hindi questionnaires were able to identify participants with impaired oral health. This study revealed that the regularity of receiving dental care affected OHRQoL in the geriatric group of the population. Conclusion: The outcome of this research found out that the OHRQol perceived using both the GOHAI and OHIP-14 was better in patients who received dental care more regularly than those who did not.


Introduction
The age distribution of the population of the world is changing. The proportion of older people will continue to rise worldwide with advances in medicine and prolonged life expectancy. Elderly people are a special category in the population, not only because of the consequences of a particular disease and conditions but also because they often have limited access to medical care, including dental care.
Recent years have seen a shift in dentistry focus from only valuing clinical evaluations to measuring patients ' subjective experiences. This shift in approach has led to a significant construction of 'Oral health-related quality of life (OHQoL)'. OHQoL is defined as "the impact of oral disease and disorders on aspects of everyday life that a patient or person values, that are of sufficient magnitude, in terms of frequency, severity or duration to affect their experience and perception of their life overall." 1 Geriatric Oral Health Assessment Index (GOHAI) was originally developed to evaluate the self-reported oral health status of elderly people. 2 It could be used at the individual level to indicate the need for dental treatment, psychosocial and functional issues affecting the individual.
The Oral Health Impact Profile (OHIP) is developed wi th a view to providing an integrated measurement of reporte d oral dysfunction, discomfort and disability. 3 This measure would enhance estimates of the prevalence of oral functiona l problems among older people, enhance understanding of th e psychological impact of oral disease and provide a means for comparing the effectiveness of various dental treatment modalities in older adults.
This study is performed to evaluate the influence of all past dental treatment on the present oral health-related quality of life in geriatric patients and to evaluate the impact of the regularity of receiving dental care on the oral health-related quality of life in geriatric patients.

Materials and Methods
A population-based geriatric evaluation was carried out on subjects over the age of 60. The topics in this study were community-dwelling and independently living people over the age of 60 who reported to the Department of Prosthodontics Crown and Bridge, for a period of 7 months.

Sample size estimation
Sample size estimation was done by using G Power software (version 3.0). The sample size was estimated for independent t-test (comparing the OHRQoL among subjects with regular and irregular dental visits) A minimum total sample size of 72 was found to be sufficient for an alpha of 0.05, power of 95 %, 0.79 as effect size (assessed from a similar study). The sample size was further rounded off to 75. This study included 75 individuals with conventional dentures (maxillary and mandibular). The age of the patient ranged between 60-75 years. To be included in the study, participants should have no medical disease including mental problems and psychological disorders that might affect their ability to understand and/or to score the questionnaires, adults free from any systemic diseases which will affect oral functions, denture wearer and who did not have difficulty in recollecting history.
The institutional review board obtained ethical clearance. The patient's informed consent was obtained to participate in the study.

The GOHAI questionnaire
The GOHAI is used to report oral function problems and psychosocial impacts associated with oral diseases. The GOHAI's 12 items evaluate three dimensions: physical function, pain & discomfort, and psychosocial function. 1. Items 1, 2, 3 and 4 assess the physical function which impacts eating, speaking, and swallowing. 2. Items 6, 7, 9, 10 and 11 assess the psychosocial function that includes oral-dental health concerns, physical appearance dissatisfaction, oral-dental health self-awareness, and social contact difficulties due to dental and oral problems. 3. Items 5, 8 and 12 assess pain and discomfort, including the use of drugs to relieve pain in the oral-dental cavity. Patients are asked if they have Never, Hardly ever, Occasionally, Fairly often, Very often experienced any of those problems in the past three months. Questions were asked sometimes in a positive and sometimes in a negative way, which requires the respondent to consider their answers. The total scores range from 12 to 60 for the ADD-GOHAI and from 14 to 70 for the ADD-OHIP-14 with a higher score indicating better oral health. Simple count scores (SC-GOHAI or SC-OHIP-14) are obtained by counting' sometimes,'' often' or' always / very often' responses to the number of items. Using this approach, the scores for the SC-GOHAI and the SC-OHIP-14 range from 0 to 12 and 0 to 14 with a higher score indicating poor oral health respectively.

Data collection
OHRQoL data were gathered by using the Hindi versions of GOHAI and OHIP-14, which were self-administered followed by a clinical oral examination performed by a single dentist in the outpatient department using sterilized instruments.
The questionnaire also included socio-demographic data such as age, gender. Participants were also asked about the regularity of receiving dental care and then divided into two different groups, patients who received dental care 6 monthly were put in the REGULAR group and the remaining in the IRREGULAR group.

Data analysis
The data collected was entered into the excel sheet using Microsoft Excel Software by the examiner. Then this data was transferred to Statistical Package for Social Sciences (SPSS) version 21, IBM Inc. for analysis. It was subjected to descriptive statistics for calculation of mean, standard deviation, absolute and relative frequencies. Presentation of data was done using Tables and Graphs. Normality of data related to interval or ratio variables was checked by the Shapiro Wilk test. As data was found to be normally distributed parametric tests of significance were used. The Independent t-test was used for comparing the mean between two groups. Chisquare test was used for categorical variables. A level of significance was set at 0.05.

Result
1. Seventy-five participants were recruited from the Department of Prosthodontics. All participants answered the self-administered questionnaires and were clinically examined. The majority of participants were men 58 (77%) and women 17 (22%). 2. The Regular Visit Group had a total of 28 subjects, of which 22 (78%) were males and 6 (21%) were females. There were a total of 47 subjects in the Irregular Patient Group, of which 36 (76%) were males and 11 (22%) were females. Therefore, the study sample consisted of a total of 58 males and 17 females. (Table 3) a. Group of patients on regular visits according to age distribution were-sixteen patients aged between 60 and 65, six were aged between 66 and 70, four were aged between 71 and 75, and two were aged between 76 and 80. b. In the group of patients visiting irregularly-eight patients were aged 60-65, seventeen were aged 66-70, twenty were aged 71-75 and two were aged 76-80. Therefore there were twenty four subjects in the age group of 60-65, twenty three in the age group of 66-70, twenty four in the age group of 71-75 and four in the age group of 76-80. (Table 4)     Groupwise distribution of MEAN OHIP AND GOHAI scores. When mean OHIP scores were compared using independent ttest among regular and irregular visit group, QoL was found to be better among subjects with a regular dental visit (p<0.05). When QoL was compared using GOHAI scores, it failed to reach the level of statistical significance (p>0.05) ( Table 9).

Discussion
The purpose of this study was to examine the effect of all previous dental treatments on the current oral health-related quality of life (OHRQoL) and the effect of the regularity of receiving dental care on the OHRQoL in geriatric patients using the GOHAI Hindi version 4 and OHIP-14 Hindi version. 5 The GOHAI and OHIP-14 questionnaires were selected for this study as they are short allowing higher response rates. 6 Hindi is a standardized register of the Indian subcontinent and is the official language of the Republic of India 7 . In our study, seventy-five Hindi speaking individuals above the age of sixty years with conventional dentures (maxillary and mandibular) were asked to fill the GOHAI Hindi AND OHIP-14 Hindi. They were also asked about the regularity of them receiving dental care.
Past studies have reported on specific types of dental treatment in comparing OHRQoL after treatment with conventional dentures and implants. 8 However, there is sparse literature on the impact of past dental treatment (complete denture) and routine dental care on the geriatric population. Locker 7 did report deterioration and improvement in the oral status and observed improvement in pain and chewing oral health indexes. Fisher et al only reported the recovery from an oral disadvantage but did not measure the impact (improvement or deterioration) in OHRQoL.
In our study both GOHAI AND OHIP-14 showed good reliability for measurement of OHRQoL. The GOHAI and OHIP-14 Hindi questionnaires were able to identify participants with impaired oral health.The GOHAI and OHIP-14 are similar measures but there are many differences in their item content that can affect their ability to detect the health-related quality of life outcomes. The present results are per previous studies which showed that GOHAI is more successful than OHIP-14 at detecting the oral function problems. 6 In this study, more number of individuals in the irregular group reported the problem in eating (Physical Function) 48.9% reported often which was more than the individuals in regular group 35.7% reported sometimes. Physical function was most often affected domain of the GOHAI and Physical disability of the OHIP-14 was most affected, reflecting the functional needs of these geriatric patients. "Limit the type of food" and "trouble biting/chewing" were the most frequently reported problems. These findings were similar to the study done by Sarah M. Osman et al. 7 Psychosocial impacts such as "limit contact with other", "worried", "nervous" and "medication for pain" were the least reported oral problems. Our result provides additional support to Locker's theoretical model of oral health, which indicates that social disability and handicap are least frequent. OHRQoL was found to be better among subjects with a regular dental visit in our study than the irregular group.
This study revealed that the regularity of receiving dental care affected OHRQoL in the geriatric group of population. To best of our knowledge, there is no such study done which shows the effect of the past dental treatments (denture wearer) and impact of regularity on the OHRQoL in Geriatric patients. Therefore, comparisons with the results of the other studies will be limited.
The study has some limitations especially the small sample size and the population was limited to a particular area. The result cannot be applied to elderly living in other parts of the country. Also, Evaluation of the dentures was not done, factors such as retention, stability and aesthetic may have influenced the individual's responses to both questionnaires.

Conclusion
The results of this study concluded that the perceived OHRQoL for both GOHAI and OHIP-14 was better in patients who received dental care more regularly than those who did not. GOHAI and OHIP-14 had a strong correlation. According to the measures obtained in both the questionnaire, the relationship between variables such as regularity of dental care and OHRQoL can be similarly assessed.
The most frequently affected physical function and physical disability and the least reported oral problems were psychosocial impacts and psychological disability. They showed a statistically significant difference (p<0.05).
This result can serve the geriatric population if policies that support their well-being and social contributions are put in place.