|Year : 2017 | Volume
| Issue : 2 | Page : 109-114
Oral hygiene status of elderly population in Port Harcourt, Rivers State, Nigeria
Omoigberai Bashiru Braimoh, Modupe Omotunde Soroye
Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Choba Port Harcourt, Rivers State, Nigeria
|Date of Web Publication||18-Jan-2018|
Dr. Omoigberai Bashiru Braimoh
Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Choba Port Harcourt, Rivers State
Source of Support: None, Conflict of Interest: None
Background: The value of good oral hygiene practices has increased over the years, and the removal of bacteria plaque and other deposits from the teeth is essential for the prevention of dental caries and periodontal disease. Aims: The objectives of this study were to assess the oral hygiene status of the elderly population in Port Harcourt, Rivers State and investigate the influence of sociodemographic variables on oral hygiene. Subjects and Methods: The research was cross-sectional study. A total of 543 old people were selected by systematic random sampling. Data were collected with a self-developed oral health assessment questionnaire designed in two sections (A and B) and analyzed using SPSS version 20 (IBM SPSS Armonk, New York, USA). The relationship between variables was established using independent t-test and analysis of variance, and significance determined at 0.05 alpha level. Results: The overall mean oral hygiene score for the sample was 2.55 (standard deviation = 0.85). Most of the respondents had poor 245 (45.1%) and fair 254 (46.8%) oral hygiene. Females had significant better oral hygiene than males, while there was a significant increase in the oral hygiene score with increasing age. Educational status and retirement grade level were inversely and significantly associated with the oral hygiene score of the pensioners. Conclusion: The oral hygiene score recorded among the pensioners in this study was inadequate; therefore, the study participants need to be educated on the role of plaque in the development of dental caries and periodontal diseases, and the need to keep good oral hygiene.
Keywords: Elderly, Nigeria, oral hygiene, plaque, sociodemographics
|How to cite this article:|
Braimoh OB, Soroye MO. Oral hygiene status of elderly population in Port Harcourt, Rivers State, Nigeria. Afr J Med Health Sci 2017;16:109-14
|How to cite this URL:|
Braimoh OB, Soroye MO. Oral hygiene status of elderly population in Port Harcourt, Rivers State, Nigeria. Afr J Med Health Sci [serial online] 2017 [cited 2018 Mar 24];16:109-14. Available from: http://www.ajmhs.org/text.asp?2017/16/2/109/223584
| Introduction|| |
Oral hygiene is the practice of keeping the mouth clean and healthy. It is an essential requirement of one's health. The purpose of oral hygiene is to prevent the accumulation of plaque, a sticky film of bacteria, calculus, food debris, and stains on the teeth. Various factors such as; hygiene, nutritional status, tobacco smoking, and stress are linked to a wide range of oral diseases, forming the fundamental basis of the common risk factor approach to prevent the oral diseases. Among these, oral hygiene is the most significant factor in terms of prevention of oral diseases. The value of good oral hygiene practices has increased over the years , and the removal of bacteria plaque and other deposits from the teeth is essential for the prevention of dental caries and periodontal disease, the two most common dental conditions worldwide.,,
Oral hygiene is reported to be influenced by gender, age, level of education, and socioeconomic status (SES). Women are reported to have better oral hygiene than men.,,,,, A number of studies have also reported significant poor oral hygiene with increasing age.,, Similarly, observed relationship between SES and oral hygiene has been reported. Higher social class has better oral hygiene compared to individuals in the lower strata. Level of education also influence oral hygiene status, higher level of education is associated with better oral hygiene.,,,
The population for this study were pensioners in Port Harcourt, Rivers State. This population group was selected for the study because they were 60 years and above. This coincides with the age at which the workers proceed on retirement from civil service. According to the United Nation Population Division, the Nigerian National Population Commission define the elderly in Nigeria as person's age 60 years and over, therefore, the pensioners were considered as elderly in the present study and the two terms were used interchangeably. To best of the authors' knowledge, there is little information and paucity of data on the oral hygiene status as well as the influence of sociodemographics on oral hygiene, particularly among the old people in Port Harcourt, South-South Nigeria. According to Petersen et al. the study of behavioral and socioeconomic factors associated with the occurrence and distribution of oral diseases is one of the research priorities of the World Health Organization (WHO) in the 21st century. The aim of this study, therefore, was to contribute to the scarce literature on the oral health of the elderly; hence, the objectives of this study were to determine the oral hygiene status and investigate the influence of sociodemographic characteristics on the oral hygiene status of the elderly population in Port Harcourt, Rivers State.
| Subjects and Methods|| |
The research design employed in this study was a cross-sectional design. Thus, in this study, the authors compared the oral hygiene status of the elderly in relation to their gender, retirement grade level, age, and educational status.
Sample and sampling technique
The population of the study were pensioners in Port Harcourt, Rivers State. The group was considered as elderly since it comprised of old people 60 years and above. The sample size (n) was determined according to the formula for sample size determination by Lwanga and Lemeshow  given as n = for population <10,000 at 95% confidence interval, standard normal deviate (z) of 1.96 and degree of accuracy (d) 0.05. The proportion (p) of elderly with dental caries was 0.305 (30.5%), and the proportion (q) without dental caries was 0.695 (69.5%). Therefore, the minimum sample size obtained for this study was 325.
The subjects were selected by systematic random sampling. The selection was done at the Secretariat of the Nigerian Union of Pensioners (NUP) located at the State Civil Service Secretariat in Port Harcourt. Pensioners in Rivers State routinely visit the secretariat daily and congregate once monthly for their meetings. The register of the pensioners constituted the sampling frame for this study (source: NUP Secretariat) and every second subject was selected from the register. Individuals selected who were not present in a particular visit were contacted through their phone numbers for subsequent visit.
Instrument for data collection
Data were collected by the use of questionnaire. The questionnaire was a structured self-developed oral health assessment questionnaire designed in two sections (A and B). Section A contained information on sociodemographic data (gender, age, retirement grade level, and educational status). The oral hygiene status was recorded in Section B of the questionnaire, this was recorded using the simplified oral hygiene index according to Green and Vermillion, 1964. Six selected teeth were examined, each for soft deposits (debris) and hard deposits (calculus). The debris and calculus scores for an individual ranged from 0 to 3; hence, the total oral hygiene score for an individual is the sum of debris and calculus score which ranged from 0 to 6. The population mean oral hygiene was calculated by adding up individual oral hygiene score divided by the number of study participants. A total of 543 copies of the questionnaire were administered to the respondents, and all were retrieved. The recording of oral hygiene was done by the first author. Data were collected over a period of 2 years from April 2015 to March 2017. The study was approved by the research ethics committee, University of Port Harcourt and informed consent obtained from the participants. Pensioners who retired from public service of Rivers State government voluntarily or retired as a result of years of service, who were below the age of 60 years were excluded from the study since they do not meet the age to be classified as elderly.
Validity and reliability of the instrument
Validity is defined as the accuracy, quality, and appropriateness of the modalities adopted for finding answers to the research questions. The researcher believes that this research study is accurate and valid due to the fact that procedures adopted for this study are from scientific and peer-reviewed sources. The validity was further justified by presenting the data collecting instrument to two other lecturers in the faculty of dentistry, University of Port Harcourt, based on their expert opinion, comments, criticisms, and observations the instrument was modified.
The reliability of the instrument was done using old people different from those recruited for the study. Twenty of them were selected; the selected participants completed the questionnaire and were examined by the researcher. The filling of the questionnaire and examination was repeated after an interval of 1 week. The reliability of the instrument was determined using the Cronbach's alpha, and alpha coefficient of 0.82 was obtained. The intraexaminer reliability for recording of oral hygiene was determined by intraclass correlation and reliability coefficient of 0.79 was obtained. The reliability testing also served as the pilot-test for the data collecting instrument, from the reaction of the participants to the questionnaire, it was evident that they quite understood the question items. There was evidence that some words were not understood under attitude and knowledge section. This was identified and modified according to the level of participants understanding.
The completed copies of the questionnaires were collated, coded, and entered into the statistical package for social sciences (SPSS) spreadsheet. The data were subsequently analyzed using SPSS version 20 (IBM SPSS Armonk, New York, USA). Descriptive statistics of percentage, mean, and standard deviation (SD) were used describe the oral hygiene status of the sample.
According to Green and Vermillion (1964), oral hygiene was graded as good, when participant scored 0.0–1.2 of 6; fair, when participant scored 1.3–3.0 of 6; and poor, when participant scored 3.1–6.0 of 6. Inferential statistics of independent t-test and analysis of variance was used to test the association of oral hygiene status of the respondents with gender, retirement grade level age and educational status. Significant association between the dependent variable (oral hygiene status) and independent variables (gender, retirement grade level age, and educational status) was determined at P < 0.05 or t-calculated and F-calculated values greater than their respective t-critical and F-critical values at 0.05 alpha level.
| Results|| |
A total of 295 (54.3%) of the respondents were males and 248 (45.7%) were females. There were more respondents 234 (43.1%) in the 60–64 years of age group and the age group 65–69 years constituted 206 (37.9%) of the respondents. Regarding educational status, 226 (41.6%), 198 (36.5%), and 119 (21.9%) had tertiary education, secondary and primary, respectively. A total of 277 (51%) respondents retired on grade level 1–6 [Table 1].
|Table 1: Distribution of the respondents based on gender, age, educational status and retirement grade level|
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[Table 2] shows the distribution of poor, fair and good oral hygiene among the respondents. The overall mean oral hygiene score for the sample was 2.55 (SD = 0.85). The respondents with poor oral hygiene (score of 3.1–6.0) were 245 (45.1%), participants with fair oral hygiene (score of 1.3–3.0) were 254 (46.8%), and 44 (8.1%) of the respondents had good oral hygiene (score of 0.0–1.2).
|Table 2: Good, fair, and poor of oral hygiene among the pensioners in Port Harcourt, Rivers state|
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There was difference in the oral hygiene score of the elderly with gender and retirement grade level as shown in [Table 3]. The score was higher in males than in females, oral hygiene score in males was 3.5 and 1.6 in females. The critical t = 1.965 at the degree of freedom of 541 and 0.05 alpha level was less than the calculated t = 3.31 obtained in this study, this suggested that gender of the elderly significantly influenced their oral hygiene status and the null hypothesis was rejected [Table 3]. The retirement grade level of the respondents inversely influenced their oral hygiene score, respondents who retired on level 1–6 had higher score than respondents who retired on level 7–17, the score was 3.7 for level 1–6 and 1.5 for level 7–17, indicating that as grade level increases, there was a decrease in the oral hygiene score. The critical t = 1.965 at the degree of freedom of 541 and 0.05 alpha level was less than the calculated t = 2.88 obtained in this study, this suggested that the influence of retirement grade level on oral hygiene status of the elderly was significant and the null hypothesis was rejected [Table 3].
|Table 3: Influence of gender and retirement grade level on oral hygiene score of the pensioners in Port Harcourt|
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There was the difference in oral hygiene score with age; the oral hygiene score for 60–64 years was 1.5, 65–69 years, 2.6 and ≥70 years 3.5, indicating that the oral hygiene score increases with increasing age [Table 4]. The critical F = 3.00 at the degrees of freedom (2 and 540) and 0.05 was less than the calculated F = 3.54, suggesting that the oral hygiene status of the pensioners was significantly associated with their age [Table 4]. The level of education influenced the oral hygiene score of the elderly. The oral hygiene score for participants with primary education was 3.7, secondary education 2.1, and tertiary education 1.7 [Table 4]. This shows that oral hygiene score decreased with increasing level of education, indicating an inverse relationship between the level of education and the oral hygiene score. The critical F = 3.00 at the degrees of freedom (2 and 540) and 0.05 was less than the calculated F = 4.10, suggesting that the oral hygiene status of the respondents was significantly influenced by their level of education [Table 4].
|Table 4: Influence of age and educational status on oral hygiene score of the pensioners in Port Harcourt|
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| Discussion|| |
The present study found that 8%, 47%, and 45% of the participants had good, fair, and poor oral hygiene, respectively. Whereas the level of poor oral hygiene recorded in this study was higher than that recorded in other studies, the level of good and fair oral hygiene recorded was less than that of other studies. Azodo and Amenaghawon reported that 33.1%, 57.2%, and 9.7% of the participants in their study had poor, fair, and good oral hygiene status, respectively. Olabisi et al. reported that 12.5% of the participants had good oral hygiene, 68.4% had fair oral hygiene, and 19.1% had poor oral hygiene. These studies were community-based studies, which involved adolescents, young adults, and adults, in the present research, the age of the participants was ≥60 years. Therefore, the difference between these studies and present research may not be unconnected to the difference in age of the study participants. Previous studies also reported that oral hygiene becomes poor as the age increases., The oral hygiene status recorded among the pensioners in this study was inadequate considering the role of plaque and calculus in the etiology of periodontal diseases and dental caries. Therefore, the pensioners need to be educated on the role of plaque in the development of dental caries and the need to keep good oral hygiene.
The oral hygiene score recorded in females was 1.6 and 3.5 in males. The mean oral hygiene score was significantly lower in females than in males suggesting that females had better oral hygiene than males. A number of studies have reported better oral hygiene status in females than in males as observed in the present study.,,,, Sogi and Bhaskar reported that the better oral hygiene status observed among females was attributable to better oral health-care seeking behavior exhibited by females as compared to males. Individuals who have good attitude and behavior by brushing the teeth daily have better oral hygiene compared to those who do not brush the teeth daily.,, This was also found to be true for those who brush their teeth twice daily compared to those who brush once daily.,, Researchers have shown that women brush their teeth twice daily than men and hence have better oral hygiene than men.,
Regarding the influence of age on the oral hygiene status; the age of the respondents significantly influenced the oral hygiene score. The oral hygiene score of the elderly increased with increase in age, suggesting that as the pensioners get older; the oral hygiene status becomes poor. These findings are in agreement with the findings of other studies which reported significant poor oral hygiene with increasing age., Azodo and Amenaghawonalso reported that older respondents had poor oral hygiene than younger ones. The World Health Organization reported that inadequate oral hygiene observed in the elderly may be due to poor manual dexterity in tooth brushing leading to accumulation of plaque and calculus. Irregular tooth brushing may also contribute to the poor oral hygiene with increasing age.
Regarding educational status, the present study showed that educational status of the pensioners significantly inversely influenced their oral hygiene score, indicating that as the level of education of the pensioners' increases, there was a decrease in the oral hygiene score of the pensioners. This means that as the level education increases from primary to tertiary level, the oral hygiene score of the participants became significantly lower. This is in agreement with other studies that reported similar findings., Azodo and Amenaghawon also reported that significant better oral hygiene status was associated with higher level of education in their study. This may not be unconnected to the better oral health knowledge, attitude, and behavior among individuals with higher level of education reported in other studies.,
The oral hygiene score recorded for the elderly who retired on grade level 7–17 was 1.3 and 3.7 for those who retired on grade level 1–6. Like educational status, retirement grade level significantly inversely influenced the oral hygiene score of the pensioners. Suggesting that as the grade level increases, the oral hygiene score decreases. Retirement grade level was used as measure of SES in this study; the pensioners on grade level 7–17 belong to higher SES compared to those on level 1–6. This group is graduates, retired as senior staff and earns more retirement benefit than those on levels 1–6. Research has reported that individuals in higher SES are more educated, more dentally aware and visit the dentist for care more frequently, this may account for the difference in oral hygiene status observed in these groups.
| Conclusion|| |
The present study showed that gender, retirement grade level, age, and educational status significantly influence oral hygiene score of the participants. Most of the respondents had fair and poor oral hygiene; therefore, oral hygiene status recorded among the elderly in this study was inadequate, considering the role of plaque, and calculus in the etiology of periodontal diseases and dental caries. Therefore, the study participants need to be educated on the role of plaque in the development of dental caries and periodontal diseases, and the need to keep good oral hygiene.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Sheiham A, Watt RG. The common risk factor approach: A rational basis for promoting oral health. Community Dent Oral Epidemiol 2000;28:399-406.
Petersen PE. Challenges to improvement of oral health in the 21st
century – The approach of the WHO Global Oral Health Programme. Int Dent J 2004;54:329-43.
Petersen PE, Kwan S. Evaluation of community-based oral health promotion and oral disease prevention – WHO recommendations for improved evidence in public health practice. Community Dent Health 2004;21:319-29.
Petersen PE. Priorities for research for oral health in the 21st
century – The approach of the WHO Global Oral Health Programme. Community Dent Health 2005;22:71-4.
Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005;83:661-9.
Yee R, Sheiham A. The burden of restorative dental treatment for children in Third World Countries. Int Dent J 2002;52:1-9.
Al-Ansari JM, Honkala S. Gender differences in oral health knowledge and behavior of the health science college students in Kuwait. J Allied Health 2007;36:41-6.
Omitola OG, Arigbede AO. Prevalence of dental caries among adult patients attending a tertiary dental institution in South-South region of Nigeria. Port Harcourt Med J 2011;6:52-8.
Azodo CC, Amenaghawon OP. Oral hygiene status and practices among rural dwellers. Eur J Gen Dent 2013;2:42-5. [Full text]
Olabisi AA, Udo UA, Ehimen UG, Bashiru BO, Gbenga OO, Adeniyi AO, et al.
Prevalence of dental caries and oral hygiene status of a screened population in Port Harcourt, Rivers State, Nigeria. J Int Soc Prev Community Dent 2015;5:59-63.
Adeyemo WL, Oderinu HO, Oluseye SB, Taiwo OA, Akinwande JA. Indications for extraction of permanent teeth in a Nigerian teaching hospital: A 16-year follow-up study. Nig Q J Hosp Med 2008;18:128-32.
Al-Shehri SA. Oral health status of older people in residential homes in Saudi Arabia. Open J Stomatol 2012;2:307-13.
Braimoh OB, Sofola OO, Okeigbemen SA. Oral hygiene profile of inmates in a correctional home. Ann Biomed Sci 2012;11:36-43.
Sofola OO, Shaba OP, Jeboda SO. Oral hygiene and periodontal treatment needs of urban school children compared with that of rural school children in Lagos State, Nigeria. Odontostomatol Trop 2003;26:25-9.
Thomson WM. Social inequality in oral health. Community Dent Oral Epidemiol 2012;40 Suppl 2:28-32.
Bonfim Mde L, Mattos FF, Ferreira e Ferreira E, Campos AC, Vargas AM. Social determinants of health and periodontal disease in Brazilian adults: A cross-sectional study. BMC Oral Health 2013;13:22.
United Nation Population Division. World Population Prospect:The 2002 Revision. New York: United Nations; 2003.
Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies: A Practical Manual. Geneva: World Health Organisation; 1991.
Esan TA, Oziegbe EO. Oral health status and treatment needs of elderly people in Ile-Ife, Nigeria East. Afr J Public Health 2013;10:535-8.
Greene JC, Vermillion JR. The Simplified Oral Hygiene Index. J Am Dent Assoc 1964;68:7-13.
Kumar R. A step by step for beginners. Research Methodology. 3rd
ed. New Delhi, SAGE; 2011.
Sogi G, Bhaskar DJ. Dental caries and oral hygiene status of 13-14 year old school children of Davangere. J Indian Soc Pedod Prev Dent 2001;19:113-7.
Burt BA, Eklund SA. Dentistry, Dental Behavior and the Community. 6th
ed. Atlanta, GA: Elsevier/Saunders; 2005.
Braimoh OB, Udeabor SE. Self-assessed oral health behavior and knowledge of undergraduate medical students. Afr J Med Sci 2012;5:55-9.
World Health Organisation. Active ageing: A policy framework. Geneva: World Health Organization; 2002.
Fajemilehin BR, Ogunbodede EO. Oral health behaviour among the elderly in Osun State, Nigeria. J Soc Sci 2002;6:257-61.
Singh K, Kochhar S, Mittal V, Agrawal A, Chaudhary H, Anandani C. Oral health: Knowledge, attitude and behaviour among Indian population. Educ Res 2012;3:66-71.
Al-Sharbatti S, Sadek M. Oral health knowledge, attitudes and practices of the elderly in Ajman. UAE Gulf Med J 2014;3:152-64.
[Table 1], [Table 2], [Table 3], [Table 4]