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2548;28:189-98
CU Dent J. 2005;28:189-98

Original Article

Chief complaints, dental health status and

dental treatment needs in elderly patients
Aree Jainkittivong B.Sc. (Hons), D.D.S. (Hons), M.S.1
Vilaiwan Aneksuk D.D.S., Grad.Dip. in Clin.Sc. (Periodontology)1
Robert P. Langlais D.D.S., M.S., FACD, FICD, FRCD (C)2
1
2

Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University

Department of Dental Diagnostic Science, The University of Texas Health Science Center at San Antonio

Abstract
Objective The aims of this study were to investigate the principal oral complaints, dental health status
and dental treatment needs in elderly patients.
Materials and methods The study sample consisted of 484 dental patients who were 60 years of age
and older. Interviews were conducted to identify the oral complaints whereas the dental health status
and dental treatment needs were assessed by oral examination.
Results There were 17 principal oral complaints identified; and the four leading problems were faulty
prostheses (21.1%), pain or/and swelling (16.3%), tooth loss or inefficient chewing (16.1%), and broken
teeth and restorations (11.6%). There were more edentate subjects in the 70 years and older group
(21.3%) than the other two younger groups (14.6% and 6.4% respectively, p = .001). With reference to
denture wearing status, there were 246 denture wearers, including 62.2% partial denture wearers and
37.8% complete denture wearers. Of the 416 dentate subjects, there were 85.3% subjects who had at
least one carious lesion. The DMF scores were higher in the oldest group (21.16.8) as compared to
those of the two younger groups (19.27.9 and 18.96.8 respectively, p = .038). There were 30.5%
subjects with gingivitis and 65.9% with periodontitis. The incidence of periodontitis increased with age
(p < .001). Prosthetic treatment was the main requirement, applying to 84.5% of the group, followed by
the periodontal treatment (80.8%), and restorative treatment (75.4%).
Conclusion The results of this study shows high incidence of dental diseases in our sample. Therefore
the appropriate dental treatment is a high priority for this group of patients.
(CU Dent J. 2005;28:189-98)
Key words: chief complaint; dental health status; dental treatment needs; elderly

190 Jainkittivong A, et al

Introduction
It has been shown that older adults usually have
poor oral health, visit the dentist infrequently, and rarely
complain of oral problems. Petersen et al1 reported only
43% older Lithuanians visited the dentist within the past
year and the main reasons were related to acute symptoms. Mattin and Smith2 also reported fewer than 15%
of the older Asians attended the dentist on a regular
basis; the remaining subjects reported it was not necessary to do so unless they were in pain or required new
dentures. MacEntee and Scully3 stated oral health
deteriorates with advancing age and the disorders
progress further to the state of more serious neglect in
later years. In older individuals, periodontal disease and
caries become about equally responsible for tooth loss.4
The main risk factor for tooth loss in older adults was
usually associated with a poor oral health status.5-7
Shimazaki et al7 showed that the number of teeth,
number of decayed teeth, periodontal pocket depth, and
plaque index were significant predictors for the number
of teeth lost. Loesche et al8 stated medical health and
oral health are linked. Recent studies have shown a
correlation between dental or periodontal infections and
cardiovascular or cerebrovascular disease. Pajukosky
et al9 reported edentulousness correlated significantly
with cardiovascular diseases and drugs taken daily.
Epidemiological studies have shown the numbers
of elderly people around the world are increasing. In
addition, the current data suggest that old adults continue to keep more of their teeth longer than previous
generations,10-12 and their dental needs are certain to
increase. Previous studies indicated prosthodontic treatment, periodontal therapy, restorative procedures and
pain relief were the major treatment categories needed
by the elderly.13-16 As the number of old people
increases, more time and effort by the dental profession
should be directed to meet the demands and needs of
the elderly. Thus baseline information regarding their

CU Dent J. 2005;28:189-98

complaints and dental health status is necessity in order

to plan for and to provide proper dental care for this
group of patients.
The aims of this study were to investigate the
principal oral complaints, dental health status and dental treatment needs in a group of Thai elderly dental
patients.

Materials and methods

The study was conducted on a sample of 484
subjects attending the Oral Diagnosis Clinic at
Chulalongkorn University Dental School for an oral
examination and a dental treatment plan. The study
sample consisted of subjects who were 60 years of age
and older. Authors AJ and VA performed the interviews and oral examinations. The interviews were conducted to identify the subjects principal oral complaints
whereas their dental health status and treatment needs
were assessed by a clinical examination. The dental
status (number of decayed, missing, filled teeth, filled
teeth with recurrent caries, retained roots), pulpal diseases, periodontal conditions, edentulousness, denture
wearing status and dental treatment needs were recorded.
The data was analyzed using the Statistical Package for the Social Sciences (version 11.0). Frequency
distributions were used to describe the data. Differences in variables in relation to age group were tested
by the Pearson chi-square test and the analysis of variance. P values lower than .05 were considered statistically significant.

Results
The sample included 195 (40.3%) men and 289
(59.7%) women, who were divided into three age ranges:
60-64 years = 156 (32.2%), 65-69 years = 178 (36.8 %)
and 70 years and older = 150 (31%). The average age
for men was 67.85.7 years and for women 67.25.3
years.

 2548;28:189-98

Table 1 lists the principal oral complaints among

the 484 elderly subjects and 17 principal oral complaints
identified. The four leading oral complaints were faulty
prostheses (21.1%), pain or/and swelling (16.3%), tooth
loss or inefficient chewing (16.1%), and broken teeth
and restorations (11.6%). Other less frequent complaints
were mobile teeth (6.6%), soreness or ulcer (5.6%),
caries or cavity (5.2%), sensitive teeth (4.5%), gum
problems (4.8%), etc. There were no differences in the
frequency distribution of the principal oral complaints
among the three age groups (p = .135).
Table 2 shows frequency distribution of edentulousness in the study sample. There were 399 (82.4%)

partially dentate, 63 (13%) edentate and 17 (3.5%) fully

dentate subjects. Five (1%) subjects had only retained
roots remaining in the oral cavity. There were more
edentulous subjects in the 70 years and older group
(21.3%) than the other two younger groups (14.6% and
6.4% respectively, p = .001). Of the 399 partially edentulous subjects, there were 338 (69.8%) subjects who
had teeth remaining in both dental arches, 40 (8.3%)
were completely edentulous in the maxilla and 21 (4.3%)
were completely edentulous in the mandible. With
reference to age, the edentate subjects were older
(69.65.5 years) than the partially dentate subjects and
the fully dentate subjects (67.15.4 years and 65.53.4
years respectively, p = .001).

Table 1 Frequency distribution of the principal oral complaints by age in 484 elderly subjects

Oral complaints

Faulty prostheses
Pain and/or swelling
Tooth loss/inefficient chewing
Broken teeth/restorations
Mobile teeth
Soreness/ulcer
Caries/cavity
Sensitive teeth
Gum problems
Regular check up
TMJ disorders
Orofacial pain
Food impaction
Bad breath
Dental deposits
Epulis
Exostoses
Chi-square value = 40.897, p = .135

60-64 yrs
(n=156)
n (%)

65-69 yrs
(n=178)
n (%)

26 (16.7)
28 (17.9)
29 (18.6)
18 (11.5)
7 (4.5)
5 (3.2)
9 (5.8)
9 (5.8)
8 (5.1)
5 (3.2)
5 (3.2)
1 (0.6)
2 (1.3)
3 (1.9)
0 (0.0)
1 (0.6)
0 (0.0)

35 (19.7)
27 (15.2)
24 (13.5)
24 (13.5)
19 (10.7)
11 (6.2)
9 (5.1)
6 (3.4)
10 (5.6)
3 (1.7)
3 (1.7)
3 (1.7)

2 (1.1)
0 (0.0)
2 (1.1)
0 (0.0)
0 (0.0)

70

yrs
(n=150)
n (%)

Total
(n=484)
n (%)

41 (27.3)
24 (16.0)
25 (16.7)
14 (9.3)
6 (4.0)
11 (7.3)
7 (4.7)
7 (4.7)
5 (3.3)
2 (1.3)
0 (0.0)
5 (3.3)
0 (0.0)
1 (0.7)
0 (0.0)
1 (0.7)
1 (0.7)

102 (21.1)
79 (16.3)
78 (16.1)
56 (11.6)
32 (6.6)
27 (5.6)
25 (5.2)
22 (4.5)
23 (4.8)
10 (2.1)
8 (1.7)
9 (1.9)
4 (0.8)
4 (0.8)
2 (0.4)
2 (0.4)
1 (0.2)

191

192 Jainkittivong A, et al

CU Dent J. 2005;28:189-98

Table 2 Frequency distribution of the edentulousness by age in 484 elderly subjects

Completely edentulous
Subjects with only retained roots remained
Edentulous (total)*
Fully dentate
Teeth remained in both arches
Maxillary edentulous
Mandibular edentulous
Dentate (total)

60-64 yrs
(n=156)
n (%)

65-69 yrs
(n=178)
n (%)

10 (6.4)
0 (0.0)
10 (6.4)
6 (3.8)
126(80.8)
(80.8)
126
6 (3.8)
8 (5.1)
146 (93.5)

23 (12.9)
3 (1.7)
26 (14.6)
9 (5.1)
119 (66.9)
18 (10.1)
6 (3.4)
152 (85.5)

70 yrs
(n=150)
n (%)

Total
(n=484)
n (%)

30 (20.0)
2 (1.3)
32 (21.3)
2 (1.3)
93 (62.0)
16 (10.7)
7 (4.7)
118 (78.7)

63 (13.0)
5 (1.0)
68 (14.0)
17 (3.5)
338 (69.8)
40 (8.3)
21 (4.3)
416 (85.9)

Chi-square value = 14.175, p = .001

Table 3 Frequency distribution of denture wearing status in 246 denture wearers

Denture wearing status

n (%)

Partial dentures only

Partial dentures + crowns/bridge
Partial denture wearing group
Complete maxillary and mandibular dentures
Maxillary/mandibular denture with partial denture or with
partial denture + crowns/bridges
Maxillary/mandibular denture
Maxillary/mandibular denture + crowns/bridges
Complete denture wearing group

With reference to denture wearing status (Table

3), there were 246 denture wearers, with 153 (62.2%) in
the partial denture wearing group (PDW) and 93 (37.8%)
in the complete denture wearing group (CDW). Within
the PDW group, there were 86 (34.9%) subjects with
partial dentures only and 67 (24.2) subjects had partial
dentures in combination with crowns and/or bridges.

86 (34.9)
67 (24.2)
153 (62.2)
53 (22.5)
24 (4.7)
13 (5.2)
3 (1.2)
93 (37.8)

In the CDW group there were 53 (22.5%) subjects

with both complete maxillary and mandibular dentures;
24 (4.7%) subjects with a maxillary or mandibular
complete denture in combination with a partial denture
only or with a partial denture together with crowns
and/or bridges; 13 (5.2%) subjects with a maxillary
or mandibular complete denture and 3 individuals

 2548;28:189-98

with a maxillary or mandibular complete denture in

combination with crowns and/or bridges. Other subjects included 57 (11.8%) with crowns and/or bridges
and 181 (37.4%) who were partially or fully edentulous
but had no prostheses.
Figure 1 shows the caries frequency in 416
dentate subjects in relation to age. There were 355
(85.3%) subjects who had at least one carious lesion.
However, there was no difference in the caries frequency among the subjects of the three age groups
(31.5% in the 60-64 year group, 31% in the 65-69 year
group and 22.8% in the 70 years and older group,
p = .107).

Fig. 1 Caries frequency in 416 dentate subjects in relation

to age (Chi-square value = 4.473, p = .107)

Table 4 Mean number of remaining teeth, sound, decayed (D), missing (M), filled (F), DMF scores, filled teeth with recurrent
caries by age in 416 dentate subjects
60-64 yrs
Mean (SD)

65-69 yrs
Mean (SD)

70

yrs
Mean (SD)

Total
Mean (SD)

p-value

18.5 (7.6)
12.4 (6.9)
3.0 (2.6)
12.8 (7.3)
3.1 (3.3)
18.9 (6.8)

17.0 (8.2)
12.2 (8.0)
2.8 (3.1)
14.4 (8.1)
2.0 (2.8)
19.2 (7.9)

15.2 (7.5)
10.0 (6.7)
3.1 (3.1)
15.9 (7.5)
2.1 (3.3)
21.1 (6.8)

17.0 (7.9)
11.6 (7.3)
3.0 (2.9)
14.3 (7.7)
2.4 (3.1)
19.6 (7.2)

.003
.016
.667
.006
.003
.038

11 (1.4)

0.6 (1.2)

0.6 (1.2)

0.8 (1.3)

.001

Remaining teeth*
Sound teeth*
Decayed teeth
Missing teeth*
Filled teeth*
DMF scores*
Filled teeth with
recurrent caries*
* ANOVA, significant differences p < .05

Table 4 shows the mean number of remaining

teeth, sound teeth, decayed, missing and filled teeth,
decayed missing and filled (DMF) scores and filled teeth
with recurrent caries by age. Of the 416 dentate subjects, the mean number of teeth present was 17.07.9
and the mean number of sound teeth was 11.67.3. The
mean number of DMF scores was 19.67.2, and missing teeth was the major component. Subjects in the

youngest age group had a higher number of teeth present

(18.57.6) than those in the two older groups (17.08.2
and 15.27.5 respectively, p = .003). The number of
sound teeth was highest in the youngest group (12.46.9),
followed by the 65-69 year group (12.28.0) and the 70
years and older group (10.06.7) (p = .016). There was
also no difference in number of decayed teeth among
the three age groups (p = .667). The mean number of

193

194 Jainkittivong A, et al

CU Dent J. 2005;28:189-98

decayed teeth was 3.02.6 in the 60-64 year group,

2.83.1 in the 65-69 year group and 3.13.1 in the
70 years and older group. Subjects in the 60-64 year
group also had more filled teeth (3.13.3) than those
in the 65-69 year (2.02.8) and 70 years and older
groups (2.13.3) (p = .003). Subjects in the oldest group
had the highest number of missing teeth (15.97.5),
followed by the 65-69 year group (14.48.1) and the
60-64 year group (12.87.3) (p = .006). With reference
to decayed missing and filled (DMF) scores, DMF
scores were higher in the oldest groups (21.16.8) as
compared to those of the two younger groups (19.27.9
and 18.96.8 respectively, p = .038). Subjects in the
60-64 year group showed a higher number of filled
teeth with recurrent caries (1.11.4) than those in the
65-69 year and 70 years and older groups (0.61.2 and
0.61.2 respectively, p = .001).

group with gingivitis. There were 83 (20%) subjects in

the 60-64 year group, 102 (24.5%) in the 65-69 year
group, and 89 (21.4%) in the 70 years and older group
with periodontitis. The incidence of gingivitis decreased
with age whereas the incidence of periodontitis increased
with age (p < .001).

Of the 484 subjects, one hundred and sixty-eight

subjects (34.7%) had pulpal diseases. One hundred
and thirty-one subjects (27.1%) had at least one root
retained in the maxilla and/or mandible (range = 1-11).

Fig. 2 Frequency distribution of subjects who had a functional dentition of 20 or more teeth in relation to age
(Chi-square value = 24.582, p < .001)

Figure 2 shows the frequency distribution of the

subjects who had a functional dentition of 20 or more
teeth in relation to age. Of the 178 (36.8%) subjects who
had 20 or more teeth, 16.1% were in the 60-64 year
group, 13.6% were in the 65-69 year group, and 7%
were in the 70 years and older group (p < .001).
Figure 3 shows the incidence of periodontal
disease in 416 dentate subjects in relation to age. Only
15 (3.6%) subjects were free from periodontal disease.
Of the remainder, 127 (30.5%) subjects had gingivitis
and 274 (65.9%) had periodontitis. There were 61 (14.7%)
subjects in the 60-64 year group, 45 (10.8%) in the
65-69 year group and 21 (5%) in the 70 years and older

Fig. 3 Incidence of periodontal disease in 416 dentate

subjects in relation to age (Chi-square value = 21.000,
p < .001)

 2548;28:189-98

Table 5 shows the frequency distribution of the

dental treatment needs in our study sample. Prosthetic
treatment was the main requirement, applying to
84.5% of the group, followed by periodontal treatment
(80.8%), and restorative treatment (75.4%). Periodontal
and restorative treatments were needed more among
subjects in the aged 60-69 years than those who were

70 years and older (p = .012 and p < .001 respectively).

In contrast, treatment of conditions related oral medicine was needed more in the two older groups than the
youngest group (p < .001). The need for prosthodontic
treatment, surgical treatment, endodontic treatment and
temporomandibular dysfunction management were not
different among the three age groups.

Table 5 Frequency distribution of dental treatment needs in 484 subjects in relation to age

Prosthetic treatment
Periodontal treatment*
Restorative treatment*
Surgical treatment
Endodontic treatment
Oral Medicine*
Treatment of TMD

60-64 yrs
(n=156)
n (%)

65-69 yrs
(n=178)
n (%)

124 (25.6)
135 (27.9)
134 (27.7)
65 (13.4)
32 (6.6)
4 (0.8)
3 (0.6)

151 (31.2)
146 (30.2)
133 (27.5)
72 (14.9)
25 (5.2)
29 (6.0)
3 (0.6)

70 yrs
(n=150)
n (%)

Total
(n=484)
n (%)

p-value

134 (27.7)
110 (22.7)
98 (20.2)
62 (12.8)
17 (3.5)
26 (5.4)
0 (0.0)

409 (84.5)
391 (80.8)
365 (75.4)
199 (41.1)
74 (15.3)
59 (12.2)
6 (1.2)

.058
.012
< .001
.973
.070
< .001
.251

* Chi-square test, significant differences p < .05

Discussion
The most prevalent principal oral complaints in
our sample were related to denture wearing and pain.
There were only 2.1% subjects who visited the dental
school for a regular check up. These findings correspond with the report by Mattin and Smith2 stated only
a small number of patients visited the dentist on regular
basis and most patients visited the dentist when they
were in pain or required dentures.
The percentage of carious teeth in the present study
was 85.3%. This finding is in agreement with other
studies in that caries is one of the major problems in
the elderly.17,18 The highest incidence of caries was found
in the youngest group. This may be because this group
retained more natural teeth than the two older groups.

However, when tested statistically, the incidence of caries

was not different among the three age groups. This was
confirmed by the lack of difference in caries frequency
and number of carious teeth among the three age groups.
The mean value of sound teeth in our dentate
subjects (11.6) is in the same range as an Australian
study (12.0),17 but lower than those found in Swedish
(13.9)19 and Bangladeshi studies (22.4).4 Moreover, the
present sample showed a greater number of DMF
scores (19.6) than the number reported in the Bangladeshi
study (3.8)4 but lower than those in the Australian (24.7) 17
and the Canadian (26.6) studies.18 The results indicate
a high incidence of dental caries and tooth loss in our
study sample.

195

196 Jainkittivong A, et al

Our results show a lower percentage of edentulousness (14%) as compared to other studies reporting
25% to 48.8%14,20,21 possibly because our subjects
were younger. Our findings agree with those of other
investigations in that edentulousness increases with
age.21-23 Although the number of dentate subjects in
our study was high, most of them were partially dentate.
In this sample, only 20.6% subjects aged 65
years and older were able to meet the minimum
standard of 20 or more teeth. Therefore, the oral health
goal for the year 2000 (50%) as suggested by the
World Health Organization24 was not met by our sample.
In this study, 27.1% subjects had at least one retained
root. This is lower than the 48% as reported by Altieri
et al.25
Our subjects showed a high frequency of periodontal disease and the incidence of periodontitis
increases with age. This corresponds with other reports
indicating age is a factor in periodontitis.
Prosthetic treatment was the main requirement in
our population. This finding corresponds with other
investigations.16,26,27 Periodontal treatment was required
more often in the two older groups than in the youngest
group. This is further evidence supporting age as a
factor in the development of periodontitis. The need
for restorative treatment was lower in the group of
individuals who were 70 years and older when compared to those in the age range of 60-69 years. This
is because the oldest group retained a lower number
of natural teeth than the two younger groups. Fewer
elderly patients in our study were affected by temperomandibular joint dysfunction. This finding is in
agreement with other studies.20,28 Miyazaki et al22
reported 19% of their subjects had unusual symptoms in
their temperomandibular joint whereas Maupome et al20
reported 9.6% of their subjects had jaw dysfunction.

CU Dent J. 2005;28:189-98

Conclusion
The results of this study indicate high incidence
of dental diseases in our sample. Therefore, appropriate dental treatment is a high priority for this group of
patients.

Acknowledgement
The authors would like to thank Vanida Thongtha
and Mayurate Prasomthong for their help in clinical
assistance and data collection.

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CU Dent J. 2005;28:189-98

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.., . ()1
Robert P. Langlais D.D.S., M.S., FACD, FICD, FRCD (C)2
1
2

Department of Dental Diagnostic Science, The University of Texas Health Science Center at San Antonio

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21.1 16.5
16.3 11.6 70
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