Relationships between periodontal disease and oral health-related quality of life in the urban older population in Indonesia

Abstract

Improvement in prevention of disease and effective management of health are leading to increased life expectancy globally. This increased life expectancy is associated with challenges for the global public health in relation to the burden of chronic non-communicable diseases (NCDs). These chronic diseases often reduce the quality of life of older people. Dental caries and periodontal disease have been identified as the two most significant oral NCDs in terms of the burden of disease globally. It has been estimated that periodontal disease is the 11th most prevalent disease worldwide. Despite this prevalence and the potential burden of periodontal disease to the global population, there are fewer epidemiological studies and dental public health interventions about periodontal disease compared with those for dental caries. Very few qualitative studies have been performed concerning periodontal disease and quality of life, especially in the context of developing countries. This thesis attempted to bridge this knowledge gap in the relationship between periodontal disease and oral health-related quality of life (OHRQoL), in a developing country, using an urban older population in Indonesia as its sample. The thesis presents a mixed-methods approach to scrutinise the relationship between periodontal disease and OHRQoL as well as to describe personal periodontal disease experiences in the older population in Indonesia. The quantitative data were collected from three districts in Depok, West Java province, Indonesia. Three hundred and sixty-three participants were involved and met the inclusion criteria to participate in the first stage of the data collection, which included an oral health examination and questionnaire completion. It was found that only around 3 per cent of these older people had a healthy periodontal condition, and 97 per cent had periodontal pockets (75% had generalised periodontitis and 22 % had localised periodontitis). In the qualitative phase of the data collection, 31 participants who met the inclusion criterion, of having chronic generalised periodontitis, were interviewed using semi-structured interviews. The interviews were processed until thematic data saturation was achieved. The findings of the analyses reported in this thesis highlight some distinctions between the quantitative and qualitative findings regarding the impacts of periodontal disease on OHRQoL. The quantitative data showed a lack of statistical evidence for a relationship between periodontal disease status and OHRQoL measured using the short form of the Oral Health Impact Profile (OHIP-14). However, the qualitative data demonstrated that oral health symptoms likely related to periodontal disease affected the well-being of older Indonesians living in an urban population. These older people described how the oral symptoms related to periodontal disease brought some impact on their daily life beyond pain, physical discomfort, and restrictions of physical functions. The symptoms of periodontal disease also affected the psychological and social aspects of everyday life. This study demonstrated an agreement between the quantitative and qualitative data regarding the negative impacts of both clinically identified and self-reported tooth mobility on well-being. This relationship was confirmed based on the prevalence, severity, and extent of the impacts measured. The older people described the daily life problems caused by tooth mobility as something noticeable and hard to ignore. These data also found that individuals and environmental characteristics might also considerably affect the OHRQoL of the population under study. These predictors are brushing habits, dental visit, family income, and subjective assessment of dental health which had a significant association with the OHRQoL. In addition to this, other clinical measures of oral health, such as DMF-T and teeth with furcation involvement, were significantly associated with reported OHRQoL in this sample. Finally, the qualitative data highlighted a widespread belief that the symptoms of periodontal disease were inevitable consequences of the normal ageing process. This belief alongside the individuals and environmental characteristics of the older people might explain the discrepancy in the results between quantitative and qualitative data in this study regarding the relationship between periodontal disease status and OHRQoL. The belief affected older people’ perceptions and reactions toward their symptoms of periodontal disease, and more broadly toward their expectations regarding normal oral health and function in old age.