Socio‐medical condition and oral functional status in an older institutionalised population

Objectives: To investigate the association between the general medical condition, the socio‐economic status, and some factors related to the functional status of the stomatognathic system. Design: A survey in an elderly population. Subjects: 257 older adults, with a mean age of 83.7 years. Setting: Residential homes for the elderly. Intervention: Examination of the medical records on the overall health and the drugs consumed, a structured interview on the socio‐economic status, the complaints for xerostomia, the subjective chewing difficulties, and a clinical evaluation of the number of natural teeth and the number of posterior occluding pairs of teeth contacts (premolars and molars). Results: Multiple pathology and polypharmacy were recorded. 25% of the residents had no occluding posterior tooth contact (natural or prosthetic) and 62% were edentulous. 43% of the residents reported complaints for xerostomia, and 46% for chewing difficulties when eating specific food types. Xerostomic feelings and chewing problems were not related to age. Chewing difficulties were not related to the number of natural teeth, but to the number of posterior occluding teeth contacts, natural or prosthetic (less than two). From all medical conditions examined, only the psychiatric disorders were significantly related to dental status (p<0.05). Moreover, the number of remaining natural teeth was related to socio‐economic status, while the number of posterior occluding teeth contacts was also inversely related to the duration of institutionalisation (p<0.05). Conclusions: Psychiatric disorders, low socio‐economic status and increased duration of institutionalisation were most closely related to poor dental status. The presence of more than two posterior occluding teeth contacts, natural or prosthetic, benefit the very old patient in terms of reduced subjective chewing difficulty. A formal oral care delivery system for the institutionalised elderly, and particularly for those suffering from psychiatric disorders, is imperative.