Oral mucosal health and disease in institutionalized elderly in Brazil . l o i g e .1 . I r . A l m e i c h i tlisease

O P de. Hcv/o

in u i s t i t i i t i o n a l i / e d

I.. .Sciill\

elderl>

C\ ( i n m e r

!•: O r a l

in B r a z i l . ( ' o n i n u i n i t >

Dent

intiecisnl Oral

heallli

Jacks Jorge Junior', Oslei Paes de Almeida', Lourenco Bozzo', Crispian Scully^ and Edgard Graner' 'Do|iartmenl ot Oral Patholojiy Facuitv ol Odontology ol Pi|-,icicaba. B;a.iil. "Centre (oi the Study of Oial Disease. Brislol Dental Hospital and School. Bristol, England

and

i-pideniiol

\^M\:

19: 173 .V Abslrael ha\e

niiiiiig

t h e la.sl t i e e a d e . m a i n

e\':iliKitetl o r a l c o i u l i l i o i i s

aiul denial

sttidies ueetls

in h " t i r o | i e a n d in t h e e l d e i l \ .

Neirlh

.Anieriea

.Similar

informalicin

t l o e s n o t exi.st in B r a z i l . T h e a i m o f t h i s s t t i d y w a s t o d e t e r n i i n e t h e p r e v a l e n e e o f o r a l

lieallh

a n d d i s e a s e

m

elcleii\

p e r s o n s

l i \ i n u

i n a n i n s t i l u l i o n

i n llic

P i i a e i e a b a , S t a l e ol S a o P a t i l o , H r a / i l . Ol 3.S() ekieiiv p e r s o n s . \}4

e i l \

of

m a l e s a m i I.Vi

fciiKiles w e r e iiiler\ leweil a n d eliiiiealK' e x a m i n e i l . I e s s t h a n o n e h a l f h a d lie:illh\ n i o t i t h s . .'^N.')",, o l t h e e x a m i i a x l i i u l i x i t l u a l s s l u n \ e d o n e o r m o r e l e s i o n s i n I h e o r a l m i i e o s a . t h e n i o s I l i e q t i c n t h e i n g d e n l m e - i i u l u e e d s t o m a t i t i s (.^().()"„). l i b r o t i s

h>per-

p l a s i i i s ( I I.N"(i) a i u l a n g u l a r e l i e i l i l i s (^'..V',,) w e r e f a i r l y e o m m o n . C i e i u l e r . u s e a n d d e g r e e ol h \ g i e n e ol I h e deiiline w e r e faelors sl:ilistieall\ sii;mfie:intl\

eontribtiliim

t(i p r e v a l e n e e o l t l e n t t n e s t o m a t i l i s . P i e e a n e e r o u s l e s i o n s s u e h a s l e i i k o j i i a k i a (.VO"ii). aeliiiie eheilitis (2.ri"(i) w e r e i i n e o m m o n b u l i h i e e e a s e s o f si.|iKimous e a i e i n o ni:i ( l . r ' o ) w e r e r e x e a l e i l .

I h i s sliitly e m p h a s i z e s t h e neetl f o r legtilar o r a l

t i o n s o f t h e e l d e r l y hy p e r s o n n e l t r a i n e d i n o r a l

The

inerease of eklerly

in \ i r l i i a l l \

all

examina-

tliagiiosis.

were sc\crcl\

ill.

Key woids: geriatric dentistiy. mouth disease Ol nl diagnosis Oslei Paes de Almeida. DepartmeiTl ol Dial Palholopy. Faculty of Odontology of Piiacicaha C.P 52, 13400 Piiacicatia. S P Brazil Accepted loi puhlicalion 17 Octohei 1990

fhc participants

were

i>f \ e a r s of

p a i l s o f i h e w o r l d is i u e i e a s n i g I h e d e -

i n t e r \ i e w e d a b o u t I h e i r g e n e r a l a n d tlen-

as

m a n d for l i e a l l h s e r v i e e s l o r Ihis p o p i i i a -

lal lieallh, :uul a elinieal o r a l e x a m i n a l i o n

Pcnttnc

w a s p e i f i ' i i n e d a e e o i x l i n g to t h e r e e o m -

as

i n e i u l a h d n s o f Ihc W b r l d I l e a i t h O r g a n -

nol

liiin. Nimieixnis epidemiologieal

sludies

in i l e n l i s t r y h a v e b e e n p u b l i s h e d in rope

aiul

Norlh

America

0

.s.

conlinuoiis rcmo\ed

when

i z a l i o n ( I S ) . I he d i a g n o s i s w a s m a d e b \

as

occlusion

p o p u l a t i o n , btit a l s o s p e e i a l g r o u p s s u c h

a c c o r d i n g lo A x i l i ( I ) . c x c c p i for tlcn-

imsatisfaetoi"\

as

Ime-nulueetl

(22) aiul r e t c n l i o n

eklerl\'

or

the

s l o m a t u i s . which

was

re-

II

ilisconlmuoiis.

ilcnluics

ncnliirc

similarh

c o r d e d as p r o p o s e d by N I W I C I N ( I ' ) ) as

cording

I. s l i g h l , 2. m o d e r a t e aiul .^. s c x e r c in-

sis ol t h e l e s i o n s w a s m a d e

llamination.

a u t h o r s (.1..I..1.).

(1.^

!.'nc o l

i h c c l l c e t s ol t h e s e l a e l o r s u p o n

k-i- a n d a g e o f 2 7 0 c l d c i i x p o i s o n s in P i i . i c i c a b a . s l a l c iif S a o I ' a i i l o

A.!ic

and

classilled

P i i a e i e a b a . s t a t e o f STio P a u l o , B r a z i l .

Materials and methods

b\

fhc clinical

a l c n c c o f (.lciiliiic-iiKliiccd

oial

nitieosal

(2}).

were

olhcrwisc

slabililx

siiggestcil

nuieosal

Io Risi

i \ r

satislaclor\

L x l e n t t i l o t i s {'•> I 2). 1 h e p i e x a l e n e e o f o r a l l e s i o n s m lliesc g r o u p s is h i g h

21

licscnbctl

the niuhl.

were coiisKlcicd as

20.

were

Ihc

dtiring

elinieal e x a m i n a l i o n of t h e o r a l m u e o s a

inslilulionahzed

10.

habils

Ihese

Ihe

(>

wearing

not only Ihe general

sludies eonsitleied

(1 S).

fu-

tisc o f t h e t l e n t t n c w a s l i n u l c d

folUiws:

1 1 , S.I",, ) I.S ( i 1.0",, ) 7i'' ( 2S,7",, ) 40 1.1(1 0 " , , ••I I l(> ^",, 1

17 , S (

s

.•;

(

? (

4"

1

„

Id 4"

,.)

„)

7iO 7'' o l

.i4 4"

,,)

sliown

m in

174 l a b l e 2 I ' i c v a l c n c c o f Dial n i i i c d s a i l e s i o n s in 2 7 0 n i s l i l i i l u H i a l i / c d c k l c i i y p e r s o n s in I ' i r a c i c a b a .

The d a t a o t I b i s w o r k u i u s l b e e o i i s i i l c i c i l as

Hia/il

rcpresenUilixe

1 CM,HIS

siiiee I )cnliiic-m(lucc! hiiiLMic p a p i l l a e I icnianj'hiina

9

I cukoplakia

X

Aclinic

7 7

chcililIN

irauinalK' nicer ( aiulidiiMs

(i

I• isitiUiiis I r a c l

4 12

( lllicr"' K>ii)iis u i l h less I h a n

It

is

known,

lor

example,

llial

iii

n o i l h e a s i ol B r a / i l t h e i n e i d e n e e ol

Ibc some

I 7.4";,) ( 7.S",,) ( 4.4",,) (

c a n c e r s is o n e ol i b c b i g b e s l m I b c w o r k l .

( 3.0"/,,) ( 2,(."'„) ( 2.(.",,)

(24).

I ( ( (

S i | n a i i U ' n s ^ ai c n u i i i i a

*()lhei

oT

s m a l l a m i |ii o s p c r o i i s a r e a ol llic e o u i i l i y ,

bill

I b i s is n o t

valid

Tor r e g i o n s s i i e b

as

I b c s o i i l l i c a s i , w l i c i e S a o I ' a i i l o is l o c a l c i l

The

ilata

Trom

Ibc

present

sUuly,

I b o u g l i siiTTeriiig T i o m all llic d r a w b a c k s

2.2",,)

oT a C l o s s - s c c l i o i i a l s l u i l \ . m i l i c a l e

IS",,)

tbe

1.1 "/,,) 4.4"/,,)

I.II",,

prevalence

oT o r a l

iiuicosal

lluit

lesions

IS l u g b in t h e B r a / i l i a i i e l d c i i y .

I'ICMOUS

sludies

America

have

111 i M i r o p e

shown

a

ami

liigh

Norlb

meiilciiec

ol

oiul

l e s i o n s 111 I h e e l d e r l y o n I b o s c e o i i l i i i c u l s Table

I.

Ibc proporlioii

i i K i l c s IS s i m i l a r were

iiia l l g r o u p s

(i.S X4 y r

living

old,

Ihe

in t h e m s l i l i i t i o u

.Some

H.3,1)",,

were

X.I)",, o f m i x e d .lust

oT m a l e : I I H 1 l e -

mean

Imie

').()",,

iiuliviiltials

IcMous.

licaltin

(.W.r',,)

I I (').3" I,) I w o a i u l

bhiek.

hail

oiic

lesion.

44

11(4,1",,) three or m o r e

pai'lieiilarly

cleanliness, deniure

antl

(Table

mental

w e r e gciulci',

conliiuious 4).

ildiciciicics

Due iii

use

to

ol

molor

some

(1,4.

der

aiul

paliciils

w a s iiol p o s s i b l e l o d e t e r m i n e

il

oeeltision.

ileiiliiie

stomalitis (9.Ci"o)

2). I. c t i k o p l a k i a s ( 3 . 0 " o ) a n d e a r -

c m o i i i a s ( 1.1",,) w e r e i m p o r t a n t

11 m l i n g s ,

2S).

Perhaps

Ibc

Ihe

mosi

miporlaul

Tuiiliuo

was that Ihiee patients had m i r a o r a l emoma

( l . r ' , i ) , vvliieb IS v c r \

eonsideiing higbcsl

s l a b i l i l y , a n d a g e oT I b c d c n l u r e .

Ihal

Bia/il

i i i c i i l c u c c s ol

has

oral

high one

earc\i'n

oT

cancer

ihe

m

ihc

w o r l d ( 2 4 . 2 6 ) . TiTleeii p a t i e n t s h a d

cxiimmed

iiioiillis. 104

(20.(1",,). a n d l l b r o i i s h y p c r p l a s i a liable

ol

a n d o n e .lapauesc.

o \ c r 4()"u o f p e r s o n s

IUKI c l i n i c a l K - l o l a l l v

d.S.I'',,

w a s (X7: IS

7.

adulls

i'»X5: /

old age pensioners W M K I R

World

lle.iUh

Mnv('v.\

iuisit'

nhdu)d.\

diologv,

/;;•

iicni

20,

MAcbNiii

l^'ox W.

\ \ \

DiR \ i \

c \ a l u . l l UMl 111 .1 s \ m p l o n i

M l . S i l l I.V C . O r a l d i s o r d e r s

S, O r a l

healih

Uiic, i b e p i c v a l c i i c c , e x e e p i

C a r e C e n l i e , ( ' o n i n n i n i l v fiiiii '»,

I ' c i b a p s m o r e stiulics a r e neeilcd m t b e

Epidc

M.VNDIR.SON

1.

Dcillal

RD. flllMilR

iilalitiii

o\

10, RISI

1dmhiirgh

Coininuiniv

iHumIV II

.1. H i i i i r

i\'nl

Mvel'Niri

I .A, Oral eoiulilions and

Olid Ml,

t-'pidi'iiiii'l

1 ')7X: () 6

siiiiiiTieanl o r a l d i s e a s e is v e r y h i g h . :iiiil

lulisni a m i d i s e a s e s r e l a l e d l o d e n l n r e s a h l c i a l u r c r e v i e w , ./ Oral

l a c k o f m o l i v a l i o n Tor d c m : i l c:iie. a s p e -

12: I9S 2 0 7 , 12,

//2

PI. SoMis BC.

Hovi'-RinniiK

(i

proslheses-

Ihey

are

I 1,

Oral

Kchabil

|9S.s:

palhology

and

rekilcil','

p r o v e Ihc d e n i a l a w a r e n e s s o T e a t e r s anil

l i o n s in a n e l d c i l v p o p n l a i i o n

tbe oral eoiulilions oTlliis popiilalion.

luibii

l')X>i: UK 7 S X'7,

mcrcasin..' l^'S>:

i In

.AMItU IRNSI \ I . \ \ M ) I KI lAI li .1. N o R I I I IM

R I S I .1 A n a p p r o a c h l o c p u l c i i i i . i l o g i c . i s sessiueni ol e o m p l e l e d e n i u r e I. / i / Odt'i: ml Sciind l'l^'>: . 1 ' ^ S ' ( , V

24,

B R I VIIM R , ( . U l c e r n o B r . i s i l . d . i d o s h i s l o p . i l o l o g i c o s l " 7 6 SO R i o d e . i a i i e i r o M i i i i s l e r i o d.i S . i i i d c . I " X 2

2S

t i K A i i o w s K i M . B r R i R \ M t l C^i.il h e n l l h s l . i l i i s . m i l n e e i i iil d e n i a l i r c . i l n i e i i ! in I h e elderlv D.iiiish popul.tiioii, i'onjnniniix Pcil! (>i\il ij'lJcniinl P > ' S ; ,• IDS U

2(1,

I ' l N D H O R i , .1.1 ( . i i K ' c r e p r c - c . i n c c i b i i c a l Isl c d i i S.'io P a i i K i ; P . i n . i i n c r i c a n . i . I " X I

12X 33,

Invesliga./ (';•,;/ /\.'-

wilh A.y.m

23

t h e p r e v a l e n c e ol e d c n -

e o n s i d e i i n g llie e c o n o m i c d i l l i c u l l i c s a n d cial p i o g i a m should be devclopcil lo im-

b>(i2.

\ ' u a i n M D c n l u r e sl.ilus a n d need l o r p r o s l h o d o n l i c I r e a l n i e n l .inions: iiisdliiIionali/ed eldeiiv in D e n m a r k i\'niniiinilv Pent (h-id i-.piiicniwl P ' S " . /.^

Pc/ii

nceil lor ilenlal Irealnienl m an eltlerlv popnlaiion in Nurlhcrn Norwav. n-,-

T r o m i b e s c l e s i i l t s il eaii b e s e e n t b a t

J

22

Oral i-:piiicinu>l 197S: .v 100 ".

B i a / . i l i a i i elilcily. in I b e B i a / i h a i i c l i l e i i v I h e p r e v a l e n c e o f

()ri!i

I 9 S 9 : /"• 2 1 2 5 ,

s l a l i i s o l llie i i i s l i l i i l i o n a l i / e i l elderlv p o p -

Tor v a r i e e s ,

m o i l i e r s t u d i e s ( I , 2).

Ih-.iiiii (ii'iiev.!

P W . T l (")vsi R v \ i i \-\ A s s c s s i n e n I o l . i n . i d d i m e i n d e x Tor p h u j u e . i c c i i n i i i i . i l i o n o n c o m p l c i c iii.ixillarv d e n l n r e s I , / . ; Odnni, X.

.screening

ol e l d e r l y p e o p l e a l l e n d m g a ( o i n m n i i i l s

n i c l a o o l i e p i g m c n l a t i o u aiul lissmcil toiiw a s lower Ihan

21,

19XX: / r i - 2 7 1 3 , Dili S. ( i i i u i i R

niiol

(h.i!

^ edii,

\ \ i II11 M i A i i i . I M . B v r v i B.I, \ c r o s l o n u : i

SI9 25,

variees.

I''X^.

N l vv I O N , \ \ , D e n d i r e s o r e i n o u l l i : .i p o s

7,S years, Communiiv Dem Oral l-.pulciinol

( 'ousidcring Ihc variations o f Ihc n o r -

Denliiie

i\rh>ih:l

Organi/.ilu>n

t o r s siieli a s x e r o s l o m i a o r ilielarv a g e g r o u p (1).

D M

./ (h,i.'

s i g n i f i c a n c e . ./ Am i\-nl

S

o\

(u-r.>./.>/!

2 0 7 12. fM.

a n d I r e a l n i e n l m i p l i c a l i o i i s m iieojile o v e r

c i c n c i c s s l i o u k l a l s o b e c o n s i d c i c d in Ibis

I'M 4

o f d c n l u r e s l o i n . i l i l i s m .i g r o u p

i n u d e n l m e s . s i i g g e s l i i i g i h a l o t b c r facdcli-

(.\>nur,unit\

I').S4. / 2

3s • 60

"iO9 I V

p r e v a l e i i e e in l l i o s e w e a i i i i g o t n o l w e a r -

Tinnish

Epidemiol

VRIMIORI

siblc

.inioiig

Denmark

t-]puiciniol

I.

imicos.il

WHO. i9s~

Conimunii)-

19 ; , 9 .

W P\l\l(l

M' o r . i l

/7 2 r 2~

n . B o R D I l R .1 M . SiMARI) P.

^ \ D e n i a l n e e d s o\ I h e e l d e r l \ : .i

/),;/,•

,\viii.niKNSi \ T7 .•\n a n . i l \ l i e e p i d c m i o l o m c

ii,\ 1"

coiiiparisoii bclwccn some T u r o p c a n and

.Angular

in

s l o n i . i l h i s : .i r e v i e w

KANDIIMAN

Peiiial

Prevalence

Norwegi.in

('n/i;-

|9S.">:

popnlaiion.

M . NVYSSIlM \

M

Orai

sUulv

c.ire

.service,

Iphlciniol

The coiidi-

.iiul d c i i l m c s ni

lesions .issocialed uilli wc.iiiii;; i c n i . n . d M c

1(1,

.IG.

N.\

niirsiii!: h o m e

MlKKOM\

Irealmciii

h e . i l l h in a l o n g - I e i n i

e l i e i l i l i s a n i l IraiiOKilie t i l e e i s , usiiallx r e -

m a l m u e o s a s u c h a s siibliiigiial

iniicosai

J I'>X V .V" . ' . 0 " I 1

1\.\IM \

1 9 X 0 : X: 3(i() 4 ,

M A I T N I I I

I li'Aia

faclors

prcxalcncc

m a \ eoiilribiilc.

i\lli

2 6 0 .i,

e x e r t a d d i t i v e effeets a n d a r e e o n s i d c i c i l relevant

ii'inmuniiv

.1.1. S ( i K i \ s i \

.1 D . m i s l i

Pcni

in T n g l a n i i

iiislilulioii

ill a e e o r i l a o c e w i l h t h e l e s t i l l s ol o l b e r s

PiNimoRc

I i o n o\ l l i e o r . i l i n u c o s . i

lioii

nuiniiv

a s s o c i a t e d a n d t b i s is

14.

dentures

W l ISS R

stahilily. a n d oeeltision were not statisti-

( U>, 17). N c v c r l b c l c s s , all t b c s c

Oral

6.S XO.

needs a n d ilemaiuis ol an eldcrlv pojiiilal-.puiemioi

slom:ititis.

s n e b a s a g e ol i b c p a l i c i i l . d e n t u r e a g e . c a l l y sigiiilicaiitlx

1

l e s i o n s assOL^ialcd v\ilh llic u c . i r i n g o l r c n u n able denlures, ./C'.j//'.(//;/'/ I'lSl: /('

o n e bail g e o g r a p h i e t o n g u e (0.4",,) a n d nciiIiiie-uKliiced

Bi n i v - . l i i R i a N s r \

References

t i e n t s ( 0 . 7 " ( i ) h a s s m o k e r ' s p:ii:ilc, oiilv

175