“Oral health is multi-faceted and includes the ability to speak, smile, touch, taste, chew, swallow and convey a range of emotions through facial expression with confidence and without pain that has been linked to overall health, including orofacial pain.” [1]

Oral disease is a large group of diseases and conditions that includes dental caries, periodontal (gum) disease, tooth loss, oral cancer, oro-dental trauma, noma and birth defects such as cleft lip and palate. Oral diseases are one of the most prevalent noncommunicable diseases globally, affecting 3.5 billion people. [2] The total toll of oral health diseases on services is likely to rise even further with the rise in global burden of oral health disease, especially in low- and middle-income countries due to population expansion and ageing. [3]

The Global Oral Health Status Report (2022), 1 released by WHO estimated that oral diseases are a significant public health problem and severe problems are the most common in low-income communities for close to one-half of the world’s population, while oral conditions presented in more than one-half of adults who suffer from poor oral health. [4]

The oral health-related quality of life (OHRQOL) is a concept that has been the subject of continuous interest and has attracted much attention in the last 20 years. Studies such as those conducted by Slade et al have pointed to an important modification in the vision about health. The shift is a progression from defining health simply as the absence of disease or infirmity to an understanding that includes total physical, mental and social well-being, definitions of the World Health Organisation. This change, occurring in the second half of the 20th century, was essential for overall HRQOL and therefore OHRQOL. OHRQOL is ‘‘a multidimensional construct that includes (but not only) people's comfort when eating, sleeping and engaging in social interaction; their self-esteem; and their satisfaction as to the condition of their own mouth.’’ [5]

Oral health, and the QOL that it influences, is an essential component of general health. This importance is recognised by the WHO which has given high priority to this area in its Global Oral Health Program. [6]

India is regarded as an ageing country and its elderly population has already crossed 77 million. The rapidly ageing population introduces several implications regarding general and oral health. [7] The age distribution of the world's population is changing. Medical technology has led to a growing percentage of elderly people worldwide. By 2030, one person in six worldwide will be aged 60 and over. It is also estimated that in 2051, 2 billion people will be older than 60; from this total 80% of them will live in developing countries. [8]

Oral cancer refers to that of the lip, mouth and oropharynx. When taken together, these constitute the 13th most prevalent cancer worldwide. Oral cancer was higher among tobacco users compared with former and never users. [9]

Many oral health problems are linked to common risk factors, such as tobacco use, harmful use of alcohol and consumption of free sugars, all being common risk factors shared with the four leading non-communicable diseases: cardiovascular disease, cancer, diabetes and chronic respiratory disease.

Moreover, diabetes and periodontal disease have a two-way relationship: not only can diabetes contribute to the development and worsening of gum disease, but severe gum disease can also make diabetes management more challenging. [10]

This is An Epidemiological Community-based Cross-sectional Study. The study was conducted in an Urban Slum which is also the field practice area attached to the Urban Health Centre under the Department of Community Medicine of the Medical College where preventive, urative, promotive, and rehabilitative health services are provided. Geriatric population aged 60 years or more, both genders were included. The total Study period was 22 months.

Inclusion Criteria:

Individuals aged 60 years or more (Both Genders)

Exclusion Criteria:

1) Individuals with currently diagnosed cases of Oral Cancer.

2) Individuals with a History of Oral Surgery in the past 3 months.

Oral Examination of the Study Participants

Oral examination was done using the ORAL HEALTH ASSESSMENT TOOL (OHAT) for non-dental professionals by Chalmers (2004). The OHAT assesses oral health regarding eight different categories (i.e., lips, tongue, gums and tissues, saliva, natural teeth, dentures, oral cleanliness, and dental pain). Each category can be divided into healthy, changes, and unhealthy situations. Further patients are divided into 2 categories: those who had poor Oral Health Status (changes/unhealthy in any of the 8 categories) and those with Good Oral Health Status. (Healthy in each of the 8 categories).

Oral Cavity was also screened for Oral premalignant lesions such as Erythroplakia, Leukoplakia, and Oral Sub Mucosal Fibrosis. (OSMF)

• Knowledge about Oral Health

Oral Health Knowledge was assessed by asking seven questions. Each correct answer was given a “1” score while the wrong answer was given a “0” score.

• Oral Health Behaviour and Practices in Participants.

Eleven Questions related to Oral Health Behaviour were asked to assess the oral health practices of the participants.

• Oral Health-Related Quality of Life (OHRQOL) using the Geriatric Oral Health Assessment Index. (GOHAI) (61)

The Geriatric Oral Health Assessment Index (GOHAI) was used to measure oral health-related quality of life (OHRQOL). It consists of 12 questions. There are five response categories for each question and a score has been assigned for each response category (l = always, 2 = often, 3 = sometimes, 4 = seldom, and 5 = never). A reversal of positive scoring was necessary for three items (‘able to swallow comfortably’, ‘able to eat without discomfort’, and 'pleased with the look of teeth') to have a higher score corresponding to more favourable oral health. The GOHAI score was computed by adding up the scores of the responses to the 12 questions. The GOHAI score is the sum of the answers to the 12 questions so that a high score (Maximum = 60) indicates Good oral health-related quality of life.

Table 1. Socio-demographic profile of participants (n = 166)

In Table 1, the Majority are “young-old” (60–74), but nearly 43% are ≥75—expecting a higher burden of xerostomia, tooth loss, and prosthetic needs with advancing age. Smokeless tobacco (36%) and multi-substance use (13%) are common—consistent with the premalignant lesion burden observed later. The HTN (31%), CHD (25%), and DM (18%) suggest substantial cardio-metabolic comorbidity that can worsen periodontal status and healing.

Table 2. Oral health status and OHAT categories

Overall oral health status (n = 166)

In table 2, 60% have poor oral health (≥1 domain ‘changes/unhealthy’), indicating a high unmet need. Dental pain (24% unhealthy), oral cleanliness (54% “changes”), saliva (33% “changes”, 7% unhealthy) and natural dentition problems (43% with ≥1–3 decayed/broken teeth among dentate). Among denture wearers, 17% have loose dentures and 13% are missing dentures—both directly impair mastication and QoL.

B.

Table 3. OHAT domain ratings

Table 4. Pre-malignant oral lesions (n = 166)

It was observed that 38.6% have a premalignant lesion—mainly OSMF (23.5%) and leukoplakia (12.7%).

Table 5. Age group and GOHAI

GOHAI declines with age; ≥85 y have the lowest median (41). Differences are significant (p=0.006), mainly between 60–74 vs 75–84 and 60–74 vs ≥85.

Table 6. Oral health status and GOHAI

Healthy oral status associates with ~10-point higher median GOHAI (51 vs 41), p<0.001.

Table 7. Substance use and premalignant lesions.

Strongly associated with smoking and multi-substance use; also with smokeless tobacco (all p≤0.001). Alcohol not significant.  Erythroplakia: Observed only in smokeless tobacco users (p=0.01). Strongly associated with smokeless tobacco and multi-substance use (p<0.001); smoking/alcohol not significant.

Table 8. Oral Health knowledge in Study Participants

Table 9 : Oral Health Behaviour in Study Participants:

This urban slum-based cross-sectional study involving 166 older adults demonstrates a high level of disease and functional burden. As a whole, 60.2% recorded poor oral health status on OHAT, and 38.6% had premalignant lesions-primarily OMSF (23.5%), followed by Leukoplakia (12.7%) and Erythroplakia (2.4%). Quality of life was severely restricted: the median GOHAI was 44 (IQR =40–51) with 54.2% classified in the poor OHRQoL category, highlighting day-to-day impact because of pain, restricted mastication and social impairments. [12]

Sharp gradients were observed between sociodemographic strata. Age presented a step-down relationship with GOHAI score (p=0.006), with 1/day, brushing for ≥1–3 minutes, cleaning tongue, mouthwash use and regular dental check-ups being associated with better clinical value and/or higher GOHAI (all p≤0.01). In contrast, tobacco chewing and Masheri use were negatively related to favourable outcomes. [16] Significantly, oral-health knowledge was moderately and positively related to GOHAI (ρ=0.554; p<0.001), suggesting that literacy-mediated approaches can reasonably influence both behaviours as well as quality of life outcomes.

Risk-lesion analyses emphasise prevention priorities. Leukoplakia, erythroplakia and OSMF were significantly associated with smokeless tobacco and multi-substance use (p≤0.001/0.01) but not with alcohol or smoking alone. Because of the high prevalence of lesions and the mucosal exposure resulting from use usually, cessation support must be integrated with active lesion screening and fast-track referral. [17]

Programmatically, the least demanding of three likely major gains are: (1) community engagement providing down referral of tobacco-cessation counselling as part of routine screen-and-refer pathways for premalignant disease; (2) a set of simple clinical actions—pain alleviation, caries and periodontal therapy, denture provision/adjustment, and xerostomia management; and (3) behaviour-change education suited to low-literate consumers based around ≥2–3-minute toothbrushing twice daily plus tongue cleaning(as ∼10% reduction in oral cancer relative chance [OR] is also observed); adjunctive mouthwashes/dentifrice including antiseptics would be useful if check-ups are at best triannual (i.e. annually). These need to be targeted for the oldest and lowest educated subgroups, where both deficits and effects are most pronounced. [18]

Strengths are the standardised OHAT/GOHAI assessment and detailed behavioural and lesion profiling. The cross-sectional design, which did not allow for causal interpretations, some self-report measures, and a single site of implementation, hinder the inferences. Nevertheless, the evidence is compelling and actionable: in view of urban-slum elders, due to the prevalence of preventable/treatable oral conditions, and tobacco-associated lesions irrespective at older ages, simple and scalable behaviours/services are strongly associated with superior OHRQoL, especially within the physical function domain. [19] 

Older residents of the urban slums are burdened with poor Oral Health and premalignant lesions with associated significant QoL impairment. Age, low education, and tobacco (smokeless; multi-use) are key drivers, while simple, scalable behaviours and routine care are strongly associated with better outcomes. Multi-component community programs coupling cessation, screening, prosthetic services, and health literacy are likely to yield the greatest gains in OHRQoL, particularly by improving the physical function domain.

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