Gender modified association of oral health indicators with oral health-related quality of life among Korean elders

Abstract

Objective: To evaluate the association between oral health-related quality of life (OHRQoL) and oral health indicators including dental status, total occlusion force (TOF), number of natural and rehabilitated teeth (NRT), number of natural teeth (NT), and to explore the effect modification on the association by gender among Korean elders.

Methods: A total of 675 participants aged 65 or above recruited by a cluster-based stratified random sampling were included in this cross-sectional study. The 14-items Korean version of the Oral Health Impact Profile (OHIP) was used to measure OHRQoL. The responses about OHIP were dichotomized by the cut-off point of 'fairly often' to determine the 'poor' versus 'fair' OHRQoL. Age, gender, education level, alcohol drinking, smoking, metabolic syndrome, frailty, and periodontitis were considered as confounders. Multiple multivariable logistic regression analyses were applied to assess the adjusted association between oral health indicators and OHRQoL. Gender stratified analysis was also applied to explore the effect modification of the association.

Results: The prevalence of poor OHRQoL was 43.0%, which was higher in women, less-educated elders, alcohol non-drinkers and frailty elders (p < 0.05). Elders with poor OHRQoL also showed lower values of oral health indicators than elders with fair OHRQoL (p < 0.05). Those with NRT ≤ 24, NT ≤ 14, and TOF < 330 N increased the risk of poor OHRQoL by 2.3 times (OR = 2.26, confidence interval [CI] 1.54-3.31), 1.5 times (OR = 1.45, CI 1.02-2.07), and 1.5 times (OR = 1.47, CI 1.06-2.04), respectively. In women, the association of NRT ≤ 24 with poor OHRQoL increased from OR of 2.3 to OR of 2.4, while, in men, the association of TOF < 330 N with poor OHRQoL increased from OR of 1.5 to OR of 3.2.

Conclusion: Oral health indicators consisting of TOF, NRT, and NT were independently associated with poor OHRQoL among Korean elders. Gender modified the association of TOF and NRT. Preventive and/or curative management for keeping natural teeth and the rehabilitation of missing teeth to recover the occlusal force may be essential for reducing poor OHRQoL.

Keywords: Gender; OHIP; OHRQoL; Oral health indicator.

Fig. 1

Gender stratified distribution in oral health indicators according to OHRQoL by OHIP-14K (poor versus fair) (n = 675) (1) Total; (2) Men; (3) Women; (A) Dental status; (B) Total occlusal force (TOF) (unit = 100 N); (C) Number of total natural and rehabilitated teeth (NRT); (D) Number of natural teeth. Error bar denotes standard deviation for crude value and standard error for adjusted value. Crude values were obtained from the T-test and adjusted values from analysis of covariance (ANCOVA) in a general linear model adjusted for age, gender (only for total sample), educational level, drinking, smoking, periodontitis, metabolic syndrome, and frailty

Fig. 2

Gender-stratified adjusted association of oral health indicators with poor OHRQoL by OHIP-14K (n = 675). DS: dental status (dentate [reference] versus denture); TOF: Total occlusion force (≥ 330 N [reference] versus < 330 N); NRT: number of total natural and rehabilitated (≥ 25 [reference] versus ≤ 24); NT: number of natural teeth (≥ 15 [reference] versus ≤ 14). Odds ratio (OR) was adjusted for age, education level, smoking, drinking, periodontitis, metabolic syndrome, and frailty in the multivariable logistic regression model. A diamond (black for men, white for women indicates OR, and bars indicate a 95% confidence interval. The horizontal dotted line is the reference as the null of association (OR = 1)