Original article

Impact of tooth loss on the quality of life

Maria Vieira de Lima Saintrain1 and Eliane Helena Alvim de Souza2

1
Collective Health, University of Fortaleza, Fortaleza, Ceará, Brazil; 2Department of Dental Public Health, University of Pernambuco, Recife,
Pernambuco, Brazil

doi: 10.1111/j.1741-2358.2011.00535.x
Impact of tooth loss on the quality of life of elderly people
Introduction: There is scientific evidence that shows health contributes to the quality of life. These
measurements have not been well guided towards the free response of oral health in people’s lives.
Objective: This study aimed to investigate the impact of tooth loss on the quality of life of elderly people.
Material and methods: Qualitative investigation with descriptive features – which used a random
sample out of the total edentulous elderly people, who lived in an institution in Fortaleza, Brazil – was
carried out. From 250 residents screened, 72 completely edentulous elderly, with ages from 60 to 79 years
were selected. A semi-structured questionnaire was used with closed and opened questions in which the
last one was used for the free flow of the interviewee’s responses. The content was analysed and codified
according to Bardin.
Results: In total, 84.7% had attended the dentist to have exodontia. Of them, 81.9% reported difficulties
after losing their teeth. Physical dimensions, characterised by the difficulties in eating and social dimen-
sions, because of interference in communication with other people were obtained.
Conclusion: Tooth loss causes disorder in the individual’s quality of life, mainly when it affects their well-
being and appearance.

Keywords: oral health, tooth loss, elderly, quality of life.

Accepted 29 November 2010

index9, components of self-reported oral health and

Introduction
general health in racial and ethnic groups10 among
According to Buss1, there is a great deal of scientific others. However, those measurements have not
evidence that shows the contribution of health to been well guided towards free responses and eval-
the quality of life of people. uation of the oral health condition as well as its
There are oral diseases in all population groups, repercussions on people’s lives.
which are strongly related to age, and as people get The population survey11 shows that the oral
older they increase in prevalence and severity. The diseases, mainly dental caries and periodontal dis-
goals established by the World Health Organisation eases, are still major public health problems. These
(WHO) concerned with dental caries have been two conditions cause major problems that affect the
used in different countries to find ways to minimise quality of life, as dental caries and periodontal
the social consequence of oral diseases2. disease may lead the individuals to tooth loss.
In dentistry, there is also extensive research and Brazil reached the desired goals from the WHO in
measurements to evaluate the quality of life: oral health by the year of 2000, but only up to the
development and evaluation of oral health impact age of 12 years11. In all other ages, oral health
profile3, oral health quality4, impact of dental conditions are below these goals, mainly because of
conditions on patients’ quality of life5, evaluation edentulism, and they are getting worse as people
of subjective oral health status indicators6, assess- get older. It is expected that decreasing caries in
ing oral health-related quality of life: findings from children will have positive effects in the medium
the normative ageing study7, the development of and long term as well as the conditions of the
measures of dental impacts on daily living8, health of adult, even though it is not possible to
development of the geriatric oral health assessment state that it is going to happen12.

e632  2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: e632–e636
 Impact of tooth loss on the quality of life e633

Investigation into the conditions that provide the study of convenience. The residents who par-
good quality of life for people as well as the varia- ticipated were from an institution that takes care of
tions of the age is of great social and scientific elderly people located in the county of Fortaleza,
importance, besides providing and generating Ceará, Brazil. Two hundred and fifty residents were
alternatives towards interventions which are aimed screened; 72 completely edentulous elderly people
at the well-being of the elderly13. were selected by age, which varied between 60 and
Quality of life is defined by the WHO as ‘indi- 79 years old and they belonged to the socio-eco-
viduals’ perceptions of their position in life in the nomic class with low income. Most of them were
context of the culture and value systems in which retired and received the minimal wage and others
they live and in relation to their goals, expecta- depended on philanthropic support. The variants of
tions, standards and concerns’14. Thus, several the study were obtained from the primary data
factors have the potential to influence the quality through the interviews, when they were used as a
of life of a person, including oral health. research tool. A semi-structured questionnaire
Good oral health should include the absence of without nominal identification of closed and
facial pain, ability to chew properly, ease of opened questions was used, with the last one being
ingestion and digestion of food. This should also to allow for the free flow of the interviewee’s
contribute to communication, especially when responses. The criteria of inclusion were individuals
speaking and smiling, which have the potential to aged 60 years old or more, edentulous and who
increase the self-esteem of people15. were able to answer the questions. Two conductive
Quality of life means maintaining the possibilities questions were asked: 1) what is the major problem
that people have been enjoying through their caused by the loss of the teeth, based on your own
life16. To Sheiham17, oral health problems probably experience? 2) how do you feel without your
have many more similarities related to an individ- teeth? Interviews lasting 1–2 h each were con-
ual’s quality of life and in personal well-being than ducted during routine clinical activities and were
the ability of the person to perform daily activities. enriched with participant observation.
Starfield18 states that the health of an individual In this study, the qualitative analysis of the con-
or population is determined by their genetic com- tent is to highlight the important data of the inter-
bination and it is largely modified by the physical viewee’s responses and to co-operate with the
and social environment and their behaviour which understanding of the attitudes, competence and
is culturally and socially determined by the atten- social relations within dentistry. According to
tion that was given to health. Minayo19 (p.17) ‘nothing could be intellectually
Nowadays, in Brazil, only 10% of people from 65 considered a problem whether this would not be
to 74 years of age have 20 or more teeth11. How- firstly a problem from the daily life’. The author
ever, the Ministry of Health has launched a pro- considered that the phenomenon or social process
gramme ‘Brasil Sorridente’, and expectations have had to be understood within their determinations
been raised to achieve an improvement in the and transformations, which were given by the
Brazilian population’s oral health conditions that individuals.
might be effective in minimising the damage The data interpretation was carried out by
caused by poor dental conservation among most of the interviews towards a descriptive analysis of the
the Brazilian elderly people. interviewees’ responses that was interpreted by
Epidemiological studies about health from the last the content. A researcher recorded the patient’s
20 years show that the improvement related to oral responses as brief handwritten notes on a prepared
health has been considered slow for most Brazilian form, expanded into descriptive text immediately
adults and elderly people. The purpose of this study afterwards. After repeated readings, its content was
was to investigate the impact of tooth loss on peo- analysed and codified according to Bardin20. The
ple’s quality of life within this context on a group of responses were interpreted against a theoretical
elderly people, taking into account some individual backdrop on ageing, medical and community den-
perspectives, as well as evaluating the importance tistry.
that was given to the dental elements. The interviews were made under free agreement
and explanation. All the interviewees were initially
informed about the research objective and the
Methodology
importance of their reports to have a deeper
The study was based on a qualitative investigation knowledge about people’s feelings, their difficulties
with descriptive and exploratory aspects, which and anxieties relating to the loss of their teeth and
involved a sample of edentulous people through the repercussion on their quality of life. The

 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: e632–e636
e634 M. V. L. Saintrain, E. H. A. Souza

research protocol was approved by the Committee cane either… nor chewing naturally… We wish we
of Ethics in Research from the University of Fort- could bite, but we can¢t…
aleza in May of 2003. Researchers showed that depression associated
with both lower quality of diet and lower self-
assessment scores included decreased appetite28, as
Results and discussion reported in an individual’s response:
Within the 72 participants, 50 (69.4%) were wo- … The digestion of food… The food is not chewed
men and 22 (30.6%) were men. More than half enough… everything becomes heavy… and disturbs
(54.2%t) had not graduated from elementary our sleepiness...
school and only seven (9.7%) of them had gradu- Researchers showed in the distribution of
ated from elementary school. With regard to mar- responses to the OHIP-14 items that 37.3% of the
ital status, 24 (33.3%) were widowed, 17 (23.6% patients have painful mouths and 32.3% feel
were married, 17 (23.6%) were single and 14 uncomfortable eating any kind of food29.
(19.5%) were separated or divorced. With regard to
their origin, 41(56.9% elder people came from the
Tooth loss and communication
cities and 31(49.1%) migrated from rural commu-
nities. All the participants were edentulous; only 38 limitation
(52.8%) used a dental prosthesis and the remain- The social representation was marked by the most
der had no prostheses. remarkable comments from the interviewees.
From the 72 elderly people who were inter- …The speech gets blurred; the pronunciation of the
viewed, only 11 (15.3%) stated that they had words is different… I get embarrassed when I have to
gone regularly to the dentist. Most of them talk to someone… That is, when a person is toothless;
(84.7%) had gone to the dentist to have extrac- he puts the hand over the mouth in order to cover it…
tions. Throughout the reports relating to the … After taking out my teeth, I couldn¢t meet my
answers which were given to the question ‘what boyfriend anymore… I was ashamed of him… I star-
is the major problem caused by the lack of teeth, ted crying… There are so many gap-toothed people…
based on your own experience?’ it was possible to The fact is that I am one of them…
group the participants into two dimensions: one …There are so many… The toothless people don¢t
with a negative impact and another with a posi- worth anything… The face gets ugly… It gets older…
tive one. The mouth gets thinner… Toothless means to be ugly,
In the first situation, more than two-thirds of the horrible…
interviewees 59 (81.9%) reported difficulties after …It is very good to have your own teeth… I miss them
losing their teeth. Most of them reported that they a lot… I feel well with my denture… With my denture
were more concerned with the physical level than I feel complete…
the social level. In these responses, the denture represents the
… Lord takes out the teeth, but he widens the importance of the teeth which were lost.
throat… We ourselves eat like animals… Foods such as nuts, apples and raw carrots
The ultimate dehumanisation of human beings cannot be eaten easily by over half the edentu-
is atrocities of war which animalises the body of lous. Daily intake of non-starch polysaccharides,
the enemy21. In oral health, edentulism may lead protein, calcium, non-haem iron, niacin, vitamin
to dehumanisation of the patient who is deprived C, intrinsic and the milk sugar was significantly
of food for their needs, as the interviewees lower in this group. Plasma ascorbate and retinol
reported: were significantly lower in the edentulous than
… Everything seems to be as a whole… To eat care- dentate patients, affecting intakes of nutritional
fully… We have to tear the meat with the hands, status30.
otherwise we have to eat everything well-cooked… With regard to the dimension of the positive
For these researchers22–27, tooth loss is the result impact, 13 elderly people (18%) answered that
of a complex interaction of dental diseases, lack of they felt relieved after tooth extraction. From this
preventive measures, poverty, faulty nutrition and dimension, emerged the category below.
hunger, access barriers, inadequate treatment and
much more. Within this context, the interviewees’
Pain relief because of tooth loss
response was:
.… Unfortunately we can¢t eat all sort of food… It is … It was a relief… It was the best thing, have no
very sad, when a person can¢t eat... I can¢t eat hard toothache anymore… When I used to have my teeth, I
brown sugar made of sugar cane… I can¢t suck sugar had so much headache… I couldn¢t sleep well… I

 2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: e632–e636
 Impact of tooth loss on the quality of life e635

have swollen face… I used to have all kind of herbs to role. Pinto38 says that the fundamental problems
relieve the pain…To take out the teeth was the best such as edentulism have strong social and eco-
thing I did, because I don¢t suffer with toothache nomical roots and could only be well understood
anymore… The toothache is strong … and explained when the edentulous are heard and
In the research of Fleck et al.13, the importance of when self-diagnosis and opinions from these
eating well and having an appetite were considered people are respected. In this context, Saintrain
relevant to the evaluation of elderly people’s and Lopes39 point out the importance of identi-
quality of life. In this context, the need for dentures fying the fragmentations of the current oral health
also remains associated with the influence of oral system as well as finding operational ways to
health in establishing relationships31. contribute to the improvement of the population’s
Nowadays, it is understood that collective oral health.
health represents the direction to improve the
quality of life and the population’s health as a
priority of the Agenda 2132. It is urgent and Conclusion
necessary to discuss the problem related to health Tooth loss causes disorder in the quality of life of
in the social, collective and public field to the individual, especially when it affects their well-
incorporate effectively the complex ‘promotion- being, appearance and nutritional status. The
health-disease-care’ under a new pragmatic per- elderly people in this research contributed signifi-
spective through public health policies with cantly through their reports for the strengthening
effective society participation33. According to Esan of new ways of observing dentistry, which is
et al.34, edentulism is attributed to low educational essential to the improvement of the health profes-
level as well as the patient’s social and economical sional considering people’s belief and knowledge,
status. as well as their perception of values.
Research about the perception of the conditions
of elderly people’s oral health concluded that
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