Observational Study Medicine ®

OPEN

Correlation between oral health and quality of life

among the elderly in Southwest China from 2013
to 2015
∗
Xun Sheng, MDa, Xia Xiao, PhDb, Xiaoxiao Song, PhDb, Lei Qiao, MDa, Xihong Zhang, MDa, Hua Zhong, PhDc,

Abstract
The aim of this study was to evaluate the oral health among the elderly in Southwest China and to analyze the correlation between
common oral diseases and quality of life (QOL) in the same population, thus providing recommendations to improve their oral health
and life quality.
Elderly people (>60 years’ old) were randomly recruited into our study, and we performed oral health examinations and diagnoses,
using the Community Periodontal Index (CPI) to assess the periodontal condition, and Oral Health Impact Profile-14 (OHIP-14) to
score life quality associated with oral health. Then we analyzed correlations between oral health and QOL as well as body mass index
(BMI).
A total of 687 subjects participated in our study and 212 (30.9%) were diagnosed with gingivitis or subgingival calculus, 291
(42.4%) with moderate chronic periodontitis, 136 (19.8%) with severe chronic periodontitis, 514 (74.8%) with dental caries, and 648
(94.3%) with dentition defects. A total of 653 (95.1%) qualified OHIP-14 scores were collected, with a median score of 13. The scores
of the severe and moderate periodontitis were similar to the dentition defects, but higher than the scores for gingivitis and subgingival
calculus. Considering the most common side effect, 11% of the subjects with severe chronic periodontitis were reported to be
“unsatisfied with eating,” and 48.4% of the participants with dentition defects complained about “troubles with pronunciation.” A
logistic regression analysis revealed that underweight (BMI <20) correlated with dental caries (odds ratio [OR]: 0.167, P = .040) and
dentition defects (OR: 0.119, P = .016).
The general oral health condition was poor among the elderly in Southwest China. Periodontitis and dentition defects have
considerable negative effects on the QOL among this population.
Abbreviations: CPI = Community Periodontal Index, CPITN = community periodontal index of treatment needs, OHIP-14 = Oral
Health Impact Profile-14, OHRQOL = oral health-related quality of life, QOL = quality of life.
Keywords: dental caries, dentition, gingivitis, life quality, periodontitis

1. Introduction layer of the periodontium (periodontal ligament, alveolar bone,

and dental cementum). The periodontal disease induces peri-
Oral diseases in the Chinese elderly are mainly composed of
odontal tissue destruction and alveolar bone absorption, causing
periodontal disease, dental caries, dentition defects, and other
the teeth to drop out and in fact it has become the main reason for
conditions.[1] Periodontal disease is a term generally used to
the loss of teeth in elderly Chinese people.[2] Dental caries is a
describe specific diseases that affect the supporting tissues and is
progressive lesion of the tooth enamel influenced by multiple oral
divided into gum diseases and periodontitis, which affect the deep
factors, manifested as demineralization of the inorganic part and
degradation of the organic part.[3] As the lesion progresses, dental
Editor: Yiqiang Zhan. caries can gradually induce the formation of holes, residual
XS and XX contributed equally to the manuscript. crowns, residual roots, and eventually teeth loss.[4] On account of
Funding information: This study was supported by Yunnan Applied Basic the oral environmental change in the elderly (such as less
Research Projects (No. 2015FB075). secretion of saliva), along with the degeneration of cognitive
The authors report no conflicts of interest. sensitivity, unnoticed dental caries can proceed rapidly and as
a
Department of Stomatology, The Affiliated Stomatological Hospital of Kunming notable symptoms show up, they are unlikely to preserve the
Medical University, b Department of Community Health, Kunming Medical involved teeth. Hence, the 2 diseases can cause dentition defects
University School of Public Health, c Department of Ophthalmology, First Affiliated and even tooth loss, bringing trouble to the elderly regarding
Hospital of Kunming Medical University, Kunming, China.
∗
mastication and pronunciation, thus affecting their life quality.
Correspondence: Hua Zhong, Department of Ophthalmology, First Affiliated Quality of life (QOL) refers to the feelings of individuals in a
Hospital of Kunming Medical University. No 295 Xichang Road, Kunming
650032, China (e-mail: [email protected]).
certain cultural environment and is associated with personal
goals, expectations, standards and concerns, and includes
Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.
This is an open access article distributed under the Creative Commons physiological health, the mental state, independency, social
Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build relationship, personal beliefs, and the environment.[5] QOL not
upon the work, even for commercial purposes, as long as the author is credited only provides clinical doctors and researchers with more
and the new creations are licensed under the identical terms. information about the disease, but also quantifies the influence
Medicine (2018) 97:21(e10777) of a certain disease on physical, psychological, and social aspects
Received: 17 October 2016 / Accepted: 24 April 2018 for patients, which is beneficial for health risk factor tracing,
http://dx.doi.org/10.1097/MD.0000000000010777 treatment selection, and prognosis monitoring, and this supports

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Sheng et al. Medicine (2018) 97:21 Medicine

the concept of modern health and the transition of medical

models.[6] In oral medicine, because oral health-related QOL
(OHRQOL) can also function as an assessment of oral diseases
on physical, psychological, and social aspects for patients, it has
recently been paid much more attention and taken into
consideration in practice.[7]
OHIP-14 is a widely used scale in the OHRQOL area, whose
reliability and validity have been intensively verified. The OHIP-14
scale has 14 items, divided into 7 domains: functional limitation,
physical pain, psychological discomfort, physical disability,
psychological disability, social disability, and handicap. Several
studies have successfully applied this scale to evaluate the effects of
chronic periodontitis on life quality in the elderly.[8,9]
At present, large sample size studies on oral health are scarce in
China and our study investigated the epidemiology of oral
diseases among the elderly in Southwest China by evaluating their
current oral health status as well as any correlations between
common oral diseases and QOL to produce a regional survey on Figure 2. Dental CPI probe used for measuring periodontal pocket depths.
present oral health awareness in a Chinese province. CPI = Community Periodontal Index.

2. Patients and methods

responsible for the oral examinations of all participants. Detailed
2.1. Investigation population oral examination and diagnostic standards were as follows: the
The study was approved by our institutional review board and periodontal disease was diagnosed using the Community
informed written consent was obtained from all of the recruited Periodontal Index of treatment needs (CPITN).[10] The teeth
patients. Population data were collected from 13 districts in have been categorized into 4 quadrants (upper right and left and
Southwest China (Panlong, Wuhua, Xishan, Guandu, Cheng- lower right and left, with 8 teeth in each quadrant according to
gong, Jinning, Fumin, Songming, Anning, Dongchuan, Xundian, the World Dental Federation (FDI) guideline.[11] Periodontal
Shilin, Luquan) from September 2013 to January 2015. conditions, including gingival bleeding, subgingival calculus, and
Inclusion criteria were: ≥60 years’ old with self-care ability and depth of periodontal pocket, were evaluated in 6 zones: 17-14,
could move freely; local resident; conscious; able to communicate 13-23, 24-27, 47-44, 43-33, and 34-37 (Fig. 1). Each patient was
and willing to participate in the study. Exclusion criteria were: local diagnosed according to CPI criteria with a CPI probe (Fig. 2)
resident <2 years in Kunming City; receiving seizure, thyroid, or from Code 0 to Code 4 (Code 0: healthy periodontal conditions;
chemotherapy/radiation medications; positive HIV status; and Code 1: gingival bleeding on probing; Code 2: calculus and
denial of participating in the study. We enrolled patients based on bleeding; Code 3: periodontal pocket 4–5 mm; and Code 4:
the records of their household register in the hospitals and the periodontal pocket ≥6 mm).[10]
inclusion and exclusion criteria defined for our study. Dental caries status was assessed using criteria of the Decayed-
Missing-Filled Teeth index (DMFT index) recommended by the
World Health Organization.[12] Oral examination should be
2.2. Oral Examination
focused on visual examination, assisted by probing, mainly
Two dental doctors who had unified test standards after training, evaluating the color change of the surface and morphology
to reduce the error caused by standard deviation, were defects such as a chalk color or a brown patch on the surface,

Figure 1. World Dental Federation classification of teeth in 4 quadrants with 8 teeth per quadrant numerated from the incisors to the molar teeth. The bold numbers
indicate the teeth zones, which have been analyzed in the study.

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black tooth fossa, ink change on the groove and edge of the Table 1
occlusal surface, dark brown cavity, and residual root or crown. General demographic data.
Group Number %
2.3. Dentition status and treatment demand Sex Male 359 52.3
We checked and recorded coronary dental caries, root dental Female 328 47.7
caries, secondary dental caries, history of filling a tooth, dentition Age, y 60–64 214 31.1
loss and reason for dentition loss, abutment stat,e and the 65–70 258 37.6
71–75 139 20.2
treatment program for each tooth. Dentition defects refer to
76–80 61 8.9
different numbers of natural teeth missing in the maxillary and >80 15 2.2
mandible, whereas dentition loss means that no natural teeth or BMI Obesity (>28) 24 3.5
tooth roots are left on the entire dental arch. Overweight (>24, <28) 103 15.0
Underweight (<20) 26 3.8
Normal (20–24) 534 77.7
2.4. Questionnaire survey
Ethnic groups Han 644 93.7
The general demographic data and OHIP-14 scale were collected Bai 19 2.8
by questionnaire survey.[13] General demographic data included Dai 1 0.1
sex, age, nationality, residence, living conditions, education level, Hui 18 2.6
occupation, monthly income, and marital status, and so on. The Man 1 0.1
NaXi 1 0.1
OHIP-14 scale contained 7 dimensions and 14 items, namely 14
Yi 3 0.4
questions. Each question had 5 answers about frequency, which
Education level Primary school or below 83 12.1
were respectively “very often,” “often,” “sometimes,” “seldom,” Middle school 161 23.4
and “never,” The participants could choose one answer under High and secondary school 259 37.7
investigation and one explanation. The score of OHIP-14 ranged Junior college and above 184 26.8
from 0 to 56. A higher score suggested a worse life quality Monthly income (Yuan) <500 17 2.5
associated with poor oral health. 500–1000 31 4.5
1000–1500 108 15.7
1500–1999 231 33.6
2.5. Statistical analysis 2000–2499 140 20.4
We used Epidata software to establish a data input template, and 2500–2999 78 11.4
>3000 67 9.8
adopted a double input method for all valid questionnaires. We
No fixed income 15 2.2
insured the integrity of data by a data verification program. The score
Marital status Married 631 91.8
of OHIP-14 scale are presented as median and quartile intervals. The Divorced 10 1.5
methods of statistical analysis included logistic regression, descriptive Unmarried 2 0.3
statistics, Pearson x2 test, Fisher x2 test, and rank sum test. Inter-rater Widowed 44 6.4
reliability has been determined by Cohen Kappa coefficient Family members 1 7 1.0
calculation. P < .05 was considered to be statistically significant. 2 180 26.2
3 128 18.6
4 181 26.3
3. Results 5 156 22.7
3.1. General demographic data 6 28 4.1
7 1 0.1
This study investigated 700 participants, 687 of whom completed 8 3 0.4
valid questionnaires (98%). Among the respondents, the number of 9 3 0.4
males was slightly higher than females; 60- to 70-year-old subjects BMI = body mass index.
accounted for the majority (68.7%); most of them were from the
Han nationality (93.7%); the education level was high school or
secondary school among most participants (37.3%), followed by more likely to develop into the severe stage in male subjects (30.9%
junior college and above (26.8%); monthly income was relatively vs. 35.5%). Moreover, we found that with an increase in age, the
high (>1500 yuan, 75.2%); most of them were married (91.8%) and severity of the disease also increased gradually: subjects aged 60 to
had 2 to 5 family members (93.8%) (Table 1). 64 years were mainly diagnosed with gingivitis or subgingival
calculus (45.5%), those aged 65 to 70 years and 71 to 75 years were
diagnosed with moderate periodontitis (48.4% and 58.3%),
3.2. Oral diseases
whereas the oldest subjects (76–80 years) were likely to be
Kappa values of interexaminer agreement were 0.75 to 0.80. The diagnosed with either severe periodontitis or moderate periodon-
results of the oral health evaluation for the 687 respondents were titis (respectively 32.6% and 37.0%). There were only 10
reported as a serious problem, and the numbers of subjects with participants above 81 years of age, which limited the interpretation
gingivitis or subgingival calculus, moderate periodontitis, and for patients in this group. Considering the education level,
severe periodontitis were reported to be 212 (30.9%), 291 participants of the middle school group were more likely to be
(42.4%), and 136 (19.8%), respectively. Only 2 subjects had diagnosed with gingivitis or subgingival calculus, whereas the
completely healthy teeth and the remaining 41 had no experiences others mostly had moderate periodontitis. We further analyzed the
or no access to CPI examination. As shown in Table 2, both male correlation between monthly income and the prevalence of each
and female participants were mainly in the moderate stage of condition, and found that as income increased, the prevalence of
periodontitis. When compared with females, periodontitis was moderate or severe periodontitis decreased: the prevalence rate of

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Table 2
Comparison of correlations between different stages of periodontitis and the baseline information of enrolled patients.
Severe chronic Moderate chronic Gingival bleeding with or
Group periodontitis (136) periodontitis (291) without plaque (212) x2 P
Sex Male 84 (25.5) 144 (43.6) 102 (30.9) 8.128 .043
Female 52 (16.8) 147 (47.6) 110 (35.6)
Age, y 60–64 39 (18.7) 75 (35.9) 95 (45.5) 32.232 <.001
65–70 60 (23.6) 123 (48.4) 71 (28.0)
71–75 20 (16.7) 70 (58.3) 30 (25.0)
76–80 15 (32.6) 17 (37.0) 14 (30.4)
>81 2 (20.0) 6 (60.0) 2 (20.0)
Education level Primary school or below 8 (11.0) 44 (60.3) 21 (28.8) 39.375 <.001
Middle school 20 (13.4) 55 (36.9) 74 (49.7)
High and secondary school 58 (24.3) 121 (50.6) 60 (25.1)
Junior college or above 50 (28.1) 71 (39.9) 57 (32.0)
Monthly income (Yuan) <500 2 (18.2) 8 (72.7) 1 (9.1) 17.341 .001
500–1000 4 (13.8) 22 (75.9) 3 (10.3)
1000–1500 24 (22.9) 55 (52.4) 26 (24.8)
>1500 103 (21.5) 198 (41.3) 178 (37.2)
No fixed income 3 (21.4) 8 (53.3) 4 (28.6)
The analysis was performed using Pearson x2 or probability analysis on different classifications (sex, age, education degree, and monthly income) of various periodontitis patients. Data are represented as n (%).

the low-income (<500 yuan) subjects was 90.9%, whereas the rate 3.3. Dental caries, tooth loss and filled teeth
of the high income (>1500 yuan) subjects was 62.7%. Two healthy There was a significant difference between the age groups
participants were found in the high-income group (>1500 yuan). regarding dental caries and dentition defects (P < .001). Among
Finally, according to Pearson x2 test, there were significant 687 respondents, 514 (74.8%) had dental caries. The prevalence
differences (P = .043) between male and female subjects, among of dental caries in the older subjects (>75 years’ old) was lower
subjects of different ages (P < .001), education levels (P < 0.001), than those aged 60 to 75 years. In addition, 648 (94.3%) of them
and monthly income (P = .001). had dentition defects, the average missing teeth were 11.21, and
31 (4.5%) had dentition loss. The rate of dentition defects in
Table 3 males and females was comparable (93.9% and 94.8%). Similar
The prevalence of dental caries and dentition defects in subjects of to dental caries, the dentition defect rate was lower in the older
different age groups. subjects (>75 years’ old) compared with those aged 60 to 75
Age, y Dental caries Dentition defect P years (Table 3).
60–64 (214 cases) 159 (74.3) 209 (97.7) .064
65–70 (258 cases) 210 (81.4) 254 (98.4) .141 3.4. OHIP-14 scores
71–75 (139 cases) 101 (72.7) 124 (89.2) .282
76–80 (61 cases) 36 (59.0) 49 (80.3) .322 In total we collected 653 (95.1%) qualified OHIP-14 scores from
≥81 (15 cases) 8 (53.3) 12 (80.0) .569 687 respondents. As shown in Figure 3, the median score was 13
P <.001 and the highest score was 39. We further analyzed the correlation
between oral diseases and QOL. Participants with severe and
Data are represented as n (%).

Figure 3. Distribution of the OHIP-14 scores. OHIP-14 = Oral Health Impact Profile-14.

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Table 4
The effect of periodontitis stages in subjects on OHIP-14 Chinese version evaluation items.
Gingivitis and subgingival Moderate periodontitis Severe periodontitis
OHIP-14 items calculus (CPI = 1 or 2) (n = 212) (CPI = 3) (n = 291) (CPI = 4) (n = 136) x2 P
Trouble pronouncing words 11 (5.2) 19 (6.5) 13 (9.6) 2.555 .279
Sense of taste worse 6 (2.8) 16 (5.5) 12 (8.8) 5.931 .052
Painful aching in mouth 5 (2.4) 6 (2.1) 11 (8.1) 9.247 .010
Uncomfortable to eat foods 12 (5.7) 11 (3.8) 12 (8.8) 4.574 .102
Being self-conscious 4 (1.9) 10 (3.4) 7 (5.1) 2.827 .243
Felt tense 3 (1.4) 2 (0.7) 3 (2.2) 1.757 .415
Unsatisfactory diet 7 (3.3) 6 (2.1) 15 (11.0) 15.517 .000
Had to interrupt meals 2 (0.9) 2 (0.7) 4 (2.9) 3.353 .187
Difficult to relax 3 (1.4) 6 (2.1) 3 (2.2) 0.396 .820
Being embarrassed 4 (1.9) 2 (0.7) 1 (0.7) 1.7077 .426
Being irritable with others — 1 (0.3) 4 (2.9) 4.979 .026
Difficulty doing usual jobs 2 (0.9) 2 (0.7) 1 (0.7) 0.106 .949
Felt life is less satisfying 1 (0.5) 2 (0.7) 5 (3.7) 6.525 .038
Totally unable to function — — 1 (0.7) — —
The analysis was performed using a Pearson x2 or probability analysis on different items of OHIP-14 scale among moderate and severe periodontitis patients; “—” means having no available data. CPI =
Community Periodontal Index, OHIP-14 = Oral Health Impact Profile-14.

moderate chronic periodontitis had similar OHIP-14 scores, with Concerning the item of “trouble pronouncing words,” both
a median score of 15.5 (10, 19) and 14 (7, 18), respectively. dentition defects and loss patients reported the most pronounced
In comparison, the OHIP-14 scale scores of gingivitis and negative effects (7.1% and 48.4%) (Table 5). In addition,
subgingival calculus participants were relatively lower, with a dentition loss patients experienced more negative effects than
median score of 6 (2.75, 11.5) and 8 (2, 14), respectively. It was those with dentition defects in the following items: “trouble
noted that participants with severe periodontitis complained pronouncing words,” “sense of taste worse,” “unsatisfactory
mostly about “being unsatisfied with eating” (11.0%), whereas diet,” “had to interrupt meals,” and “felt life is less satisfying,”
patients with moderate periodontitis commonly reported (6.5%) with statistical significance being achieved (Table 5).
“trouble pronouncing words,” whereas patients with gingivitis
and subgingival calculus (5.7%) were “uncomfortable eating
3.5. Body mass index (BMI) was associated with dentition
foods” (Table 4). When comparing the negative effects of
defects and dental caries
moderate and severe chronic periodontitis, we concluded that
severe periodontitis had more negative effects than moderate Finally, we analyzed correlations between oral health and body
periodontitis on the following items: “painful aching in the weights of the subjects in a logistic regression analysis. The results
mouth,” “unsatisfactory diet,” “being irritable with others,” and showed that dental caries and dentition defects were significantly
“felt life is less satisfying,” with statistical significance being reflected in subjects with BMIs <20 (odds ratio [OR]: 0.167,
attained (Table 4). P = .040 and OR: 0.119, P = .016, respectively) (Table 6).
Considering the effect of dentition defect/loss of life quality, we
found that the median OHIP-14 score in the elderly with
4. Discussion
complete dentition was 3 (0.25, 5.75), the median score of
patients with dentition defects was 13 (6, 18), and the median Oral diseases, especially periodontal disease and dental caries, are
score of patients with dentition loss was as high as 23 (16, 28). still major health problems in the world today.[14] Our study

Table 5
The effect of dentition defects or dentition loss on OHIP-14 item scores.
∗
OHIP-14 items Dentition defect (n = 648, %) Dentition loss (n = 31, %) x2 P
Trouble pronouncing words 46 (7.1) 15 (48.4) 61.680 <.001
Sense of taste worse 34 (5.2) 11 (35.5) 43.710 <.001
Painful aching in mouth 23 (3.5) 1 (3.2) 0.009 .923
Uncomfortable to eat foods 37 (5.7) 11 (35.5) 39.922 <.001
Being self-conscious 22 (3.4) 7 (22.6) 14.429 <.001
Felt tense 9 (1.4) 1 (3.2) 0.523 .470
Unsatisfactory diet 31 (4.8) 9 (29.0) 17.817 <.001
Had to interrupt meals 8 (1.2) 4 (12.9) 10.590 <.001
Difficult to relax 14 (2.2) 1 (3.2) 0.137 .711
Being embarrassed 7 (1.1) — — —
Being irritable with others 5 (0.8) — — —
Difficulty doing usual jobs 6 (0.9) 1 (3.2) 1.0083 0.315
Felt life is less satisfying 8 (1.2) 3 (9.7) 6.5967 0.010
Totally unable to function 1 (0.2) — — —
The analysis was performed using Pearson x2 or probability analysis on different items of the OHIP-14 scale among patients with dentition defect and loss; “—” meant have no data. OHIP-14 = Oral Health Impact
Profile-14.

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Table 6 compared with gingivitis and subgingival calculus, the influence

A logistic regression analysis of associations between BMI and of moderate or severe chronic periodontitis on oral health-related
dentition defect and dental caries. life quality was more obvious, especially up to 11% of severe
periodontitis patients who reported an “unsatisfactory diet.” The
OR 95% CI P
most common negative effects in gingivitis and subgingival
Dentition defect calculus patients were “uncomfortable to eat foods.” Dentition
Obesity (BMI >28) 1.363 0.178, 10.428 .765 defects also significantly affected the QOL related to oral health,
Overweight (BMI >24, < 28) 1.162 0.441, 3.061 .762
the OHIP-14 score being similar to periodontitis, but the most
Underweight (BMI <20) 0.119 0.0209, 0.672 .016
Normal (BMI 20–24) 1.000
frequent negative effect was “trouble pronouncing words.”
Dental caries Moreover, in the investigation of all oral diseases, the OHIP-14
Obesity (BMI >28) 0.813 0.330, 2.002 .653 score of dentition loss was highest, indicating that the QOL was
Overweight (BMI >24, <28) 1.165 0.705, 1.924 .551 lowest, and how to improve QOL should be an important
Underweight (BMI <20) 0.167 0.030, 0.924 .040 research direction of oral medicine. In addition, a logistic
Normal (BMI 20–24) 1.000 regression analysis showed that dental caries and dentition
BMI = body mass index, CI = confidence interval, OR = odds ratio.
defects significantly correlated with subjects being underweight,
a finding which has been reported in previous studies and
attributed to inadequate intake of essential amino acids and
showed that the oral health of the elderly in Southwest China was vitamins owing to avoidance of difficult to chew foods such as
worrying. Among 687 respondents, only 2 subjects had fruits, vegetables, and meat.[17,18]
completely healthy teeth (0.3%), whereas the prevalence of In conclusion, our results showed that the oral health of the
gingival bleeding, dental caries, and moderate or severe elderly in Southwest China was relatively poor, compared with
periodontitis were 30.9%, 42.4%, and 19.8%, respectively. the eastern developed areas. Periodontal disease, dental caries,
With an increase in age, the main disease type changed from and dentition defects significantly affected the QOL of the elderly.
gingivitis and dental caries to severe periodontitis, which led to We need to enhance the awareness and behavior of oral
severe oral disease consistent with our expectations. Because the healthcare in the elderly, intensify education about oral health-
dental plaques of the elderly (>65 years’ old) could not be well care, pay more attention to the relationship between general
controlled, dental caries and dentition defects were more health and oral healthcare, and provide affordable services and
common in these people, coupled with a worse systemic health professional interventions and treatment measures to improve the
condition, and decreased disease resistance or self-repair oral health status of the elderly in Southwest China in an effective
capacity. All of these factors resulted in a vicious cycle, causing manner.
severe periodontitis. Similarly, as income increased, we found a
gradual decrease in the prevalence of moderate and severe
periodontitis, suggesting a close relationship between individual Author contributions
income and oral health. Because of insufficient income, the elderly Conceptualization: Xun Sheng, Xihong Zhang, Hua Zhong.
tended to put general health as a first priority, paying more Data curation: Xun Sheng, Xia Xiao, Xiaoxiao Song, Lei Qiao,
attention to the health of respiratory, circulatory, digestive, and Xihong Zhang, Hua Zhong.
neural systems, while ignoring the importance of oral health. For Formal analysis: Xia Xiao, Xiaoxiao Song, Lei Qiao, Xihong
example, we found that most elderly people thought loose teeth Zhang.
was normal and not worthy of attention! Therefore, this kind of Project administration: Hua Zhong.
unadvisable concept of oral health could also be related to the Validation: Xun Sheng.
high prevalence of periodontitis among these subjects. Writing – original draft: Xun Sheng, Xia Xiao, Xihong Zhang.
Our study also found that the prevalence of dental caries and Writing – review & editing: Xun Sheng, Hua Zhong.
dentition defects was high in the elderly in Southwest China,
whereas the corresponding repair was insufficient. In all
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