Oral Health Status among Elderly Hill Tribe Villagers in Mae Sot, Thailand pot

Asia Journal of Public Health Journal homepage:http://www.ASIAPH.org Original Articles Oral Health Status among Elderly Hill Tribe Villagers in Mae Sot, Thailand Sroisiri Thawebo

Asia Journal of Public Health

Journal homepage:http://www.ASIAPH.org

Original Articles

Oral Health Status among Elderly Hill Tribe Villagers

in Mae Sot, Thailand

Sroisiri Thaweboon* Boonyanit Thaweboon* Futoshi Nakazawa**

Surachai Dechkunakorn* Theeralaksna Suddhasthira* Mari Fujita**

*Faculty of Dentistry, Mahidol University, 6 Yothi Road, Rajthevee, Bangkok 10400 Thailand

** School of dentistry, Health Science University of Hokkaido, 1757 Kanazawa, Tobetsu-cho, Ishikari-gun,

Hokkaido 061-0293 Japan

ARTICLE INFO

Article history :

Received July 2010

Received in revised form October 2010

Accepted November 2010

Available online January 2011

Keywords:

Oral health

elderly

hill tribe

Corresponding Author:

Thaweboon S,

Faculty of Dentistry,

Mahidol University,

6 Yothi Road,

Bangkok 10400,Thailand

Email : dtstw@mahidol.ac.th

Asia J Public Health 2010;1(2):11-15

ABSTRACT

Objective: This study aimed to determine the oral health conditions among

elderly hill tribe villagers living in Mae Sot, Thailand Materials and methods:

The study was performed in 5 relatively isolated hill tribe villages A total of 90 elderly villagers aged 54-80 years participated in this study Dental caries were measured by the Decayed, Missing and Filled Tooth (DMFT) index according to criteria recommended by the WHO Periodontal status was assessed using the Community Periodontal Index (CPI) Data were analyzed using ANOVA and

Chi-square test Results: The prevalence of dental caries was 78% with a mean

DMFT-score of 6.53 + 6.32 All hill tribe villagers had periodontal disease with the mean CPI-score of 2.06 + 0.32 No statistically significant differences in DMFT- and CPI-scores were found among the villages or between males and females Almost all of them (99%) had never accessed dental health care services

Very few (11%) had toothbrushes The habit of chewing betel quid (Areca

catechu L.) was found among all individuals This may cause the deterioration of

oral hygiene and the development of periodontal disease found in the study participants Most of the participants had traditional knowledge of medicinal plants and they preferred using them as first aid remedies to treat illness

Conclusion: The oral health status of the elderly hill tribe villagers in Mae Sot,

Thailand was quite poor Periodontal disease was a major oral health problem though they did not request any dental care The results from this study could be used as base-line information for health authorities and dental professionals for planning strategies for oral health promotion, prevention, and treatment among the elderly in hill tribe villages

INTRODUCTION

Mae Sot is a district in Tak province,

northwestern Thailand It is located at the

Thai-Myanmar border with the Moei River as a natural

boundary Therefore, Mae Sot is one of the most

important gateways to Myanmar Many

indigenous people are native to Mae Sot, and

many hill tribes have migrated from southern

China and Tibet to this area It is estimated that

there may be thousands of hill tribe people

including Karen, Akha, Lahu (Museur), Lisu, and

Yao 1 They have their own languages, cultures,

ways of dressing and beliefs Hill tribe people

grow rice, corn and other agricultural products on

mountainsides, living in rural remote areas, and have limited access to health services

The oral health status of elderly people has been gaining more importance in both developing and developed areas because this population segment is growing rapidly due to extended life expectancy Dental caries and periodontal disease are the two major diseases found in the oral cavity According to Reichart and Gehring 2, the prevalence of dental caries in >50-year old hill tribe people of northern Thailand was quite low with a mean DMFT (Decayed, Missing and Filled Tooth) score of 0.2 No information regarding

periodontal health was reported in this group at

that time

At present, contact and trade between hill

tribes and local natives has become frequent

Modernization has increased, causing many

changes to the lifestyle of these people as well as

affecting their health Thus, the aim of this study

was to determine oral health status in this group of

hill tribe people residing in Mae Sot

MATERIALS AND METHODS

The study was performed in February, 2008 in

five relatively isolated hill tribe villages in Mae

Sot after approval by the village committees and

in accordance with Helsinki Declaration They

were Poo Tor, Rom Glao Sahamitr, Pa Dae, Koon

Huay Mae Sot, and Huay Pla Lod villages After

giving their verbal consent, a total of 90 villagers

aged 54-80 years agreed to participate in this

study We used 50 years of age and older as our

definition of elderly, which is different from the

general criterion of 60 years and older The reason

for this is based on the traditional social roles and

functional abilities related to work and health

status of this studied population

The dental examination took place in the

village where they lived and was performed by

one dentist from the Faculty of Dentistry, Mahidol

University, Thailand The study participants were

comfortably placed on a chair in front of the

examiner, both sitting Examinations were

performed with the aid of dental mirrors and ball

point periodontal probes (Martin, Solinger,

Germany) under natural light The dental caries

experience was measured by the DMFT index

according to criteria recommended by the WHO,

1997 3

Periodontal status was assessed using the

Community Periodontal Index (CPI) The ten

index teeth examined consisted of four upper

molars, four lower molars, one upper incisor and

one lower incisor (17, 16, 11, 26, 27, 37, 36, 31,

46 and 47) Each sextant containing at least two

functional teeth was assigned a code number The

condition of the worst affected site in the sextant

was recorded Plaque and calculus was evaluated

on all four surfaces of central incisors, canines and

first molars If one of these teeth was absent, the

tooth distal to that was examined Plaque and

calculus were identified by means of a probe,

sweeping the buccal, lingual (palatal), mesial and

distal tooth surfaces Bleeding on probing was

recorded as present or absent after probing at each

probing site on the same teeth that were scored for

plaque and calculus Pocket depth was measured

from the free gingival margin to the base of the

sulcus The subjects were classified according to

the highest code number (codes 0-4) assigned to any sextant of their mouth 4

The data were analyzed using analysis of variance and Chi-square test to evaluate the statistical significance between variables

RESULTS

The study population comprised elderly people from five villages, 28 from Rom Glao Sahamitr Village, 18 from Poo Tor Village, 23 from Pa Dae Village, 11 from Koon Huay Mae Sot Village, and

10 from Huay Pla Lod Village Demographic data

of subjects are shown in Table 1

Table1 Demographic characteristics of elderly hill tribe people

Villages Tribes

Gender Age male female

51-60

61-70

>

70

1 Poo Tor (n=18)

2 Rom Glao Sahamitr (n=28)

Lahu, Lisu, Yao, Akha

17 11 13 13 2

3 Pa Dae (n=23)

Karen 8 15 1 16 6

4 Koon Huay Mae Sot (n=11)

5 Huay Pla Lod (n=10)

Lahu 3 7 6 3 1

There were more males (53%) than females (47%) Almost all of these hill tribe people had never accessed dental health care services Only one male reported that he had his tooth filled at a local hospital almost 20 kilometers down from the village Very few (11%) had toothbrushes and among those who had a toothbrush, only 27% brushed their teeth twice a day Interestingly, almost all of them (94%) disclosed that they chewed betel quid every day after meals Seven (8%) were edentulous The prevalence of dental caries in all the elderly hill tribe villagers was 78% with a mean DMFT-score of 6.53 + 6.32 Median and mean DMFT-scores in each village were shown in Table 2 No significant differences

in DMFT-score were found between males and females Even though those in Pa Dae Village showed the highest mean DMFT-score, no significant differences in DMFT-score were found among the villages

Table 2 Distribution of elderly hill tribe people by dental caries experience

Villages

Decayed teeth Missing teeth Filled teeth DMFT*

Edentulous median

mean+SD

median mean+SD

median mean+SD

median mean+SD

0.77+1.98

3 2.72+3.49

0

0

3 3.50+3.95

0

2 Rom Glao Sahamitr 5

2.32+2.65

5 3.96+5.61

0.5 0.04+0.20

2 6.65+6.32

2

3 Pa Dae 0

0

14 11.85+10.30

0

0

14 11.85+10.30

3

4 Koon Huay Mae Sot 0

0

5 4.70+6.07

0

0

5 4.70+6.07

1

5 Huay Pla Lod 3

1.33+2.23

2.5 2.33+3.57

0

0

2.5 3.66+5.59

1

* DMFT = Decayed, Missing and Filled Teeth

Table 3 Distribution of elderly hill tribe people by periodontal health

Villages

on probe

No (%)

Calculus

No (%)

Pocket 4-5 mm

No (%)

Pocket

>6 mm

No (%) median mean+SD

2 Rom Glao Sahamitr 2.00 1.93+0.32 0 26 (100) 26 (100) 7 (27) 0 (0)

4 Koon Huay Mae Sot 2.35 2.17+0.22 0 10 (100) 10 (100) 4 (40) 0 (0)

5 Huay Pla Lod 2.00 2.05+0.14 0 9 (100) 9 (100) 3 (33) 0 (0)

The assessment of periodontal status (Table 3)

according to CPI demonstrated that all hill tribe

villagers had periodontal disease with the mean

CPI-score of 2.06 + 0.32 and had calculus

indicating poor oral hygiene Almost all of them

had moderate gingival inflammation according to

the classification of Loe, 1967 5 No statistically

significant differences in CPI-score were found

among the villages or between males and females

DISCUSSION

No comprehensive data were available for

caries and periodontal status among elderly hill

tribe villagers in Mae Sot District, Thailand The

data collected showed poor oral health conditions

among the hill tribes All self-care oral health

habits were excessively poor with high

percentages of not having toothbrush (89%) and

inadequate oral hygiene-related habits such as

regular toothbrushing Most of them performed

oral hygiene procedures by sanding or polishing

teeth with betel nut shell, charcoal powder, salt,

and miswak or chewing stick

The mean number of caries expressed as the

DMFT-score was found to be 6.53 of which the

missing component was 5.5 Our results were

different from those of the previous Turkish or

Western Australian studies which reported higher

DMFT-scores of 29.3 and 9.8 respectively The

major factors to explain these situations were the

characteristics of the people and lifestyle These

hill tribe villagers lived on mountainsides isolated

from urban areas with a high fluoride level in the

water In addition, their diet consisted of food grown on small plots of land and taken from the surrounding forest Their diet included highly abrasive food while excluding those consisting mostly of refined carbohydrates, and included such foods as rice, chili paste with fermented soy bean, salt and vegetables Consumption of meat was infrequent The previous study of Reichart and Gehring in 1984 2 showed that the mean DMFT-score of northern elderly hill tribe villagers in Chiang Mai Province of Thailand was 0.2 We hypothesize that the increase in DMFT-score among these hill tribes from that reported in

1984 may be the effect of modern lifestyle invading their way of life such as advertising media that influenced them to access commercial cariogenic foods and beverages

In this study, two results were found to be similar to other studies 6-8 First, the same percentages of males and females were edentulous Second, all of these edentulous elderly and those with missing teeth reported tooth mobility due to loss of tooth support, the sign of periodontal disease Other studies 9-10 have confirmed that periodontitis is the major cause of tooth loss commonly found in elderly population groups in many countries

Nevertheless, tooth loss was not found

to be as widely prevalent as in other studies The percentage of edentulism in this group of hill tribe villagers (8%) was much lower than the previous reported rates of 67.4% and 16-30% among the Turkish 7 and German subjects 11, respectively

Conversely, it was quite closer to that reported for

the elderly people in Southern Australia (3%) The

reason may be the severity of periodontal disease

in this group was quite low Less than half of

them (40%) had tooth pockets and very few

(4.8%) had a pocket depth >6 mm

Even though periodontal disease was a

significant health problem facing these hill tribe

villagers, oral health was generally perceived to

be of lower importance than physical health

According to a study among the elderly in Italy,

though the level of self-reported problems such as

pain and tooth mobility was high, only a small

proportion of people requested dental care 12

The habit of chewing betel quid (Areca

catechu L.) was found in all individuals Chewing

betel quid is a traditional ritual which dates back

thousand of years from South Asia to the Pacific

It constitutes an important and popular cultural

activity in many Asian and Oceanic countries,

including Thailand Many studies have proven

that regular chewing of betel quid is a risk factor

for gum disease and oral cancer 13 Betel quid

generally consists of areca nut, piper betel leaf,

and slaked lime An experimental study showed

that areca nut extracts impaired human gingival

fibroblast functions by depleting intracellular

thiols and inhibiting mitochondrial activity,

supporting the concept that betel quid chewing

may affect periodontal health status 14

Additionally, areca nut extracts favor the

colonization of periodontopathogens and interfere

with the microbial mechanisms of neutrophils,

suggesting that areca nut extracts might increase

periodontal infection 15-16 Hence, the chewing of

betel quid may play an important role in the

deterioration of oral hygiene and the increasing

prevalence of periodontal diseases found among

the participants in this study

Due to their minority status, hill tribes are not

fully recognized in governmental resource

allocation for public health services Treatment of

dental caries and periodontal disease is expensive

and has been inaccessible to these hill tribe elderly

villagers in Mae Sot The long distance from

health services forces them to stay in the village

and seek traditional herbal remedies Most hill

tribe villagers have traditional knowledge of

medicinal plants and they prefer using them as

first aid remedies to treat illnesses such as cough,

toothache or bleeding gums Among those

reported herbal medicines are Ya Kho (Nicotiana

tabacum L.,) and Ba Ko (Illicium Hook f.) used

by cooking with chicken to treat a sore tooth or by

chewing daily as preventive medicine 17

In conclusion, the data show caries and

periodontal diseases experienced in 90 elderly hill

tribe villagers in Mae Sot, Thailand Generally,

the oral health was quite poor Periodontal disease was a major oral health problem though they did not request any dental care The data could be used as base-line information for health authorities and dental professionals for planning strategies for oral health promotion, prevention, and treatment in this group of villagers

ACKNOWLEDGEMENTS

The Faculty of Dentistry, Mahidol University was thanked for funding this study We gratefully acknowledge the help of the Royal Patrol Police Bureau at Mae Sot, the hill tribe leaders and all of the study participants in Poo Tor, Rom Glao Sahamitr, Pa Dae, Koon Huay Mae Sot, and Huay

Pla Lod Villages

CONFLICT OF INTEREST

We declare that we have no conflict of interest

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