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  • Research article
  • Open Access
  • Open Peer Review

The prevalence of edentulism and their related factors in Indonesia, 2014/15

BMC Oral Health201818:118

https://doi.org/10.1186/s12903-018-0582-7

  • Received: 26 October 2017
  • Accepted: 25 June 2018
  • Published:
Open Peer Review reports

Abstract

Background

Little information exists about the loss of all one’s teeth (edentulism) among older adults in Indonesia. The aim of this study was to investigate the prevalence of edentulism and associated factors among older adults in Indonesia.

Method

This study examines the self-reported prevalence of edentulism and associated factors among older adults (50 years and older) in a cross-sectional national study using the Indonesia Family Life Survey IFLS-5, 2014/15. The community-based study uses a multi-stage stratified sampling design to interview and assess household members, with a household response rate of over 90%.

Results

The overall prevalence of edentulism was 7.2, 29.8% in 80 years and older and 11.8% in those with no formal education. In adjusted Poisson regression analysis, older age, living in five major island groups and having functional disability were associated with edentulism. In addition, among men, having quit and current tobacco use and among women, having low social capital were associated with edentulism. Further, in adjusted analysis, among men, edentulism was positively associated with hypertension and negatively associated with diabetes, and among women, edentulism was associated with functional disability.

Conclusions

Results suggest that overall and/or among men or women that older age, living in five major island groups, having functional disability, tobacco quitters and users and those with low social capital was associated with edentulism. The identified associated factors of edentulism may be utilized in oral health programmes targeting older adults in Indonesia.

Keywords

  • Edentulism
  • Nutrition
  • Health status
  • Tobacco use
  • Older adults
  • Indonesia

Background

Edentulism (=having lost all of one’s natural teeth) is a significant public health problem globally because of its high prevalence (> 10% in individuals 50 years and older) and related disability [1, 2]. The disability-adjusted life-years (DALYs) of oral conditions dramatically increased between 1990 and 2015 (16.9 million years live with disability) [3]. Among oral disorders, edentulism accounted for more than one third (7.6 million DALYs) of the oral disorder disability burden, globally [4]. Monitoring the occurrence of edentulism [5] provides an indication of both population oral health and oral health care system response [6]. There is a lack of community data on oral health among older adults in low- and middle-income countries [7]. Based on data from the World Health Survey, conducted from 2002 to 2004, the prevalence of self-reported edentulism among persons 50 years and older in countries of the Southeast Asian region were 4.2% in Laos, 22.2% in Malaysia, 2.4% in Myanmar, 14.6% in the Philippines and 5.6% in Vietnam [1]. In a more recent study (2007–2008) among adults 50 years and older, the overall prevalence of edentulism was 11.7% in the six middle-income countries, with India, Mexico, and Russia having higher prevalence rates (16.3–21.7%) than China, Ghana, and South Africa (3.0–9.0%) [2, 8]. In Indonesians aged 65 years or over the prevalence of measured edentulism was 17.6% in 2007 [9].

Using a social determinants of health approach, factors associated with edentulism may include, in addition to caries and periodontal disease [10], sociodemographic factors such as increasing age, female gender, no or lower education, lower economic status and rural residence [2, 8, 11, 12]. Along with socioeconomic factors, health risk behaviours, such as smoking and former smoking remain strong predictors of edentulism [2, 11, 1316]. Having chronic diseases [17], such as diabetes [18], having underweight [11], arthritis [2, 19], asthma [2, 11], depression [11, 17], reduced physical function [11], functional disability [2, 12], poor self-rated health [12, 17], lack of social support [17] and lack of social capital [20, 21] have also been found to be associated with edentulism. On the other hand, edentulism has been associated with poor health status [12, 22], insufficient fruit and vegetable consumption [22, 23], smoking [24], underweight, poor nutrition [2527], overweight/obesity [2729], hypertension [30, 31], angina [32], strokes [33], diabetes [25, 34], rheumatoid arthritis [25], asthma [25], and functional disability [35, 36].

There is a lack of studies on edentulism and associated factors in Indonesia [37, 38]. The aim of this study was to investigate the prevalence of edentulism and associated factors among older adults in Indonesia. The objectives include: (1) to estimate the prevalence of self-reported edentulism in older adults, and (2) to identify possible factors such as sociodemographics and health variables associated with edentulism in Indonesia.

Method

Study design and participants

Secondary data from the fifth wave of the “Indonesia Family Life Survey (IFLS-5) 2014-15” were analysed, being the only of the five surveys that assessed edentulism [39]. The IFLS-5 is a community survey interviewing household members (7994 50 years and older with complete endentulism measurements) selected by multistage stratified sampling representing 83% of the Indonesian population, with a household response rate of over 90%, more details [39, 40].

Measures

Edentulism was assessed with the question, “Have you lost all your teeth?” (Yes, No) [39].

Socio-demographic variables included age, sex, education, area of residence, province, region and subjective socioeconomic background [39, 40].

Social capital was assessed with 4 items related to the past 12 month participation in “1) Community meeting, 2) Voluntary labour, 3), Programme to improve the village/neighbourhood, and 4) Religious activities.” Response options, were “yes” or “no” [39]. (Cronbach’s alpha 0.59). Those who scored 0 times with “yes” were considered as having low social capital.

Self-reported health status was measured with the item, “In general, how is our health?” (Responses ranged from 1 = Very healthy to 4 = Unhealthy) [39].

Nutrition status. Heights and weights were taken using standard procedures [39], and body mass index (BMI) calculated according to Asian criteria: “underweight (<18.5 kg/m2), normal weight (18.5 to <23.0 kg/m2), overweight (23.0 to <25.0 kg/m2) and 25+ kg/m2 as obesity” [41].

Functional disability was assessed by 5 items of Activity of Daily Living (ADL) and 6 items of Instrumental Activity of Daily Living (IADL) [42, 43]. A total functional disability score was calculated, with having no difficulty = 0 and one or more ADL/IADL items = 1.

Tobacco use was grouped into never, quitters and current tobacco users, following the questions of ever and current use of various tobacco products [39, 40].

Inadequate fruit and vegetable consumption was defined as eating less than 3 days a week fruits and less than daily vegetables, following questions on the number of days in the past week vegetables (green leafy vegetables and carrots) and fruits (banana, papaya and mango) had been consumed [39, 40].

Chronic condition was measured based on health care provider diagnosed “Diabetes or high blood sugar, High blood pressure, Heart attack, coronary heart disease, angina or other heart problems, Stroke, Arthritis and Asthma” (Yes, No) [39, 40].

Hypertension

Average blood pressure was calculated arithmetically for three averaged measurements of systolic and diastolic blood pressure, assessed by using standard procedures [39]. Hypertension was defined as “SBP ≥140 mm Hg and/or DBP ≥90 mm Hg and/or current use of antihypertensive medication”. [44].

The Centres for Epidemiologic Studies Depression Scale (CES-D: 10 items) was used to assess depressive symptoms, and scores of 10 or more were classified as having depressive symptoms [45] (Cronbach’s alpha = 0.67).

Data analysis

Descriptive statistics were used to describe the variables. Nonparametric tests were used for trend analyses across ordered groups. Associations between key outcomes of edentulism and sociodemographic and health variables were evaluated by calculating prevalence ratios (PR). Poisson regression was used for evaluation of the association of explanatory variables for the outcome of edentulism (binary dependent variable). The Pearson goodness-of-fit test was used. Logistic regression was used to determine the association of edentulism on various health outcome variables. The Hosmer-Lemeshow goodness-of-fit test was used to evaluate multivariable model fit. Potential multi-collinearity between variables was assessed with variance inflation factors, none of which exceeded critical value. P < 0.05 was considered significant. “Cross-section analysis weights were applied to correct both for sample attrition from 1993 to 2014, and then to correct for the fact that the IFLS-1 sample design included over-sampling in urban areas and off Java. The cross-section weights are matched to the 2014 Indonesian population, again in the 13 IFLS provinces, in order to make the attrition-adjusted IFLS sample representative of the 2014 Indonesian population in those provinces.” [39] Both the 95% confidence intervals and P-values were adjusted considering the survey design of the study. All analyses were done with STATA software version 13.0 (Stata Corporation, College Station, TX, USA).

Results

Sample characteristics

The total sample included 7994 older adults, 50 years and older (mean age 62.8 years, SD = 9.8, age range of 50–110 years) in Indonesia. The proportion of women was 51.9, 72.2% had no or elementary education, 44.2% described themselves as having medium economic status, 52.0% resided in urban areas, 58.1% were living in Java and 20.8% had low social capital. Regarding health status, 32.9% rated their health as unhealthy, and 31.3% had at least one functional disability. In all, 14.1% of participants were underweight and 21.3% overweight or obese, 33.5% infrequently consumed fruit and vegetables, 33.3% were current tobacco users and 9.8% quit tobacco use. In terms of chronic conditions, 6.3% had diabetes, 58.5% hypertension, 3.6% heart attack, angina or other heart problems, 2.9% had a stroke, 11.8% had arthritis, 11.8% asthma and 17.0% depressive symptoms. The overall prevalence of edentulism was 7.2, 7.6% among women and 6.8% among men, and among those 50 to 59 years 3.1% and those aged 80 years and older 29.8%, and with no education the prevalence of edentulism was 11.8% and those with higher education 2.1% (see Table 1).
Table 1

Sample characteristics and prevalence rate of edentulism among older adults in Indonesia

 

Total sample

Prevalence rate of edentulism

N (%)

n

% (95% CI)a

Sociodemographics

 All

7994

685

7.2 (6.7, 7.8)

 Age in years

  50–59

4024 (52.6)

142

3.1 (2.5, 3.7)

  60–69

2226 (27.9)

169

6.4 (5.4, 7.5)

  70–79

1251 (14.0)

222

15.9 (13.8, 18.2)

  80 or more

493 (5.5)

152

29.8 (25.5, 34.4) P- trend < 0.001

 Sex

  Female

4317 (51.9)

392

7.6 (6.8, 8.5)

  Male

3677 (48.1)

293

6.8 (6.0, 7.7)

 Education

  None

1324 (16.7)

185

11.8 (10.0, 13.8)

  Elementary

4308 (55.5)

373

7.3 (6.5, 8.1)

  High school

1723 (21.1)

92

4.7 (3.8, 5.8)

  Higher education

569 (6.8)

16

2.1 (1.2, 3.7)

 Subjective economic background

  Poor

2072 (31.0)

135

6.5 (5.5, 7.7)

  Medium

3024 (42.3)

194

6.3 (5.2, 7.5)

  Rich

1789 (26.7)

112

6.8 (6.0, 7.8)

 Rural

3541 (48.0)

334

7.9 (7.0, 8.9)

 Urban

4453 (52.0)

351

6.6 (5.8, 7.4)

 Region

  Sumatra

1659 (20.8)

130

6.6 (5.5, 7.8)

  Java

4647 (58.1)

309

6.4 (5.7, 7.2)

  Main island groupsb

1688 (21.1)

246

14.8 (13.1, 16.7)

 Social capital (low)

1467 (20.8)

134

9.1 (7.8, 10.7)

Health variables

 Self-rated health (Unhealthy)

2849 (32.9)

335

9.9 (8.8, 11.2)

 Body mass index

  Normal

2856 (39.0)

258

7.4 (6.4, 8.4)

  Underweight

1063 (14.1)

145

11.7 (9.7, 13.9)

  Overweight

1177 (15.8)

85

5.6 (4.4, 7.0)

  Obese

2355 (31.1)

98

3.8 (3.0, 4.7)

 Functional disability

2639 (31.3)

490

12.6 (11.3, 14.0)

 Tobacco use

  Never

4663 (56.9)

371

6.6 (5,9, 7.4)

  Quit

832 (9.8)

103

11.5 (9.3, 14.0)

  Current

2499 (33.3)

211

7.1 (6.1, 8.2)

 Diabetes

505 (6.3)

31

5.3 (3.6, 7.7)

 Arthritis

1037 (11.8)

108

8.1 (6.6, 10.0)

 Asthma

284 (3.4)

34

10.1 (7.0, 14.3)

 Depression symptoms

1166 (17.0)

74

6.3 (5.1, 7.9)

 Fruit (< 3 days/week) and vegetable consumption (<daily/week)

2119 (33.5)

141

6.7 (5.7, 7.8)

 Hypertension

4391 (58.5)

417

9.5 (8.7, 10.4)

 Heart attack, coronary heart disease, angina, or other heart problems

299 (3.6)

29

9.1 (6.1, 13.4)

 Stroke

243 (2.9)

31

13.2 (9.0, 18.9)

aThe analysis was adjusted considering the survey design of the study

bMajor Island groups: Bali, West Nusa Tenggara, South Kalimantan, and South Sulawesi

Associations with edentulism

In adjusted Poisson regression analysis, older age, living in five major island groups and having functional disability were associated with edentulism. In addition, among men, having quit and current tobacco use and among women, having low social capital were associated with edentulism. In further adjusted age stratified analysis, among 50 to 64 year olds, being male was negatively (Adjusted Prevalence Ratio: APR = 0.60, CI = 0.37, 0.98) and having underweight as positively (APR = 1.85, CI = 1.20, 2.83) associated with edentulism (see Table 2).
Table 2

Associations with edentulism estimated by Poisson regression

 

All

Men

Women

Variable

Adjusted Prevalence Ratioa (95% CI)

Adjusted Prevalence Ratioa (95% CI)

Adjusted Prevalence Ratioa (95% CI)

Sociodemographics

 Age in years

  50–59

1 (Reference)

1 (Reference)

1 (Reference)

  60–69

2.21 (1.68, 2.91)***

2.38 (1.55, 3.68)***

2.13 (1.52, 3.00)***

  70–79

4.89 (3.65, 6.56)***

4.92 (3.10, 7.79)***

5.05 (3.52, 7.25)***

  80 or more

5.94 (3.76, 9.39)***

7.91 (4.27, 14.64)***

4.33 (2.08, 9.01)***

 Sex

  Female

1 (Reference)

  Male

0.83 (0.63, 1.10)

  

 Education

  None

1 (Reference)

1 (Reference)

1 (Reference)

  Elementary

1.20 (0.88, 1.64)

1.00 (0.58, 1.72)

1.28 (0.86, 1.78)

  High school/Higher education

0.88 (0.59, 1.30)

0.86 (0.46, 1.63)

0.79 (0.48, 1.32)

 Subjective economic background

  Poor

1 (Reference)

1 (Reference)

1 (Reference)

  Medium

1.12 (0.88, 1.43)

1.12 (0.79, 1.59)

1.15 (0.83, 1.59)

  Rich

1.27 (0.95, 1.69)

1.40 (0.91, 2.16)

1.19 (0.82, 1.73)

 Urban residence (base = rural)

1.10 (0.88, 1.38)

0.98 (0.70, 1.35)

1.28 (0.94, 1.73)

 Region

  Sumatra

1 (Reference)

1 (Reference)

1 (Reference)

  Java

0.77 (0.59, 1.00)

1.14 (0.74, 1.75)

0.56 (0.40, 0.79)***

  Main island groups

2.08 (1.59, 2.71)***

2.75 (1.79, 4.21)***

1.74 (1.24, 2.45)***

 Social capital (low)

1.16 (0.92, 1.47)

1.00 (0.68, 1.47)

1.32 (1.00, 1.79)*

Health variables

 Self-rated health (Unhealthy)

1.07 (0.86, 1.36)

1.17 (0.83, 1.65)

0.97 (0.73, 1.29)

 Body mass index (Underweight)

1.23 (0.93, 1.62)

1.26 (0.85, 1.86)

1.18 (0.80, 1.75)

 Functional disability

1.34 (1.08, 1.66)**

1.22 (0.89, 1.68)

1.40 (1.05, 1.87)*

 Tobacco use

  Never

1 (Reference)

1 (Reference)

1 (Reference)

  Quit

1.25 (0.86, 1.82)

1.95 (1.12, 3.39)*

0.73 (0.27, 1.92)

  Current

1.17 (0.87, 1.56)

1.64 (1.01, 2.69)*

0.89 (0.51, 1.55)

 Diabetes

0.56 (0.31, 1.01)

0.30 (0.09, 1.02)

0.78 (0.40, 1.52)

 Arthritis

0.93 (0.69, 1.24)

0.80 (0.47, 1.38)

0.97 (0.69, 1.38)

 Asthma

0.89 (0.52, 1.51)

0.45 (0.16, 1.29)

1.26 (0.69, 2.31)

 Depression symptoms

0.73 (0.45, 1.16)

0.69 (0.34, 1.39)

0.74 (0.40, 1.39)

CI confidence interval; ***P < 0.001; **P < 0.01; *P < 0.05

aPearson goodness-of-fit test > 0.9 for all models

Associations between edentulism and health outcomes

In order to estimate the independent association between edentulism and 13 individual health outcomes, 13 separate multivariable models are calculated with edentulism as predictor and each health outcome as dependent variable. In adjusted analysis, among men, edentulism was positively associated with hypertension and negatively associated with diabetes and among women, edentulism was associated with functional disability (see Table 3).
Table 3

Associations between edentulism and health variables (outcomes) estimated by logistic regression

Health outcome

Men

Women

COR

AORa,b

COR

AORa,b

Health status (unhealthy)

2.30 (1.78, 2.97)***

1.18 (0.80, 1.75)

1.98 (1.58, 2.48)***

1.11 (0.80, 1.51)

Functional disability

2.40 (1.83, 3.84)***

1.36 (0.96, 1.92)

3.30 (2.59, 4.20)***

1.43 (1.05, 1.95)*

Underweight (vs. normal weight)

2.11 (1.51, 2.95)***

1.33 (0.83, 2.15)

1.92 (1.37, 2.69)***

1.16 (0.72, 1.88)

Overweigh or obesity (vs. normal weight)

0.48 (0.35, 0.67)***

0.64 (0.40, 1.01)

0.50 (0.38, 0.66)***

0.83 (0.58, 1.17)

Infrequent fruit and vegetable consumption

1.02 (0.74, 1.39)

1.02 (0.71, 1.47)

0.86 (0.64, 1.16)

0.96 (0.68, 1.34)

Current tobacco use

0.89 (0.69, 1.16)

1.15 (0.76, 1.75)

2.16 (1.44, 3.24)***

1.01 (0.55, 1.85)

Hypertension

2.40 (1.81, 3.17)***

1.74 (1.17, 2.57)**

2.00 (1.54, 2.58)***

0.93 (0.62, 1.39)

Heart problemsc

2.04 (1.07, 3.88)*

1.09 (0.69, 5.17)

1.16 (0.65, 2.07)

1.05 (0.48, 2.31)

Stroke

2.72 (1.43, 5.15)**

0.89 (0.25, 3.18)

2.90 (1.02, 5.19)***

1.35 (0.31, 5.87)

Asthma

2.16 (1.25, 3.72)**

0.58 (0.21, 1.58)

1.40 (0.81, 2.44)

1.35 (0.68, 2.70)

Arthritis

1.29 (0.84, 1.97)

0.88 (0.50, 1.56)

1.58 (1.18, 2.10)**

0.98 (0.66, 1.44)

Diabetes

0.61 (0.29, 1.32)

0.29 (0.09, 0.98)*

1.26 (0.78, 2.03)

0.92 (0.47, 0.82)

Depression

0.56 (0.26, 1.18)

0.68 (0.31, 1.46)

0.70 (0.39, 1.25)

0.67 (0.34, 1.37)

COR crude odds ratio, AOR adjusted odds ratio

aAdjusted for age, education, socioeconomic status, rural-urban, region, social capital and all other health variables, as shown in this table

bHosmer-Lemeshow goodness-of-fit test between predicted and observed probabilities was for all models P > 0.05

cHeart attack, coronary heart disease, angina, or other heart problems

***P<0.001; **P<0.01; *P<0.05

Discussion

The study found in a national community-based survey among individuals 50 years and older, a 7.2% self-reported prevalence of edentulism in 2014/15 in Indonesia, which is similar to a measured survey of 17.6% in 2007 in Indonesia in individuals 65 years and older [7] (in this study 15.7% in the 65 years and older age group) and to what was found previously in China and South Africa [2]. The found prevalence rate of edentulism in Indonesia was higher than previously found in Ghana, Laos, Myanmar and in Vietnam, and lower than in India, Malaysia, Mexico, Philippines and Russia and the global prevalence of 14.0% [1, 2, 15]. The lower than global prevalence rate of edentulism in this study in Indonesia may be attributed to a lower consumption of non-refined carbohydrates and consequently lower dental caries and eventually tooth loss [1, 46]. The study found a significantly higher prevalence of edentulism in the five major island groups (Bali, West Nusa Tenggara, South Kalimantan, and South Sulawesi) than in Java and Sumatra. Reasons for this are not clear. It is possible that in the five major island groups greater gaps in dental care access exists than in Java and Sumatra.

The study found, in agreement with previous studies [2, 15, 4750], that increasing age and in bivariate analysis having no education were associated with edentulism. It is possible that having no education translates into lower oral health knowledge and lower oral health services utilization where available [46]. Some previous studies [2, 48, 49] found a preponderance of edentulism among women and those living in rural areas, while in this study overall no significant gender and urban-rural differences were found. However, in age stratified analysis, among 50 to 64 year-olds, women had a higher prevalence of edentulism than men. Lower economic status was in this study not associated with edentulism, as found in some previous other studies [2, 48, 51]. This may be because economic status was assessed with a subjective measure, rather than an objective measure. Low social capital was in this study among women associated with edentulism. This finding is consistent with previous studies [20, 52]. It is possible that persons that belong to social networks are more likely to follow health-enhancing behaviours and, hence, have better health and oral health [5355]. Previous research also showed that the effect of edentulism on facial appearance, eating and speech may decline in social capital due to embarrassment [1, 56].

Previous studies [2, 18, 48, 57] found an association between former and current tobacco use and edentulism, which was confirmed in this study among men. Edentulism was also associated with former smokers in China [15]; China and Indonesia have the highest prevalence of tobacco use among men in the world. Smoking is a known risk factor for periodontitis and tooth loss, meaning that the higher prevalence of edentulism among tobacco users may be directly related to the negative effects of tobacco use on periodontal health [18, 57]. Functional disability was found in this study to be both, a risk factor and a consequence of edentulism, which has also been found in previous studies [2, 12, 35, 36]. It is possible that people with a functional disability are less likely visit dental health care services [12]. Unlike in some previous studies [12, 17, 22], this study did not find an association between poor self-rated health as a risk factor for and consequence of edentulism. Arthritis, asthma, diabetes, angina and depression were in this study not associated with edentulism, as this was found in some previous studies [2, 11, 18, 19].

Among having different chronic conditions, this study found that edentulism was associated with hypertension. Similar results were found in previous studies [30, 31]. It is possible that total tooth loss is a risk factor for developing hypertension, which may be attributed to dietary changes of not be able to consume nutritious foods [30].

Some studies [11, 2527, 58] found a significant association between undernutrition as a risk factor and consequence of edentulism, both of which were confirmed in this study in bivariate analysis, and in age stratified adjusted analysis, among 50 to 64 year-olds, having underweight was associated with edentulism. In a study among older adults in care homes in Indonesia it was found that individuals who were underweight had a significantly lower number of functional tooth units than those with normal weight [38]. The loss of teeth changes digestive processes and food choices contributing to nutritional deficiencies [38, 58]. Contrary to some previous studies [2629, 59], this study found that edentulism was negatively associated with overweight or obesity in bivariate analysis. It is possible that edentulism caused individuals in this study to alter their diet, resorting to a diet that is high in fiber and low in saturated fat, reducing the risk of being obese. Contrary to some studies [23, 24], this study did not find that edentulism had a negative impact on fruit and vegetable consumption.

Contrary to some previous studies [24, 3234], this study did not find an association between having edentulism and heart problems, stroke, asthma, arthritis, diabetes and depression. In a study in Indonesia the prevalence and severity of periodontitis (and consequently tooth loss) was not associated with arthritis [60] and among elderly in Indonesia, tooth loss was not associated with diabetes and heart diseases [10]. The diet and dietary habits of edentulous individuals in Indonesia may not be putting them at increased risk of heart diseases and diabetes [2]. It is also possible, since in this study arthritis, asthma, diabetes, and heart diseases were assessed by self-reported diagnosed conditions; they were underreported and thus contributing to these findings [2]. Sudiono [10] proposes that among elderly in Indonesia the loss of teeth may have been influenced by “a low demand for dental hygiene” and that “improvement of dental awareness and education in oral hygiene measures in such populations might reduce both diseases (dental caries and periodontitis) responsible for tooth loss and could improve quality of life in Indonesia.”

Study limitations

Edentulism was only measured with one question. Oral examinations should be conducted in future investigations. The data analysed were based on a cross-sectional survey, so no causative conclusions be drawn between independent study variables and the prevalence of edentulism. Finally, the analysis was limited to the variables included in IFLS-5, and other factors such as inadequate oral hygiene and dental attendance found significant in previous investigations should be included in future research.

Conclusions

Almost one in ten older adults (50 years and above) Indonesians were edentate. Results suggest that overall and/or among men or women that older age, living in five major island groups, having functional disability, tobacco quitters and users and those with low social capital was associated with edentulism. The identified associated factors of edentulism may be utilized in oral health programmes targeting older adults in Indonesia.

Abbreviations

BMI: 

Body Mass Index

CES-D: 

Centres for Epidemiologic Studies Depression Scale

DBP: 

Diastolic Blood Pressure

EA: 

Enumeration Area

IFLS: 

Indonesian Family Life Survey

SBP: 

Systolic Blood pressure

Declarations

Acknowledgments

The research was conducted based on the IFLS-5 conducted by RAND (http://www.rand.org/labor/FLS/IFLS.html). We thank RAND for providing the access to the survey data and the study participants who provided the survey data.

Funding

The authors received no specific funding for this work.

Availability of data and materials

The data for the current study from the Indonesian Family Life Survey (IFLS) are in the public domain and are accessible via the Rand Labor and Population website (https://www.rand.org/labor/FLS/IFLS.html).

Authors’ contributions

KP and SP conceived and designed the analysis. KP drafted the manuscript and SP made critical revision of the manuscript for key intellectual content. Both authors read and approved the final version of the manuscript.

Ethics approval and consent to participate

The IFLS has been approved by ethics review boards of RAND and University of Gadjah Mada in Indonesia [13]. Written informed consent was obtained from all respondents prior to data collection.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
ASEAN Institute for Health Development, Mahidol University, Salaya, Thailand
(2)
Department of Research & Innovation, University of Limpopo, Turfloop, South Africa
(3)
HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Private Bag X41, Pretoria, 0001, South Africa

References

  1. Tyrovolas S, Koyanagi A, Panagiotakos DB, Haro JM, Kassebaum NJ, Chrepa V, Kotsakis GA. Population prevalence of edentulism and its association with depression and self-rated health. Sci Rep. 2016;6:37083. https://doi.org/10.1038/srep37083.View ArticlePubMedPubMed CentralGoogle Scholar
  2. Peltzer K, Hewlett S, Yawson AE, Moynihan P, Preet R, Wu F, Guo G, Arokiasamy P, Snodgrass JJ, Chatterji S, Engelstad ME, Kowal P. Prevalence of loss of all teeth (edentulism) and associated factors in older adults in China, Ghana, India, Mexico, Russia and South Africa. Int J Environ Res Public Health. 2014;11(11):11308–24. https://doi.org/10.3390/ijerph111111308.View ArticlePubMedPubMed CentralGoogle Scholar
  3. Kassebaum NJ, Smith AGC, Bernabé E, Fleming TD, Reynolds AE, Vos T, Murray CJL, Marcenes W, GBD 2015 Oral Health Collaborators. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990-2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res. 2017;96(4):380–7. https://doi.org/10.1177/0022034517693566.View ArticlePubMedPubMed CentralGoogle Scholar
  4. GBD 2015 DALYs and HALE Collaborators. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuriesand healthy life expectancy (HALE), 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388(10053):1603–58. https://doi.org/10.1016/S0140-6736(16)31460-X.View ArticleGoogle Scholar
  5. Sussex PV. Edentulism from a New Zealand perspective -a review of the literature. NZ Dental J. 2008;104:84–96.Google Scholar
  6. Thomson WM. Monitoring edentulism in older New Zealand adults over two decades: a review and commentary. Int J Dent. 2012;2012 https://doi.org/10.1155/2012/375407.
  7. Kossioni AE. Current status and trends in oral health in community dwelling older adults: a global perspective. Oral Health Prev Dent. 2013;11:331–40.PubMedGoogle Scholar
  8. Hewlett SA, Yawson AE, Calys-Tagoe BN, Naidoo N, Martey P, Chatterji S, Kowal P, Mensah G, Minicuci N, Biritwum RB. Edentulism and quality of life among older Ghanaian adults. BMC Oral Health. 2015;15:48. https://doi.org/10.1186/s12903-015-0034-6.View ArticlePubMedPubMed CentralGoogle Scholar
  9. Ministry of Health Republic of Indonesia. Report on Result of National Basic Health Research (RISKESDAS). Indonesia: the National Institute of Health Research and Development, 2007.Google Scholar
  10. Sudiono J. The features of degenerative diseases and their association with the loss of teeth in the elderly of East Jakarta (Indonesia). Southeast Asian J Trop Med Public Health. 2008;39(1):184–9.PubMedGoogle Scholar
  11. Ren C, McGrath C, Yang Y. Edentulism and associated factors among community-dwelling middle-aged and elderly adults in China. Gerodontology. 2017;34(2):195–207. https://doi.org/10.1111/ger.12249.View ArticlePubMedGoogle Scholar
  12. Olofsson H, Ulander EL, Gustafson Y, Hörnsten C. Association between socioeconomic and health factors and edentulism in people aged 65 and older - a population-based survey. Scand J Public Health. 2017; https://doi.org/10.1177/1403494817717406.
  13. Starr JM, Hall RJ, Macintyre S, Deary IJ, Whalley LJ. Predictors and correlates of edentulism in the healthy old people in Edinburgh (HOPE) study. Gerodontology. 2008;25(4):199–204. https://doi.org/10.1111/j.1741-2358.2008.00227.x.View ArticlePubMedGoogle Scholar
  14. Arora M, Schwarz E, Sivaneswaran S, Banks E. Cigarette smoking and tooth loss in a cohort of older Australians: the 45 and up study. J Am Dent Assoc. 2010;141:1242–9.View ArticlePubMedGoogle Scholar
  15. Kailembo A, Preet R, Stewart Williams J. Common risk factors and edentulism in adults, aged 50 years and over, in China, Ghana, India and South Africa: results from the WHO Study on global AGEing and adult health (SAGE). BMC Oral Health. 2016;17(1):29. https://doi.org/10.1186/s12903-016-0256-2. View ArticlePubMedPubMed CentralGoogle Scholar
  16. Musacchio E, Perissinotto E, Binotto P, Sartori L, Silva-Netto F, Zambon S, Manzato E, Corti MC, Baggio G, Crepaldi G. Tooth loss in the elderly and its association with nutritional status, socio-economic and lifestyle factors. Acta Odontol Scand. 2007;65(2):78–86.View ArticlePubMedGoogle Scholar
  17. Saman DM, Lemieux A, Arevalo O, Lutfiyya MN. A population-based study of edentulism in the US: does depression and rural residency matter after controlling for potential confounders? BMC Public Health. 2014;14:65. https://doi.org/10.1186/1471-2458-14-65.View ArticlePubMedPubMed CentralGoogle Scholar
  18. Islas-Granillo H, Borges-Yañez SA, Lucas-Rincón SE, Medina-Solís CE, Casanova-Rosado AJ, Márquez-Corona ML, Maupomé G. Edentulism risk indicators among Mexican elders 60-year-old and older. Arch Gerontol Geriatr. 2011;53:258–62.View ArticlePubMedGoogle Scholar
  19. de Pablo P, Dietrich T, McAlindon TE. Association of periodontal disease and tooth loss with rheumatoid arthritis in the US population. J Rheumatol. 2008;35(1):70–6.PubMedGoogle Scholar
  20. Kim EK, Jung YS, Kim KH, Kim KR, Kwon GH, Choi YH, Lee HK. Social capital and oral health: the association of social capital with edentulism and chewingability in the rural elderly. Arch Gerontol Geriatr. 2018;74:100–5. https://doi.org/10.1016/j.archger.2017.10.002.View ArticlePubMedGoogle Scholar
  21. Tsakos G, Sabbah W, Chandola T, Newton T, Kawachi I, Aida J, Sheiham A, Marmot MG, Watt RG. Social relationships and oral health among adults aged 60 years or older. Psychosom Med. 2013;75:178–86.View ArticlePubMedGoogle Scholar
  22. Medina-Solís CE, Pontigo-Loyola AP, Pérez-Campos E, Hernández-Cruz P, Avila-Burgos L, Mendoza-Rodríguez M, Maupomé G. Edentulism and other variables associated with self-reported health status in Mexican adults. Med Sci Monit. 2014;20:843–52. https://doi.org/10.12659/MSM.890100.View ArticlePubMedPubMed CentralGoogle Scholar
  23. De Marchi RJ, Hugo FN, Padilha DM, Hilgert JB, Machado DB, Durgante PC, Antunes MT. Edentulism, use of dentures and consumption of fruit and vegetables in south Brazilian community-dwelling elderly. J Oral Rehabil. 2011;38(7):533–40. https://doi.org/10.1111/j.1365-2842.2010.02189.x.View ArticlePubMedGoogle Scholar
  24. Tsakos G, Herrick K, Sheiham A, Watt RG. Edentulism and fruit and vegetable intake in low-income adults. J Dent Res. 2010;89(5):462–7. https://doi.org/10.1177/0022034510363247.View ArticlePubMedGoogle Scholar
  25. Felton DA. Complete edentulism and comorbid diseases: an update. J Prosthodont. 2016;25(1):5–20. https://doi.org/10.1111/jopr.12350.View ArticlePubMedGoogle Scholar
  26. Toniazzo MP, Amorim PS, Muniz FW, Weidlich P. Relationship of nutritional status and oral health in elderly: Systematic review with meta-analysis. Clin Nutr. 2017; https://doi.org/10.1016/j.clnu.2017.03.014.
  27. Tôrres LH, da Silva DD, Neri AL, Hilgert JB, Hugo FN, Sousa ML. Association between underweight and overweight/obesity with oral health among independently living Brazilian elderly. Nutrition. 2013;29(1):152–7. https://doi.org/10.1016/j.nut.2012.05.011.View ArticlePubMedGoogle Scholar
  28. Österberg T, Dey DK, Sundh V, Carlsson GE, Jansson JO, Mellström D. Edentulism associated with obesity: a study of four national surveys of 16,416 swedes aged 55–84 years. Acta Odontol Scand. 2010;68:360–7.View ArticlePubMedGoogle Scholar
  29. Nascimento GG, Leite FR, Conceição DA, Ferrúa CP, Singh A, Demarco FF. Is there a relationship between obesity and tooth loss and edentulism? A systematic review and meta-analysis. Obes Rev. 2016;17(7):587–98. https://doi.org/10.1111/obr.12418.View ArticlePubMedGoogle Scholar
  30. Ayo-Yusuf OA, Ayo-Yusuf IJ. Association of tooth loss with hypertension. S Afr Med J. 2008;98:381–5.PubMedGoogle Scholar
  31. Peres MA, Tsakos G, Barbato PR, Silva DA, Peres KG. Tooth loss is associated with increased blood pressure in adults--a multidisciplinary population-based study. J Clin Periodontol. 2012;39(9):824–33. https://doi.org/10.1111/j.1600-051X.2012.01916.x.View ArticlePubMedGoogle Scholar
  32. Medina-Solís CE, Pontigo-Loyola AP, Pérez-Campos E, Hernández-Cruz P, Ávila-Burgos L, Kowolik MJ, Maupomé G. Association between edentulism and angina pectoris in Mexican adults 35 years of age and older: a multivariate analysis of a population-based survey. J Periodontol. 2014;85:406–16.View ArticlePubMedGoogle Scholar
  33. Del Brutto OH, Mera RM, Zambrano M, Del Brutto VJ. Severe edentulism is a major risk factor influencing stroke incidence in rural Ecuador (The Atahualpa Project). Int J Stroke. 2017;12(2):201–4. https://doi.org/10.1177/1747493016676621.View ArticlePubMedGoogle Scholar
  34. Emami E, de Souza RF, Kabawat M, Feine JS. The impact of edentulism on oral and general health. Int J Dent. 2013;2013:498305. https://doi.org/10.1155/2013/498305.View ArticlePubMedPubMed CentralGoogle Scholar
  35. Starr JM, Hall R. Predictors and correlates of edentulism in healthy older people. Curr Opin Clin Nutr Metab Care. 2010;13(1):19–23. https://doi.org/10.1097/MCO.0b013e328333aa37.View ArticlePubMedGoogle Scholar
  36. Yu YH, Lai YL, Cheung WS, Kuo HK. Oral health status and self-reported functional dependence in community-dwelling older adults. J Am Geriatr Soc. 2011;59(3):519–23. https://doi.org/10.1111/j.1532-5415.2010.03311.x.View ArticlePubMedGoogle Scholar
  37. Asia A, Kusdhany L, Rahardjo A, Bachtiar A. Association between tooth loss and the development of dementia on the Indonesian elders. JSM Dent. 2015;3(1):1050.Google Scholar
  38. Adiatman M, Ueno M, Ohnuki M, Hakuta C, Shinada K, Kawaguchi Y. Functional tooth units and nutritional status of older people in care homes in Indonesia. Gerodontology. 2013;30(4):262–9. https://doi.org/10.1111/j.1741-2358.2012.00673.x.View ArticlePubMedGoogle Scholar
  39. Strauss J, Witoelar F, Sikoki B. The Fifth Wave of the Indonesia Family Life Survey (IFLS5): Overview and Field Report. 2016. WR-1143/1-NIA/NICHD, 2016.Google Scholar
  40. Peltzer K, Pengpid S. High prevalence of depressive symptoms in a national sample of adults in Indonesia: childhood adversity, sociodemographic factors and health risk behaviour. Asian J Psychiatr. 2018;33:52–9. https://doi.org/10.1016/j.ajp.2018.03.017.View ArticlePubMedGoogle Scholar
  41. Wen CP, David Cheng TY, Tsai SP, Chan HT, Hsu HL, Hsu CC, Eriksen MP. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr. 2009;12:497–506.View ArticlePubMedGoogle Scholar
  42. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. JAMA. 1963;185(12):914–9.View ArticlePubMedGoogle Scholar
  43. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist. 1969;9(3-Part-1):179–86.View ArticlePubMedGoogle Scholar
  44. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–52.View ArticlePubMedGoogle Scholar
  45. Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10(2):77–84.View ArticlePubMedGoogle Scholar
  46. van der Velden U, Amaliya A, Loos BG, Timmerman MF, van der Weijden FA, Winkel EG, Abbas F. Java project on periodontal diseases: causes of tooth loss in a cohort of untreated individuals. J Clin Periodontol. 2015;42(9):824–31. https://doi.org/10.1111/jcpe.12446.View ArticlePubMedGoogle Scholar
  47. Doğan BG, Gökalp S. Tooth loss and edentulism in the Turkish elderly. Arch Gerontol Geriatr. 2012;54:e162–e166.Google Scholar
  48. Gaio EJ, Haas AN, Carrard VC, Oppermann RV, Albandar J, Susin C. Oral health status in elders from South Brazil: a population-based study. Gerodontology. 2012;29:214–23.View ArticlePubMedGoogle Scholar
  49. Hugo FN, Hilgert JB, de Sousa Mda L, da Silva DD, Pucca GA Jr. Correlates of partial tooth loss and edentulism in the Brazilian elderly. Community Dent Oral Epidemiol. 2007;35:224–32.View ArticlePubMedGoogle Scholar
  50. Mendes DC, Poswar Fde O, de Oliveira MV, Haikal DS, da Silveira MF, Martins AM, De Paula AM. Analysis of socio-demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly. Gerodontology. 2012;29:e206–14.View ArticlePubMedGoogle Scholar
  51. Moreira Rda S, Nico LS, Tomita NE. Spatial risk and factors associated with edentulism among elderly persons in Southeast Brazil. Cad Saude Publica. 2011;27:2041–54.View ArticlePubMedGoogle Scholar
  52. Hanson BS, Liedberg B, Owall B. Social network, social support and dental status in elderly Swedish men. Community Dent Oral Epidemiol. 1994;22:331–7.View ArticlePubMedGoogle Scholar
  53. Wennström A, Ahlqwist M, Stenman U, Björkelund C, Hakeberg M. Trends in tooth loss in relation to socio-economic status among Swedish women, aged 38 and 50 years: repeated cross-sectional surveys 1968–2004. BMC Oral Health. 2013;13 https://doi.org/10.1186/1472%2D6831%2D13%2D63.
  54. Takeuchi K, Aida J, Kondo K, Osaka K. Social participation and dental health status among older Japanese adults: a population-based cross-sectional study. PLoS One. 2013;8(4):e61741.View ArticlePubMedPubMed CentralGoogle Scholar
  55. Rodrigues SM, Oliveira AC, Vargas AM, Moreira AN, E Ferreira EF. Implications of edentulism on quality of life among elderly. Int J Environ Res Public Health. 2012;9(1):100–9. https://doi.org/10.3390/ijerph9010100.View ArticlePubMedPubMed CentralGoogle Scholar
  56. Northridge ME, Ue FV, Borrell LN, De La Cruz LD, Chakraborty B, Bodnar S, Marshall S, Lamster IB. Tooth loss and dental caries in community-dwelling older adults in northern Manhattan. Gerodontology. 2012;29:e464–e473.View ArticleGoogle Scholar
  57. Leite FRM, Nascimento GG, Scheutz F, López R. Effect of smoking on periodontitis: a systematic review and meta-regression. Am J Prev Med. 2018; https://doi.org/10.1016/j.amepre.2018.02.014.
  58. Rauen MS, Moreira EA, Calvo MC, Lobo AS. Oral condition and its relationship to nutritional status in the institutionalized elderly population. J Am Diet Assoc. 2006;106:1112–4.View ArticlePubMedGoogle Scholar
  59. Lee JS, Weyant RJ, Corby P, Kritchevsky SB, Harris TB, Rooks R, Rubin SM, Newman AB. Edentulism and nutritional status in a biracial sample of well-functioning, community-dwelling elderly: the health, aging, and body composition study. Am J Clin Nutr. 2004;79:295–302.View ArticlePubMedGoogle Scholar
  60. Susanto H, Nesse W, Kertia N, Soeroso J, Huijser van Reenen Y, Hoedemaker E, Agustina D, Vissink A, Abbas F, Dijkstra PU. Prevalence and severity of periodontitis in Indonesian patients with rheumatoid arthritis. J Periodontol. 2013;84(8):1067–74. https://doi.org/10.1902/jop.2012.110321.View ArticlePubMedGoogle Scholar

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© The Author(s). 2018

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