The objective of the study was to determine the profile of the oral health status and treatment needs of the elderly population of El Salvador, an age group that is constantly increasing in the country and worldwide.
Of the total number of study subjects, one third have no schooling, similar to the study in China, where one third of the older adults have a low level of education, most of them being illiterate [16].
A low frequency of brushing was identified in this study, and significant differences were found between the variables sex and region. Similar to the results from El Salvador, Lu Liu et al. reported in northeastern China that one third of the elderly brush their teeth less than once a day [17]. In Poland, Wojciech Skorupka et al. report that the majority of older adults brush their teeth only 1 or 2 times a day (80%) [18]; these similarities lead to the inference that regardless of the cultural or developmental differences between countries, there are common factors that could influence the oral hygiene of this susceptible group, among these, the economic difficulty for the population of this age group to buy toothbrushes and toothpaste, prioritizing other needs such as food and medicines, together with the ingrained habits of older adults and the decrease in social life, since many of them are without productive activity, which forces them to spend most of the day in their own homes or in nursing homes for the elderly.
Consistent with the infrequency of brushing found in this study, it was also identified that more than half of Salvadoran older adults have "Poor or Very Poor" hygiene, similar to the results of other studies such as those conducted in India and Turkey in which deficient levels of oral hygiene were also reported [3, 19]. This condition worsens their oral health status, as well as the aging process, degree of physical disability, oral health assessment, access to health services, among others [20]. The results of the brushing frequency and oral hygiene variables are evidence of the need for educational-preventive care with methods that allow motivation to improve oral hygiene practices in older adults.
The DMFT index modified with ICDAS criteria reflects an average of 5.9 decayed teeth per individual, finding significant differences between sexes. This finding differ from the results of other studies such as those conducted in New Zealand, Turkey, Spain, Colombia, Belgium, China and France where fewer caries experiences in their active state were reported [16, 19, 21,22,23,24,25]. The difference in the results of our study could be primarily attributed in the first place to the criteria used to establish the diagnosis of caries, which, in our case, when using ICDAS, initial carious lesions such as the white spot were considered, while other studies that have used WHO criteria have only included cavitated carious lesions. Other factors that could be attributed to contributing to the difference could be the strength of the public health systems in developed countries, since in our country, health care programs prioritize children and pregnant women. It could also be inferred to the difference in diets, the economic, cultural and educational level of the populations surveyed in each country.
The mean number of teeth lost was 16.18, this component represents 69.20% of the total DMFT; according to the multivariate analysis, the trend is the greater the age, the greater the tooth loss. Our results are close to those reported in China, Spain, Belgium, Turkey and Colombia in which also the missing component represents a high percentage, between 71 and 86% [16, 19, 22,23,24] and different from those of Mexico and New Zealand that reported a lower percentage of missing teeth of approximately 50% of the DMFT index [21, 26]. Despite the differences in the results between countries, the data show that dental loss is a constant, representing a global public health problem that is yet to be solved due to its potential negative impact on the quality of life of those who suffer from it.
Almost one third of the older adults participating in the study are edentulous, affecting the ability to chew and subsequently the general state of health due to nutritional deficiencies as a result of the difficulty in eating; it also affects the function of speech, reduces self-esteem and impairs social integration. The same proportion of edentulous patients has been observed in other similar studies in Latin America such as those carried out in Brazil and Colombia and differing from the rate of total edentulism found in China, India, Ghana and South Africa [23, 27, 28]; the differences could be attributable to factors such as sociodemographic variables, genetic variants, dietary culture and the coverage provided by the dental care programs in each country.
In accordance with the high prevalence of missing teeth, almost all of the study subjects required prosthetic rehabilitation. Multivariate analysis showed that the higher the age, the higher the probability of needing prosthetic treatment, therefore, it is urgent at the public level to prioritize oral health care for older adults to improve their quality of life and masticatory function, thus reducing the risk of malnutrition in Salvadoran older adults [20, 29].
On the other hand, regarding periodontal health, the CPITN results indicated that the majority of the population needs periodontal treatments of professional scaling, prophylaxis and some type of periodontal surgery. These results also show the oral health deficiencies of this sector of the population and support the need to implement programs that encourage self-care and emphasize oral hygiene as soon as possible. Our results were similar to those obtained in other countries that used the same index, such as Turkey with 90% and Colombia with 93.4%, both of which reported that their population required some type of periodontal treatment [19, 23]. These data demonstrate that regardless of social, cultural or economic differences, periodontal disease is more severe in the elderly and therefore deserves to be prioritized among public health care needs.
A limitation of this study was its cross-sectional nature, since it does not allow establishing cause-effect relationships between the variables studied, so analytical studies are needed to establish the influence of the variables on oral health status. A recall bias also occurs, since it is known that in adulthood patients lose teeth also due to periodontal disease and it is impossible to determine the real reason for the indication of a periodontal.
