More than 94% of older adults examined in a study in Yogyakarta had never visited a dentist regularly. They went to the clinic only when they were already experiencing pain. This fact may not be surprising. What is more striking is what researchers discovered when they connected this habit with something deeper: how well a person can access, process, and act on information about their own oral health.
A study published in the June 2024 edition of Berkala Ilmiah Kedokteran Duta Wacana found that low oral health literacy was significantly associated with poorer gingival conditions among older adults. The study involved 193 respondents aged 60 years and above from two elderly community health posts (Posyandu Lansia) in Gondokusuman and Mergangsan Districts, Yogyakarta City, and was conducted in 2023. The study was led by Budi Rodestawati, S.Kp.G., M.P.H., from the Department of Oral Biology, Faculty of Dentistry, Universitas Gadjah Mada, together with a research team from FKG UGM.
As Age Increases, So Does Gingival Vulnerability
Aging brings changes throughout the body's systems. Immune function declines, gingival tissues become more susceptible to infection, and the risk of periodontal disease increases. Data from the 2018 Basic Health Research (Riskesdas) showed that more than 95% of Indonesians aged 55 years and above had never received care from dental health professionals. Only 2.9% brushed their teeth at the recommended times.
Gingival condition in this study was assessed using the Modified Gingival Index (MGI), a clinical index that measures the severity of gingival inflammation, ranging from no inflammation (score 0) to severe inflammation accompanied by spontaneous bleeding (score 4). Five trained dentists and dental therapists conducted direct oral examinations of each respondent using a mouth mirror, tweezers, and a periodontal probe.
Meanwhile, oral health literacy was measured using the HeLD-14 questionnaire, which consists of 14 questions rated on a scale from 1 to 5. The questionnaire assesses respondents' ability to access, understand, and use oral health information when making decisions.
The Better the Understanding, the Healthier the Gums
Statistical analysis showed a significant correlation between oral health literacy and gingival status (p=0.01). The correlation was negative: the higher a person's literacy score, the lower their MGI score, indicating better gingival health. Although the strength of the correlation was weak (r=0.242), it remained statistically significant.
“Low oral health literacy is a risk factor for poor gingival health. Older adults with higher oral health literacy have better oral health outcomes,” the research team stated in the study's conclusion.
Interestingly, behavioral variables such as toothbrushing frequency, use of additional oral hygiene products such as dental floss or mouthwash, and smoking habits were not significantly associated with gingival condition in this study. This suggests that simply knowing that toothbrushing is important is not enough. Literacy is not merely about knowledge; it is about the ability to understand, process, and act on health information in practice.
Most respondents were women (74.6%), had more than nine years of education (76.2%), and were actively involved in social activities (95.3%). Nevertheless, almost all of them did not visit dentists regularly or use additional oral hygiene tools.
More Than Just Brushing Twice a Day
These findings offer a new perspective on how we view oral health among older adults. Oral health messages have traditionally focused on practical recommendations: brush your teeth twice a day, use dental floss, and avoid smoking. But if people do not understand why these actions are important, do not know how to interpret medical information, and cannot determine when to seek professional care, those recommendations may remain mere knowledge that is never translated into action.
The World Health Organization (WHO) itself recognizes health literacy as one of the important determinants of health, alongside factors such as age, income, and educational background. This study reinforces the importance of health literacy in the context of oral health among older Indonesians.
The researchers called for further studies involving larger sample sizes and longitudinal designs so that changes in gingival condition and health literacy can be monitored over time. They also recommended developing oral health education programs specifically designed for older adults—not merely general health education, but measurable interventions based on a deeper understanding of their needs.
Ultimately, healthy gums are not simply a matter of visiting the dentist regularly. They also depend on whether people truly understand what is happening inside their own mouths.
Authors: Achmad Zam Zam Aghasy, DDS, M.Kes.; Hazra Alifia Muharam
Photo: Freepik
Source DOI: doi.org/10.21460/bikdw.v9i1.919