According to the World Health Organization, “Oral health is a key indicator of overall health, well-being, and quality of life. It encompasses a range of diseases and conditions that include dental caries, periodontal disease, tooth loss, oral cancer, oral manifestations of HIV infection, oro-dental trauma, noma, and birth defects such as cleft lip and palate”(1, 2). Nevertheless, growing untreated morbidities among the older adult population on geriatric issues especially an optimal dental treatment is an unfinished agenda and a long-neglected area for care and management in many low and middle-income countries (2–4). Further, the increasing burden of oral health and tooth-related disability in many developing countries has created global attention; however, still, no effective and preventive measures have been placed to cope up with unprecedented morbidity and mortality related to it (5). By 2025, the United Nations estimation shows that approximately 1200 million people aged 65 years across the world will suffer from oral health care and related problems (2). In case of the older adult population, the untreated oral and tooth problems put more seriousness and hazardous circumstances to them. There is a continuous rise in the older population in India. For instance, the overall aged population rose from 5.6 percent in 1961 to 8.6 percent in the 2011 census and it is also expected to rise to 20 percent in 2050 (6). At the same time, the rising of co-morbidities or multi-morbidities in the aging population creates catastrophic challenges at the individuals, household, community, and country levels (6–8).
Geriatric morbidities and related disabilities have been continuously witnessing a serious global concern. In developing countries like India the situation is even more challenging where the high prevalence of chronic diseases and associated disabilities have not been adequately addressed among the older adults and where they also face high inequality in treatment coverage(6, 8). Similarly, the lack of oral and tooth health care practices among older adults and its partial or no treatment-seeking-behavior has been seen imperative especially in the Indian context, and that deeply affects the systemic health of aged individuals (9–12). Further, there is a positive relationship between chronic and infectious diseases with oral health and tooth problems (5). Therefore, it is required to understand the present oral health concerns of the older adults with public health approach in India, where this sub-population-group faces uncaring, low supportive care by own family members, and is entirely dependent on institutions (13).
Furthermore, the most deprived groups (older adults) suffer unprecedented socio-economic, psychological, and uncaring vulnerability in oral health care services. Emerging challenges on this can be burdensome, when this population is associated with a greater prevalence of chronic diseases and disability. Although oral and tooth health problems are more persistent and widespread among older adults and it has become devastating in low and middle-income countries, including India(5, 9–11, 14, 15).Lack of awareness on tooth health and poor health care access, tooth health conspires against the older adults leading to more crucial conditions. Further, deteriorated oral health among older adults may also lead to several risk factors such as frailty conditions, high prevalence of missing teeth, poor bridge, and ill-fitting dentures(16–18). Due to the continuous loss of teeth and ill-fitting dentures can produce several other health problems and also reduce a person’s quality of life (10, 19–21). Increasing the risk of tooth decay among the aged population has decreased the enjoyment of food and nutritional quality and quantity (11, 22–24). The ill-fitting dentures among the population can lead to difficulty in chewing food and associated disadvantaged (25). In addition, smoking, drinking, and other substance use among older adults are also quite high that causes tooth decaying and other related oral problems (26).
Though it is a preventable disease with proper awareness, education, and management support from the government, however, a lack of adequate health policy intervention by the institutions has led to immense oral health problems among the older adults (15). There is evidence that shows limited and poor oral health care access to the older adults that has put at a risk for other systemic chronic and infectious diseases (3, 19). Geriatric health problems, especially oral and tooth-related health care issues are very common and highly persisting amongst disadvantaged and vulnerable groups (27–31). Poor strata of the community face unprecedented problems in accessing oral health care services and those who reside in rural areas are further vulnerable. Although it significantly varies in the prevalence of tooth loss across different socio-economic groups, age-sex, and rural-urban, however, the high prevalence rate is seen among the male older adults from the poor socio-economic strata (10, 12–14, 28, 30). Tooth-related diseases are a significant public health menace having a substantial impact on the quality of life (21, 23). Therefore, effective and preventive care management on oral and tooth health needs to be in place by ensuring every individual to quality oral health care at an affordable cost.
There may be several barriers to access to tooth-related services and it is perceived as physical incapacity or disability, travel problems or immobile activity, lack of knowledge of tooth health services, and also non-availability of oral and tooth services in the low resource settings areas (2, 13, 18, 32). Further, lack of family support, caregivers, and social services creates the mismanagement of treatment among the elderly (10, 14, 33). That produces vast disparities in oral health status and healthcare-seeking behavior across rural-urban (7, 9, 13, 15, 18). The living arrangement of the older adults has also made an influence on oral and tooth health conditions. In this way, the low coverage of oral and tooth care in older adults is evident in high levels of tooth loss, dental caries experience, and the prevalence rates of periodontal disease, xerostomia, and oral precancer/cancer (3, 5).Lack of regular check-up, screening, diagnosis, and treatment-related to tooth care services among the older adults that have led to elevated risks for future health and dental caries.
In the low access to oral and tooth care services among the older adult population gives nuance to the policy interventions (15). Further, lack of financial support, aid, or third party payment make them also low access to oral health care and unaffordable (4, 34, 35). The high demand for dentures among the older adult population creates a dilemma especially in the lower socio-economic groups’ people who cannot afford it. Concerning this, a high variation is seen across rural-urban, gender, and socio-economic groups(3, 12, 30). However, still, many developing countries are lacking such policies on oral health that can embark on several associated health problems among the older population (2, 5, 36). Therefore this study relies on, what are the prevailing determinants that influence in not seeking oral and tooth health care services among the older adults in India. Though very few studies on oral and tooth health problems have been addressed in India, however, still, a dearth of knowledge on aged person’s oral and tooth health treatment-seeking behavior and its mechanism has remained in the literature. Therefore, the present study is an attempt to understand the prevalence of tooth related problems and its health-seeking behavior among the older adults in India.