Development of a Geriatric Oral Health Vulnerability Score (GOHVS) and Its Association with Functional Tooth Loss in Older Adults: A Cross-Sectional Study

Development of a Geriatric Oral Health Vulnerability Score (GOHVS) and Its Association with Functional Tooth Loss in Older Adults: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development of a Geriatric Oral Health Vulnerability Score (GOHVS) and Its Association with Functional Tooth Loss in Older Adults: A Cross-Sectional Study Renata Samulak, Nanxi Tao, Katarzyna Krycka-Juraś, Monika Machoy-Rakoczy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8507381/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 24 You are reading this latest preprint version Abstract Background Oral health is a critical component of healthy ageing, yet many older adults postpone dental visits until oral diseases reach an advanced stage. This study aimed to describe the oral health status, multimorbidity, and hygiene behaviours among first-time dental attendees aged 65 years and older. Furthermore, it sought to identify predictors of functional tooth loss, defined as having fewer than 20 teeth, and to develop a composite risk index - the Geriatric Oral Health Vulnerability Score (GOHVS) - to facilitate early identification of individuals at increased risk of oral health decline. Methods Records of 361 patients (mean age 69.9 ± 5.9 years; 61.8% female) presenting for their first dental visit at a university clinic were retrospectively analysed. Data on systemic conditions, hygiene practices and periodontal status were extracted. Multivariable Poisson regression with robust variance estimated adjusted prevalence ratios (aPR) for functional tooth loss. Model discrimination was assessed using receiver operating characteristic (ROC) analysis. Results Hypertension (58%) and diabetes (20%) were the most common comorbidities. Periodontitis affected 54% of participants, and 48% lacked a functional dentition. Toothbrushing < 2×/day (aPR = 1.41, p = 0.001), absence of interdental cleaning (aPR = 1.27, p = 0.019), irregular dental attendance (< 1×/year; aPR = 1.29, p = 0.006), smoking (aPR = 1.36, p = 0.010) and multimorbidity (≥ 2 chronic diseases; aPR = 1.33, p = 0.002) were independent predictors. The GOHVS, integrating these five factors, demonstrated acceptable discrimination for functional tooth loss (AUC = 0.76). Conclusions Poor oral hygiene behaviours and multimorbidity are key determinants of functional tooth loss in older adults. The GOHVS offers a simple, data-driven tool for identifying high-risk individuals and guiding preventive interventions in geriatric dentistry. ageing functional dentition multimorbidity oral hygiene behaviours tooth loss GOHVS Figures Figure 1 Figure 2 Background Population ageing is a global phenomenon driven by increasing life expectancy and declining birth rates. In 2019, the United Nations reported 703 million people aged ≥ 65 years, a figure projected to exceed 1.5 billion by 2050 [ 1 ]. Poland follows this demographic trend, with adults aged ≥ 65 years comprising 17.7% of the population in 2019 and expected to reach 32.7% by 2050 [ 2 ]. Oral health is an integral component of healthy ageing, yet oral diseases such as dental caries, periodontitis, xerostomia and tooth loss remain highly prevalent among older adults [ 3 – 6 ]. These conditions, often exacerbated by multimorbidity and polypharmacy - for example, β-blocker-induced xerostomia or bisphosphonate-related osteonecrosis - can contribute to chronic systemic inflammation, thereby aggravating diabetes, cardiovascular disease and cognitive decline [ 1 ]. Functional deterioration in the oral cavity is increasingly recognised as part of the broader construct of oral frailty, which affects nutrition, health status, communication and quality of life in later years [ 7 – 10 ]. Despite this, dental attendance among older adults in Central and Eastern Europe remains suboptimal. In Poland, approximately 29% of older adults are edentulous and 44% have lost ten or more teeth [ 11 ]. Such figures suggest that access barriers, low preventive awareness and the gradual, painless nature of periodontal disease delay care until functional impairment becomes evident [ 12 ]. The absence of functional dentition is a key component of oral frailty, leading to a gradual deterioration of chewing, swallowing, and articulation functions, which can result in malnutrition, sarcopenia, and overall frailty [ 13 ]. Early identification of individuals at increased risk of tooth loss allows for the implementation of preventive and rehabilitation measures that can reverse or slow the progression of oral frailty [ 14 ]. Maintaining functional dentition is therefore not only a component of oral health but also a protective factor against physical decline, social isolation, and increased mortality in the elderly [ 15 ]. Within the framework of the WHO Decade of Healthy Ageing (2020–2030) [ 16 ] a better understanding of first-time dental attendees among older adults could inform risk-stratified preventive strategies. Therefore, this study aimed to describe the oral health status, systemic disease burden and hygiene behaviours of adults aged ≥ 65 years presenting for their initial dental visit at a university clinic. The null hypothesis is that there is no significant association between oral hygiene behaviours, multimorbidity and functional tooth loss in adults aged ≥ 65 years. The alternative hypothesis assumed that poor hygiene behaviours and higher multimorbidity are associated with an increased likelihood of functional tooth loss (< 20 teeth), therefore contributing to oral fragility. Based on these risk factors, we further aimed to propose a simple composite index - the Geriatric Oral Health Vulnerability Score (GOHVS) - to quantify cumulative oral health risk and facilitate the identification of high-risk older adults. Methods Study design and ethical approval This was a cross-sectional, retrospective review of electronic health records from the University Dental Clinic, Pomeranian Medical University, Szczecin, Poland. The study protocol received approval from the Bioethics Committee of the Pomeranian Medical University (KB 0012/14/2022) and was conducted in accordance with the Declaration of Helsinki. Reporting followed the STROBE guidelines for observational studies. The requirement for informed consent was waived by the Bioethics Committee of the Pomeranian Medical University due to the retrospective and anonymized nature of the study. Participants All patients aged ≥ 65 years who attended the clinic for the first time between 1 January 2022 and 31 December 2023 were screened (N = 395). Individuals with incomplete data - specifically missing panoramic radiographs or medical questionnaires - or previous care at the same clinic were excluded (n = 34), resulting in a final sample of 361 participants. Although institutional records confirmed that these were first-time visits to the university clinic, prior treatment in external, particularly private, dental practices could not be ruled out, introducing a potential source of selection bias. Data collection and calibration Two independent examiners, both blinded to the study hypothesis, were trained and calibrated prior to data extraction (Cohen’s κ = 0.91 for tooth count; κ = 0.88 for periodontal stage). Thirty randomly selected charts were double-scored to confirm inter-examiner reliability. Extracted variables included demographic data, medical diagnoses (ICD-10 codes), number of chronic conditions, medication profiles, smoking status, oral hygiene habits (frequency of toothbrushing and use of interdental aids), dental attendance frequency, tooth count, periodontal stage (classified according to the 2018 World Workshop criteria) and primary reason for visit. The GOHVS was derived from routinely collected clinical and behavioural data recorded at the time of the initial dental visit; no additional patient questionnaires were administered for the purpose of this study. Statistical analysis Continuous variables are expressed as mean ± standard deviation (SD) and categorical variables as percentages (n). Group differences were examined using χ² or Kruskal-Wallis tests, as appropriate. Bivariate associations between tooth number and clinical or behavioural variables were explored using Spearman’s rank correlation coefficient (ρ). Variables with p < 0.20 in bivariate analysis were entered into a multivariable Poisson regression model with robust variance to estimate adjusted prevalence ratios (aPR) for functional tooth loss, defined as < 20 remaining natural teeth in accordance with the WHO functional dentition benchmark. Model fit was satisfactory (Pearson χ²/df = 1.04; deviance/df = 1.02). All analyses were conducted using R software (version 4.3), with the level of statistical significance set at α = 0.05. Potential interactions between age group and each behavioural predictor were tested using multiplicative terms; none reached statistical significance (all p > 0.10). A sensitivity analysis restricted to the 65–74 year age stratum (n = 296) produced prevalence ratio estimates differing by < 5% from the main model, indicating the robustness of the findings. Following identification of independent predictors in the multivariable model, a composite Geriatric Oral Health Vulnerability Score (GOHVS) was constructed retrospectively using routinely collected clinical and behavioural data; no additional questionnaires were administered to participants (Supplementary File 1). Each significant variable contributed one point (range 0–5), with higher values indicating greater vulnerability. The model’s discriminative ability for functional tooth loss was evaluated using ROC analysis (AUC = 0.76) Results Cohort characteristics Participants had a mean age of 69.9 ± 5.9 years, and 61.8% were women. The mean number of remaining natural teeth was 17.9 ± 7.2 (Table 1). Overall, 13% of the cohort were current smokers (Table 2). Most participants showed limited engagement in preventive dental care: 59.8% reported visiting a dentist less than once per year, and 39.9% had never used interdental cleaning aids (Table 3). Table 1. Baseline characteristics of the participants included in the study (N = 361). Total 65-74years 74-84years ≥85years Female 223 (62.8%) 184 (82.5%) 32 (14.3%) 7 (3.1%) Male 138 (38.2%) 112 (81.2%) 21 (15.2%) 5 (3.6%) Numer of teeth (n±SD) 17.9 ± 7.2 18.6± 7.5 18.2± 7.5 15.7± 6.5 Abbreviations: N, number of participants SD, standard deviation, n, number of teeth Table.2 General health conditions, medication use, and lifestyle factors among study participants. Factor N % Condition Hypertension 211 58.4 Dyslipidaemia 142 39.3 Diabetes mellitus (type 2) 74 20.5 Cardiovascular disease (IHD/heart failure) 69 19.1 Chronic kidney disease (eGFR <60 mL/min) 36 10.0 Chronic obstructive pulmonary disease 34 9.4 Osteoporosis/osteopenia 59 16.3 Rheumatoid / inflammatory arthritis 27 7.5 Cerebrovascular disease (stroke/TIA) 32 8.9 Neurodegenerative disorder (Parkinson / Alzheimer) 29 8.0 Active or past malignancy 41 11.4 Gastro‑oesophageal reflux disease 67 18.6 Depression 48 13.3 Anxiety disorder 30 8.3 ≥ 2 chronic conditions (multimorbidity) 164 45.4 Medication Polypharmacy (≥ 5 daily medications) 118 32.7 Anticoagulant / antiplatelet therapy 79 21.9 Antiresorptive drugs use 18 5.0 Immunosuppressive therapy 11 3.0 Smoking status Current 50 13.9 Former 122 33.8 Never 189 52.4 Alcohol intake None 156 43.2 Occasional (≤ 1 ×/week) 148 41.0 Weekly (2–4 ×/week) 45 12.5 Daily 12 3.3 Table 3. Dental care utilisation and oral hygiene habits in studied population. Total 65-74years 74-84years ≥85years Frequency of dental visits n % n % n % n % More often than every 6 months 43 12 41 13.9 2 3.8 - - Every 6 months 3 0.8 3 1.0 - - - - Every year 96 26.6 83 28.0 12 2.6 1 8.3 Less often than once a year 216 60 167 56.4 38 71.7 11 91.7 No response 3 0.8 2 0.5 1 0.3 - - Frequency of brushing teeth n % n % n % n % Less than once a day 19 5.2 16 5.4 2 3.8 1 8.3 Once a day 87 24.1 63 21.3 20 37.7 4 33.3 Twice a day 254 70.4 216 73.0 31 58.5 7 58.3 No response 1 0.3 1 0.3 - - - - Was taught how to brush teeth n % n % n % n % No 183 50.7 160 54.1 19 35.8 4 33.3 Uses additional tools n % n % n % n % No 144 40 124 41.9 18 34.0 2 16.7 Oral health status and reasons for attendance The leading reasons for attending the clinic were periodontal therapy (18.8 %), tooth extraction (17.4 %) and restorative treatment (15.2 %). Other reasons included preventive examinations, prosthetic needs and management of oral mucosal lesions (Table 4). Periodontitis was diagnosed in 53.7% of participants, with stage IVB being the most frequent presentation (Table 5). Table 4 Reason for visit to the clinic along with the distribution in age groups. Total 65-74years 74-84years ≥85years Reason for visit n % n % N % n % Pain 33 9.14 24 8.4 8 15,1 1 8,3 Issuance of a certificate of the presence of infection foci 6 1.66 4 1,4 2 3,8 - - Preventive examination 43 11.9 38 12,8 4 7.5 1 8,3 Tooth extraction 63 17.45 49 16,6 9 17,0 5 41,7 Conservative treatment 55 15.2 45 15,2 10 18,9 - - Endodontic treatment 21 5.8 19 6,4 2 3,8 - - Removal of dental calculus 41 11.3 38 12,8 3 5,7 - - Prosthetic treatment 33 9.14 20 6,8 10 18,9 3 25,0 Tooth mobility 7 1.9 6 2,0 1 1,9 - Periodontal treatment 20 5.5 17 5,7 2 3,8 1 8,3 The presence of lesions on the oral mucosa 39 10.8 36 12,2 2 3,8 1 8,3 Table 5 Periodontitis stage distribution by age group Total 65-74 74-84 ≥85 n % n % n % n % Diagnosis of periodontitis 194 53.7 159 53.7 28 52.8 7 58.3 Advancement and complexity of periodontitis in age groups IIB 24 6.6 21 7.1 3 5.7 - - IIIB 67 18.5 56 18.9 9 17.0 2 16.7 IVB 95 26.3 75 25.3 15 28.3 5 41.7 IVC 8 2.2 7 2.4 1 1.9 - - Correlates of functional tooth loss Bivariate correlations between tooth count and medical or behavioural variables are summarised in Figure 1. In multivariable Poisson regression analysis, toothbrushing less than twice daily (adjusted prevalence ratio [aPR] = 1.41; 95% CI: 1.16 - 1.72; p = 0.001), irregular dental attendance (< 1 visit per year; aPR = 1.29; 95% CI: 1.07 - 1.55; p = 0.006), current smoking (aPR = 1.36; 95 % CI: 1.08 - 1.73; p = 0.010) and the presence of two or more systemic diseases (aPR = 1.33; 95 % CI: 1.11 - 1.59; p = 0.002) were independent predictors of functional tooth loss (< 20 teeth) (Table 6). Table 6 . Factors associated with having fewer than 20 teeth: multivariable Poisson regression analysis (N = 327*). Predictor aPR 95 % CI p Brushing <2 ×/day 1.41 1.16–1.72 0.001 No interdental cleaning 1.27 1.04–1.55 0.019 Dentist visits <1 ×/year 1.29 1.07–1.55 0.006 Current smoker 1.36 1.08–1.73 0.010 ≥2 systemic diseases 1.33 1.11–1.59 0.002 *Thirty‑four edentulous charts lacked covariate completeness. Abbreviations: aPR, adjusted prevalence ratios; CI, confidence interval; p, p -values; N, number of participants These findings indicate that both behavioural and systemic health factors contribute substantially to compromised oral function in older adults. To operationalise cumulative oral health risk, we developed the Geriatric Oral Health Vulnerability Score (GOHVS), summarising five independent predictors of functional tooth loss identified in the multivariable Poisson model: toothbrushing <2×/day, lack of interdental cleaning, irregular dental attendance (<1×/year), current smoking, and multimorbidity (≥2 systemic diseases). Each component contributed one point (range 0 - 5), with higher values indicating greater vulnerability. The predictive ability of the composite score for functional tooth loss (<20 teeth) was evaluated using receiver operating characteristic (ROC) analysis. Discrimination was considered acceptable (AUC = 0.76) Figure 2. Model calibration and goodness-of-fit were verified using the Pearson χ²/df and deviance/df statistics (both ≈ 1.0). Internal validity was tested via sensitivity analysis limited to the 65 - 74 year stratum, with < 5 % deviation in parameter estimates from the main model. Discussion Conducting research on the oral health of older adults is crucial because it allows for the identification of biological, behavioral, and social factors that increase the risk of tooth loss. At the same time, this research allows for the early identification of individuals at increased risk of tooth loss - before irreversible damage occurs - and the implementation of targeted interventions that can slow the development of oral frailty, improve chewing function, and contribute to maintaining overall mobility and quality of life in seniors [ 17 , 18 ]. This exploratory study provides insight into why first-time older dental attendees present with extensive unmet oral health needs, rather than merely describing how many are affected. The observed periodontal burden lies between estimates from highly serviced communities such as Korea and those with lower service accessibility, including certain United States. populations [ 19 , 20 ]. This suggests that healthcare system configuration and preventive orientation may exert a greater influence on oral health outcomes than biological ageing alone [ 19 ]. Late presentation in this cohort appears to be driven by structural barriers, therapeutic nihilism, and the insidious nature of periodontal destruction. Almost half of the participants lacked a functional dentition, a condition repeatedly associated with frailty, cognitive decline and nutrition-related sarcopenia [ 9 , 13 , 20 , 21 ]. Behavioural determinants - suboptimal plaque control and tobacco use - emerged as the most modifiable risk factors, in line with national data from Poland 11 and regional surveys [ 22 ]. Although in this study individuals with multiple chronic conditions appeared more likely to seek dental care, possibly reflecting greater awareness of their general health status [ 23 ], this tendency may decline when multimorbidity is accompanied by reduced physical functioning [ 24 ]. Furthermore, the observed associations between specific systemic diseases and tooth loss were weak (ρ < 0.10, non-significant), underscoring the need for more nuanced, disease-specific investigations. Polypharmacy warrants particular attention [ 13 ]. Xerostomia induced by β-blockers or antidepressants increases susceptibility to root surface caries [ 21 ] while anti-resorptive therapy elevates the risk of medication-related osteonecrosis [ 25 ]. The absence of a significant age-by-behaviour interaction, alongside comparable estimates obtained in the 65–74-year subgroup analysis, supports the robustness of the main findings. European context Across Europe, the proportion of older adults maintaining a functional dentition has steadily increased, yet marked East-West disparities persist. While older adults in Scandinavian countries typically retain more than 22 natural teeth, those in Central and Eastern Europe - including Poland, Bulgaria, and Hungary - average around 18–19 teeth, which closely aligns with our findings. This convergence suggests that absolute tooth retention may no longer be the primary indicator differentiating healthcare systems; instead, accessibility of services and the intensity of preventive care appear to be the key determinants of late-life oral health [ 11 , 26 – 30 ]. The relatively low prevalence of edentulism observed in this study (9.4%) compared with national estimates from 2014 (29%) [ 11 ] and 2017 (40.4%) [ 26 ] likely reflects differences in methodology and sample composition. In contrast, the prevalence of edentulism among individuals of similar age in countries such as Germany, France, Denmark, Switzerland, and Sweden remains below 15% [ 26 ] which may indicate an ongoing cultural transition away from the traditional “extraction-as-cure” model. Increasing prosthetic costs and a growing preference for fixed restorations are additional factors likely contributing to this shift [ 11 ]. Multimorbidity, polypharmacy and xerostomia as hidden drivers Although individual systemic diseases were only weakly correlated with tooth count, the cumulative burden of two or more chronic conditions remained an independent predictor of functional tooth loss. This aligns with previous evidence linking multimorbidity clusters to higher oral health expenditure [ 22 ]. Mechanistically, drug-induced xerostomia and complications related to anti-resorptive therapy represent under-recognised but clinically important contributors to oral decline. Such interactions are rarely captured in retrospective records, underscoring the need for integrated electronic health systems capable of identifying medication-related oral risks [ 17 ]. Behavioural leverage points and equity in access Behavioural factors - particularly inadequate plaque control and smoking - dominated the risk landscape, reflecting broader national trends [ 11 ]. Evidence suggests that chairside counselling can double smoking cessation rates, and that powered toothbrushes or interdental devices remain effective even among older adults with impaired dexterity [ 31 ]. The potential impact of behaviour-focused preventive interventions is therefore substantial. Nonetheless, systemic inequities persist [ 19 ]. In Poland, public funding covers primarily emergency dental services, while preventive aids remain out-of-pocket expenses [ 32 , 33 ]. Such financial arrangements disproportionately disadvantage lower-income seniors, a factor not directly measured in this study but widely recognised in European health equity analyses [ 26 , 27 , 31 , 34 ]. Interpretation of GOHVS components in light of existing evidence Each component of the GOHVS represents an established determinant of oral health decline in older adults. The two hygiene-related variables - brushing frequency below twice daily and lack of interdental cleaning - were among the strongest predictors of functional tooth loss. This finding mirrors longitudinal data from European and Asian cohorts showing that inadequate plaque control accelerates periodontal attachment loss and tooth mortality, even in the absence of overt caries [ 12 , 22 , 35 ]. Interdental cleaning remains particularly underutilised among older adults, where dexterity limitations and low preventive awareness persist [ 11 , 36 ]. Irregular dental attendance (< 1×/year) emerged as another major behavioural driver. Previous studies indicate that preventive visits are rare in ageing populations with limited insurance coverage or mobility restrictions [ 26 , 32 , 36 ]. Late presentation typically coincides with advanced periodontal disease or tooth loss, suggesting that access and care-seeking behaviour - rather than biological ageing alone - determine oral outcomes in later life [ 34 ]. Tobacco use, although less common in this cohort (13%), retained its well-documented association with periodontitis severity, impaired healing, and reduced success of prosthetic and implant therapies[ 21 , 38 ]. Targeted cessation counselling integrated into geriatric dental visits could therefore serve as a powerful preventive lever [ 26 ]. Finally, multimorbidity - defined as the coexistence of two or more chronic conditions - remained an independent systemic contributor to oral health vulnerability. Among systemic diseases, diabetes mellitus, cardiovascular disease, chronic kidney and respiratory diseases, neurological disorders, and rheumatoid arthritis have all been consistently associated with accelerated tooth loss in older adults. Diabetes exerts a particularly strong influence through chronic hyperglycaemia, which promotes dysbiosis, neutrophil dysfunction, and exaggerated inflammatory responses, ultimately leading to periodontal attachment loss and alveolar bone resorption. Cardiovascular diseases share similar inflammatory and oxidative pathways, while medications such as β-blockers or diuretics often induce xerostomia, further compromising oral homeostasis. Chronic kidney disease alters calcium-phosphate metabolism and systemic immunity, resulting in delayed wound healing and increased susceptibility to periodontitis. Likewise, chronic obstructive pulmonary disease and asthma are associated with medication-induced xerostomia, impaired hygiene, and microbial translocation between the oral cavity and airways. Neurological disorders such as Parkinson’s disease and dementia reduce manual dexterity and cognitive capacity, impeding adequate plaque control and prosthesis maintenance. Rheumatoid arthritis contributes through shared autoimmune pathways with periodontitis - particularly via Porphyromonas gingivalis-induced citrullination of proteins - and through impaired fine motor function required for daily oral hygiene.Together, these conditions exemplify the bidirectional relationship between systemic and oral health, positioning tooth loss as both a clinical endpoint and a marker of general frailty in ageing populations [ 39 , 40 ]. The influence of multimorbidity extends beyond shared risk factors to encompass medication-induced xerostomia, inflammation-mediated bone resorption, and functional limitations affecting oral hygiene [ 15 ]. Although no significant associations were observed between individual systemic diseases and tooth loss, multimorbidity itself emerged as a strong, independent predictor, reflecting the cumulative impact of chronic illness on oral health and functional dentition retention. Together, these components capture the multidimensional nature of oral frailty, spanning behavioural, systemic, and functional domains. Their integration within the GOHVS provides a pragmatic, evidence-based framework for identifying high-risk older adults in both clinical and community settings. Collectively, these findings emphasise the clinical utility of the GOHVS as a feasible screening framework that can be incorporated into preventive protocols or geriatric care pathways to identify individuals requiring intensified oral health support. Comparison of GOHVS with existing oral health indices Several composite instruments have been developed to assess oral health decline in older adults, including the Oral Frailty Index (OFI) [ 15 ], the Oral Health Assessment Tool (OHAT) [ 41 ], the Geriatric Oral Health Assessment Index (GOHAI) [ 42 ] and Oral Health Impact (OHI) [ 18 ].These tools encompass clinical, functional, and psychosocial dimensions of oral status, providing a broad perspective on oral frailty. However, they typically require clinical examination or patient-reported questionnaires, which may limit their use in routine dental or primary care settings. In contrast, the GOHVS was designed as a simplified, high-yield screening tool based on five easily obtainable variables: toothbrushing frequency, interdental cleaning, dental attendance, smoking, and multimorbidity. This minimal-data approach aligns with the pragmatic screening philosophy of geriatric medicine and public health, where time and resources are often constrained. Despite its brevity, the GOHVS achieved discrimination comparable to more comprehensive instruments (AUC = 0.76), indicating that a small set of behaviourally and systemically grounded predictors can effectively stratify risk. Rather than replacing multidimensional frailty indices, the GOHVS may serve as an initial triage tool - guiding clinicians toward more detailed assessments when elevated vulnerability is detected. External validation across diverse populations and healthcare contexts remains essential to determine its generalisability and predictive calibration [ 14 , 43 ]. Methodological and conceptual considerations The main methodological innovation of this study was the development of the Geriatric Oral Health Vulnerability Score (GOHVS), a simple composite index designed to capture cumulative behavioural and systemic risk factors affecting oral health in older adults. By integrating five readily measurable variables the GOHVS demonstrated acceptable discrimination for predicting functional tooth loss (AUC = 0.76). Its simplicity and reliance on routinely available data make it suitable for chairside use or integration into electronic screening tools in geriatric dentistry. However, since the GOHVS was both derived and tested within the same cohort, the possibility of overfitting cannot be excluded. External validation in larger, community-based populations, ideally incorporating socio-economic indicators and longitudinal follow-up, is required before wider clinical implementation. Moreover, temporal causality cannot be inferred, as poor hygiene behaviours may both contribute to and result from tooth loss. Future longitudinal studies are necessary to clarify these bidirectional relationships. To advance gerodontological research and facilitate clinical translation, future studies should focus on external validation of the GOHVS in community-based and longitudinal cohorts, including pilot testing in digital application formats. Incorporating salivary biomarkers could enhance the assessment of xerogenic medication effects and identify individuals at elevated risk of root caries or mucosal pathology. Mixed-methods research is also warranted to explore cultural and attitudinal factors underlying delayed dental attendance among older adults, while evaluations of cost-effectiveness and accessibility of mobile or rural outreach dental models -particularly within the Polish healthcare context - could inform equitable service delivery. Collectively, these actions would help reposition oral health as a cornerstone of healthy ageing rather than an elective or aesthetic service [ 31 , 44 ]. Policy priorities should include expanding domiciliary and teledentistry services for the oldest-old to address barriers related to mobility and transportation, integrating personalised hygiene coaching and adaptive oral care devices at every patient contact - especially for those with limited dexterity - and implementing the five-item GOHVS as a simple triage tool to identify high-risk individuals for preventive intervention. Although the GOHVS demonstrated fair discrimination (AUC = 0.76), its development and validation within a single cohort necessitate further testing across diverse populations before broader clinical adoption. The study’s main strengths include a well-defined first-visit geriatric cohort, rigorous examiner calibration with standardised data extraction, and robust statistical modelling supported by sensitivity analyses. Limitations include its single-centre design, which may introduce referral bias, retrospective data collection that limits causal inference, and the absence of socio-economic variables restricting generalisability. Additionally, possible survivor bias among participants aged 85 years and older and the lack of a comparison group of regular dental attenders should be considered when interpreting the findings. Conclusion Older adults attending dental care for the first time often present with preventable oral diseases that are closely linked to modifiable behaviours and the presence of multimorbidity. The GOHVS, which integrates five key risk factors - low brushing frequency, non-use of interdental cleaning devices, infrequent dental attendance, smoking, and multimorbidity - offers a practical framework for identifying individuals at greatest risk of oral health deterioration. Early, targeted prevention based on these determinants could substantially reduce disease burden, improve retention of functional dentition, and enhance overall quality of life in ageing populations. By facilitating risk stratification and guiding personalised interventions, the GOHVS supports the integration of oral healthcare into broader healthy ageing strategies and aligns with global public health objectives promoting longevity with preserved function and well-being. Because the GOHVS relies exclusively on routinely collected behavioural and medical information, it may be particularly useful as a low-burden screening tool in diverse healthcare settings, including primary care and community-based geriatric services. Due to the cross-sectional design of the study, causal relationships between the identified risk factors and functional tooth loss cannot be inferred. Abbreviations GOHVS - Geriatric Oral Health Vulnerability Score aPR - adjusted prevalence ratio CI - Confidence Interval ROC - Receiver Operating Characteristic AUC - Area Under the Curve WHO- World Health Organization OFI - Oral Frailty Index OHAT - Oral Health Assessment Tool OHI - Oral Health Impact Declarations Ethics approval This study's protocol was reviewed and approved by the Bioethics Committee of the Pomeranian Medical University in Szczecin, Poland (KB 0012/14/2022). All the protocols were followed in accordance with the 1964 Helsinki Declaration and its later amendments. Consent for publication Not applicable Competing interests The authors have no conflicts of interest to declare. Funding None Author Contribution RS conceived and designed the study, collected the data, interpreted the results, drafted the manuscript, and approved the final version. NT contributed to data collection and literature review. KKJ contributed to the literature review and manuscript drafting.MMR contributed to the study design, performed the statistical analyses, and contributed to manuscript drafting. All authors read and approved the final manuscript. Acknowledgement Manuscript preparation was supported during Harvard Medical School’s Polish Clinical Scholars Research Training Program, organised by the Agencja Badan Medycznych (ABM, English: Medical Research Agency, Warsaw, Poland) Data Availability The study datasets are available from the corresponding author upon reasonable request. References United Nations. World Population Ageing 2019. New, York. 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Periodontal status and selected parameters of oral condition of Poles aged from 65 to 74 years Przegl. Epidemiol. 2015;69:643–7. Lee JH, Yi SK, Kim SY, Kim JS, Kim HN, Jeong SH, Kim JB. Factors Related to the Number of Existing Teeth among Korean Adults Aged 55–79 Years. Int J Environ Res Public Health. 2019;16(20):3927. 10.3390/ijerph16203927 . Shwe PS, Ward SA, Thein PM, Junckerstorff R. Frailty, oral health and nutrition in geriatric inpatients: a cross-sectional study. Gerodontology. 2019;36(3):223–8. 10.1111/ger.12397 . Kossioni AE, Hajto-Bryk J, Maggi S, et al. An Expert Opinion from the European College of Gerodontology and the European Geriatric Medicine Society: European Policy Recommendations on Oral Health in Older Adults. J Am Geriatr Soc. 2018;66(3):609–13. 10.1111/jgs.15191 . Tanaka T, Tani Y, Akishita M, Hirano H, et al. Consensus statement on oral frailty from the Japan Geriatrics Society and the Japanese Society of Gerodontology. Geriatr Gerontol Int. 2024;24(3):201–11. 10.1111/ggi.14780 . World Health Organization. Decade of Healthy Ageing 2020–2030. Geneva: WHO. 2020. https://www.who.int/initiatives/decade-of-healthy-ageing Acessed November 12, 2025. Allen F, Tsakos G. Challenges in oral health research for older adults. Gerodontology. 2024;41(1):2–8. 10.1111/ger.12681 . Liu WY, Chuang YC, Chien CW, Tung TH. Oral health diseases among older people: a general health perspective. J Mens Health. 2021;17(1):7–15. 10.31083/jomh.v17i1.316 . Jiang CM, Chu CH, Duangthip D, et al. Global Perspectives of Oral Health Policies and Oral Healthcare Schemes for Older Adult Populations. Front Oral Health. 2021;2:703526. 10.3389/froh.2021.703526 . Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJCDC, Periodontal Disease Surveillance Workgroup. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012;91(10):914–20. 10.1177/0022034512457373 . Komiyama T, Ohi T, Miyoshi Y, et al. Number of teeth and functional disability in community-dwelling older adults. Gerodontology. 2025;42(1):86–92. 10.1111/ger.12775 . Listl S, Galloway J, Mossey PA, Marcenes W. Global economic impact of dental diseases. J Dent Res. 2015;94(10):1355–61. 10.1177/0022034515602879 . Ohi T, Sai M, Kikuchi M, et al. Determinants of the utilization of dental services in a community-dwelling elderly Japanese population. Tohoku J Exp Med. 2009;218(3):241–9. 10.1620/tjem.218.241 . Kovács N, Liska O, Idara-Umoren EO, Mahrouseh N, Varga O. Trends in dental care utilisation among the elderly using longitudinal data from 14 European countries: A multilevel analysis. PLoS ONE. 2023;18(6):e0286192. 10.1371/journal.pone.0286192 . Moreno-Rabié C, Fontenele RC, Oliveira-Santos N, Nogueira-Reis F, Van den Wyngaert T, Jacobs R. Key insights into antiresorptive drug use and osteonecrosis in osteoporotic patients undergoing tooth extractions: A clinical and CBCT assessment. Osteoporos Int. 2024;35(8):1431–40. 10.1007/s00198-024-07108-2 . Mehr K, Olszanecka-Glinianowicz M, Chudek J, et al. Dental status in the Polish senior population and its correlates—results of the national survey PolSenior. Gerodontology. 2018;35(4):398–406. 10.1111/ger.12364 . Dąbrowski W, Jagiełło K, Mossakowska M, et al. Evaluating changes in dental status among Polish older adults over a decade: A comparative analysis of PolSenior (2009) and PolSenior2 (2019) surveys. Dent Med Probl. 2025;62(1):23–30. 10.17219/dmp/196535 . Górska R, Wysokińska-Miszczuk J, Pietruska M, et al. Evaluating changes in dental status among Polish older adults: a 20-year analysis. Gerodontology. 2023;40(1):67–75. 10.1111/ger.12629 . Bałut M, Wierzbicka M, Borysewicz-Lewicka M, et al. Epidemiology of oral health in older adults aged 65 or over: Polish national data. Gerodontology. 2023;40(3):285–94. 10.1111/ger.12662 . Skrzypczak B, Górska R, Pietruska M. The impact of socioeconomic status, general health, and oral hygiene behaviours on dental attendance among older adults. Gerodontology. 2022;39(4):352–60. 10.1111/ger.12602 . Janto M, Iurcov R, Daina CM, et al. Oral Health among Elderly, Impact on Life Quality, Access of Elderly Patients to Oral Health Services and Methods to Improve Oral Health: A Narrative Review. J Pers Med. 2022;12(3):372. 10.3390/jpm12030372 . Gaszynska E, Szatko F, Godala M, Gaszynski T. Oral health status, dental treatment needs, and barriers to dental care of elderly care home residents in Lodz, Poland. Clin Interv Aging. 2014;9:1637–44. 10.2147/CIA.S69790 . Manski R, Moeller J, Chen H, Widström E, Listl S. Disparity in dental attendance among older adult populations: a comparative analysis across selected European countries and the USA. Int Dent J. 2016;66(1):36–48. 10.1111/idj.12190 . Ghanbari-Jahromi M, Bastani P, Jalali FS, Delavari S. Factors affecting oral and dental services` utilization among Elderly: a scoping review. BMC Oral Health. 2023;23(1):597. 10.1186/s12903-023-03285-4 . Huang X, Kang L, Bi J. Epidemiology of oral health in older adults aged 65 or over: prevalence, risk factors and prevention. Aging Clin Exp Res. 2025;37(1):193. 10.1007/s40520-025-03110-8 . Leung KC, Chu CH. Dental Care for Older Adults. Int J Environ Res Public Health. 2022;20(1):214. 10.3390/ijerph20010214 . Yoshino K, Ito K, Kuroda M, Sugihara N. Tooth Loss in Problem-oriented, Irregular, and Regular Attenders at Dental Offices. Bull Tokyo Dent Coll. 2016;57(1):11–9. 10.2209/tdcpublication.57.11 . Haworth S, Shungin D, Kwak SY, et al. Tooth loss is a complex measure of oral disease: Determinants and methodological considerations. Community Dent Oral Epidemiol. 2018;46(6):555–62. 10.1111/cdoe.12391 . Bomfim RA, Cascaes AM, de Oliveira C. Multimorbidity and tooth loss: the Brazilian National Health Survey, 2019. BMC Public Health. 2021;21(1):2311. 10.1186/s12889-021-12392-2 . Wu Y, Liu H, Qin Y, et al. Association between multimorbidity and having less than 20 natural teeth among Chinese older adults: a cross-sectional study. Sci Rep. 2025;15(1):7865. 10.1038/s41598-025-92426-6 . Chalmers JM, King PL, Spencer AJ, Wright FA, Carter KD. The oral health assessment tool–validity and reliability. Aust Dent J. 2005;50(3):191–9. 10.1111/j.1834-7819.2005.tb00360.x . Atchison KA, Dolan TA. Development of the Geriatric Oral Health Assessment Index. J Dent Educ. 1990;54(11):680–7. Allen PF, Ettinger RL, Walls AWG. Challenges in oral health research for older adults. Gerodontology. 2023;40(2):105–12. 10.1111/ger.12652 . Gryglewska B, Perera I, Klimek E, et al. Teledentistry and oral health in older adults - aspects for implementation of the Patient centric solution for smart and sustainable healthcare (ACESO) project. Folia Med Cracov. 2022;62(2):5–16. 10.24425/fmc.2022.141697 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8507381","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":585997107,"identity":"334a4f01-2441-4de9-b622-f26877a4ca0d","order_by":0,"name":"Renata Samulak","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYJADxgMMB2wgTB4g5sOn9gCcPpCG0MJGpJbDhLWYt/ce/PyhhsGef9oZgwM/zpzPM7h2gPHB2zaGPFxaZM6cS5Y4cIwhccbtHIODPTduFxvcTmA2nNvGUIxLi4REjoHEATaGBAaglgM8H24nbridwCbN28aQ2IZLi/wb4x8H/jHYy4Ns+fPhHEgL+2+8WiR4zCQOtjEwbgBqOcxz4wDYFma8WnhyzCzO9kkkbrydVnBY5kxyseTtxGbJOeckcPuF/YzxjYpvNvZyt5M3PnxzzC6P73bywQ9vymzy+HFogemEsxKAqaABJJKAXwcSSMBgjIJRMApGwYgHAFHhYXvoXZp1AAAAAElFTkSuQmCC","orcid":"","institution":"Pomeranian Medical University in Szczecin","correspondingAuthor":true,"prefix":"","firstName":"Renata","middleName":"","lastName":"Samulak","suffix":""},{"id":585997111,"identity":"2a03566a-6be6-49ed-b388-5bfe8d1d1bd6","order_by":1,"name":"Nanxi Tao","email":"","orcid":"","institution":"Pomeranian Medical University in Szczecin","correspondingAuthor":false,"prefix":"","firstName":"Nanxi","middleName":"","lastName":"Tao","suffix":""},{"id":585997112,"identity":"cd8e2714-ada8-4138-8e81-b3e714c2aa76","order_by":2,"name":"Katarzyna Krycka-Juraś","email":"","orcid":"","institution":"Pomeranian Medical University in Szczecin","correspondingAuthor":false,"prefix":"","firstName":"Katarzyna","middleName":"","lastName":"Krycka-Juraś","suffix":""},{"id":585997113,"identity":"817e04ca-978a-451a-b66a-016b62f99452","order_by":3,"name":"Monika Machoy-Rakoczy","email":"","orcid":"","institution":"Pomeranian Medical University in Szczecin","correspondingAuthor":false,"prefix":"","firstName":"Monika","middleName":"","lastName":"Machoy-Rakoczy","suffix":""}],"badges":[],"createdAt":"2026-01-03 14:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8507381/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8507381/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102211643,"identity":"45121961-d12a-49a2-9b60-72b84092b09e","added_by":"auto","created_at":"2026-02-09 12:27:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":79251,"visible":true,"origin":"","legend":"\u003cp\u003eDeterminants of tooth loss resulting resulting in tooth loss leading to the presence of fewer than 20 functional teeth\u003c/p\u003e\n\u003cp\u003eAbbreviations: \u0026lt; 2x brushing, frequency of teeth brushing less than twice a day; no interdental, lack of interdental cleaning tools usage; dentist \u0026lt;1/y, less than one dental visit per year\u003c/p\u003e","description":"","filename":"Figure11.png","url":"https://assets-eu.researchsquare.com/files/rs-8507381/v1/2d20b72b45b93415e3892215.png"},{"id":102211642,"identity":"5766c71e-de86-4276-a780-f1e5b61bc651","added_by":"auto","created_at":"2026-02-09 12:27:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":107335,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver operating characteristic (ROC) curve illustrating the diagnostic performance of the Geriatric Oral Health Vulnerability Score (GOHVS). The area under the curve (AUC) indicates the model’s ability to discriminate between individuals with and without oral health vulnerability.\u003c/p\u003e","description":"","filename":"Figure21.png","url":"https://assets-eu.researchsquare.com/files/rs-8507381/v1/e7ad09e1cf87394e620bf5ef.png"},{"id":102211682,"identity":"eb8a6c24-0764-4b5c-aea7-76200cf56681","added_by":"auto","created_at":"2026-02-09 12:28:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1265417,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8507381/v1/67f3fc2b-2ac4-408a-b711-e589356eca5d.pdf"},{"id":102211654,"identity":"a6db4427-39c7-4d88-b45a-ea7a43d66da5","added_by":"auto","created_at":"2026-02-09 12:28:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":119110,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.GeriatricOralHealthVulnerabilityScoreGOHVS.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8507381/v1/aca2b862ab386609b8894029.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development of a Geriatric Oral Health Vulnerability Score (GOHVS) and Its Association with Functional Tooth Loss in Older Adults: A Cross-Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003ePopulation ageing is a global phenomenon driven by increasing life expectancy and declining birth rates. In 2019, the United Nations reported 703\u0026nbsp;million people aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years, a figure projected to exceed 1.5\u0026nbsp;billion by 2050 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Poland follows this demographic trend, with adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years comprising 17.7% of the population in 2019 and expected to reach 32.7% by 2050 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Oral health is an integral component of healthy ageing, yet oral diseases such as dental caries, periodontitis, xerostomia and tooth loss remain highly prevalent among older adults [\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These conditions, often exacerbated by multimorbidity and polypharmacy - for example, β-blocker-induced xerostomia or bisphosphonate-related osteonecrosis - can contribute to chronic systemic inflammation, thereby aggravating diabetes, cardiovascular disease and cognitive decline [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Functional deterioration in the oral cavity is increasingly recognised as part of the broader construct of oral frailty, which affects nutrition, health status, communication and quality of life in later years [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Despite this, dental attendance among older adults in Central and Eastern Europe remains suboptimal. In Poland, approximately 29% of older adults are edentulous and 44% have lost ten or more teeth [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Such figures suggest that access barriers, low preventive awareness and the gradual, painless nature of periodontal disease delay care until functional impairment becomes evident [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The absence of functional dentition is a key component of oral frailty, leading to a gradual deterioration of chewing, swallowing, and articulation functions, which can result in malnutrition, sarcopenia, and overall frailty [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly identification of individuals at increased risk of tooth loss allows for the implementation of preventive and rehabilitation measures that can reverse or slow the progression of oral frailty [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Maintaining functional dentition is therefore not only a component of oral health but also a protective factor against physical decline, social isolation, and increased mortality in the elderly [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWithin the framework of the WHO Decade of Healthy Ageing (2020\u0026ndash;2030) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] a better understanding of first-time dental attendees among older adults could inform risk-stratified preventive strategies. Therefore, this study aimed to describe the oral health status, systemic disease burden and hygiene behaviours of adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years presenting for their initial dental visit at a university clinic.\u003c/p\u003e \u003cp\u003eThe null hypothesis is that there is no significant association between oral hygiene behaviours, multimorbidity and functional tooth loss in adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years. The alternative hypothesis assumed that poor hygiene behaviours and higher multimorbidity are associated with an increased likelihood of functional tooth loss (\u0026lt;\u0026thinsp;20 teeth), therefore contributing to oral fragility.\u003c/p\u003e \u003cp\u003eBased on these risk factors, we further aimed to propose a simple composite index - the Geriatric Oral Health Vulnerability Score (GOHVS) - to quantify cumulative oral health risk and facilitate the identification of high-risk older adults.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and ethical approval\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional, retrospective review of electronic health records from the University Dental Clinic, Pomeranian Medical University, Szczecin, Poland. The study protocol received approval from the Bioethics Committee of the Pomeranian Medical University (KB 0012/14/2022) and was conducted in accordance with the Declaration of Helsinki. Reporting followed the STROBE guidelines for observational studies. The requirement for informed consent was waived by the Bioethics Committee of the Pomeranian Medical University due to the retrospective and anonymized nature of the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eAll patients aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years who attended the clinic for the first time between 1 January 2022 and 31 December 2023 were screened (N\u0026thinsp;=\u0026thinsp;395). Individuals with incomplete data - specifically missing panoramic radiographs or medical questionnaires - or previous care at the same clinic were excluded (n\u0026thinsp;=\u0026thinsp;34), resulting in a final sample of 361 participants. Although institutional records confirmed that these were first-time visits to the university clinic, prior treatment in external, particularly private, dental practices could not be ruled out, introducing a potential source of selection bias.\u003c/p\u003e\n\u003ch3\u003eData collection and calibration\u003c/h3\u003e\n\u003cp\u003eTwo independent examiners, both blinded to the study hypothesis, were trained and calibrated prior to data extraction (Cohen\u0026rsquo;s κ\u0026thinsp;=\u0026thinsp;0.91 for tooth count; κ\u0026thinsp;=\u0026thinsp;0.88 for periodontal stage). Thirty randomly selected charts were double-scored to confirm inter-examiner reliability. Extracted variables included demographic data, medical diagnoses (ICD-10 codes), number of chronic conditions, medication profiles, smoking status, oral hygiene habits (frequency of toothbrushing and use of interdental aids), dental attendance frequency, tooth count, periodontal stage (classified according to the 2018 World Workshop criteria) and primary reason for visit. The GOHVS was derived from routinely collected clinical and behavioural data recorded at the time of the initial dental visit; no additional patient questionnaires were administered for the purpose of this study.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and categorical variables as percentages (n). Group differences were examined using χ\u0026sup2; or Kruskal-Wallis tests, as appropriate. Bivariate associations between tooth number and clinical or behavioural variables were explored using Spearman\u0026rsquo;s rank correlation coefficient (ρ).\u003c/p\u003e \u003cp\u003eVariables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.20 in bivariate analysis were entered into a multivariable Poisson regression model with robust variance to estimate adjusted prevalence ratios (aPR) for functional tooth loss, defined as \u0026lt;\u0026thinsp;20 remaining natural teeth in accordance with the WHO functional dentition benchmark. Model fit was satisfactory (Pearson χ\u0026sup2;/df\u0026thinsp;=\u0026thinsp;1.04; deviance/df\u0026thinsp;=\u0026thinsp;1.02).\u003c/p\u003e \u003cp\u003eAll analyses were conducted using R software (version 4.3), with the level of statistical significance set at α\u0026thinsp;=\u0026thinsp;0.05. Potential interactions between age group and each behavioural predictor were tested using multiplicative terms; none reached statistical significance (all p\u0026thinsp;\u0026gt;\u0026thinsp;0.10). A sensitivity analysis restricted to the 65\u0026ndash;74 year age stratum (n\u0026thinsp;=\u0026thinsp;296) produced prevalence ratio estimates differing by \u0026lt;\u0026thinsp;5% from the main model, indicating the robustness of the findings. Following identification of independent predictors in the multivariable model, a composite Geriatric Oral Health Vulnerability Score (GOHVS) was constructed retrospectively using routinely collected clinical and behavioural data; no additional questionnaires were administered to participants (Supplementary File 1). Each significant variable contributed one point (range 0\u0026ndash;5), with higher values indicating greater vulnerability. The model\u0026rsquo;s discriminative ability for functional tooth loss was evaluated using ROC analysis (AUC\u0026thinsp;=\u0026thinsp;0.76)\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCohort characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants had a mean age of 69.9 \u0026plusmn; 5.9 years, and 61.8% were women. The mean number of remaining natural teeth was 17.9 \u0026plusmn; 7.2 (Table 1). Overall, 13% of the cohort were current smokers (Table 2). Most participants showed limited engagement in preventive dental care: 59.8% reported visiting a dentist less than once per year, and 39.9% had never used interdental cleaning aids (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 1. Baseline characteristics of the participants included in the study (N = 361).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e65-74years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e74-84years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026ge;85years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e223 (62.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e184 (82.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e32 (14.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e7 \u0026nbsp;(3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e138 \u0026nbsp;(38.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e112 (81.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e21 (15.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e5 \u0026nbsp;(3.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eNumer of teeth (n\u0026plusmn;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e17.9 \u0026plusmn; 7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e18.6\u0026plusmn; 7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e18.2\u0026plusmn; 7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e15.7\u0026plusmn; 6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: N, number of participants \u0026nbsp;SD, standard deviation, n, number of teeth\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable.2 General health conditions, medication use, and lifestyle factors among study participants.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.801%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactor\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.801%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCondition\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e58.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eDyslipidaemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e39.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eDiabetes mellitus (type\u0026nbsp;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e20.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eCardiovascular disease (IHD/heart failure)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e19.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eChronic kidney disease (eGFR\u0026nbsp;\u0026lt;60\u0026nbsp;mL/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eChronic obstructive pulmonary disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eOsteoporosis/osteopenia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eRheumatoid / inflammatory arthritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eCerebrovascular disease (stroke/TIA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e8.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eNeurodegenerative disorder (Parkinson / Alzheimer)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eActive or past malignancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eGastro‑oesophageal reflux disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eAnxiety disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003e\u0026ge; 2 chronic conditions (multimorbidity)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e45.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.801%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003ePolypharmacy\u0026nbsp;(\u0026ge; 5 daily medications)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e32.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eAnticoagulant / antiplatelet therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e21.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eAntiresorptive drugs use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eImmunosuppressive therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.801%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking status\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eCurrent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eFormer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e33.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eNever\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e52.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 70.801%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlcohol intake\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e43.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eOccasional (\u0026le; 1 \u0026times;/week)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e41.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eWeekly (2\u0026ndash;4 \u0026times;/week)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e12.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 70.801%;\"\u003e\n \u003cp\u003eDaily\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1447%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17.0543%;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 3. Dental care utilisation and oral hygiene habits in studied population.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"609\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e65-74years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e74-84years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;85years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of dental visits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eMore often than every 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eEvery 6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eEvery year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e26.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eLess often than once a year\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e56.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e71.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e91.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eNo response\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency of brushing teeth\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eLess than once a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e8.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eOnce a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e21.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e37.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eTwice a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e70.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e73.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e58.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eNo response\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWas taught how to brush teeth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e50.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e54.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e35.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUses additional tools\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e41.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e34.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10%;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOral health status and reasons for attendance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe leading reasons for attending the clinic were periodontal therapy (18.8 %), tooth extraction (17.4 %) and restorative treatment (15.2 %). Other reasons included preventive examinations, prosthetic needs and management of oral mucosal lesions (Table 4). Periodontitis was diagnosed in 53.7% of participants, with stage IVB being the most frequent presentation (Table 5).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 Reason for visit to the clinic along with the distribution in age groups.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"679\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 21.3235%;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 21.4706%;\"\u003e\n \u003cp\u003e65-74years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 21.4706%;\"\u003e\n \u003cp\u003e74-84years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 19.4118%;\"\u003e\n \u003cp\u003e\u0026ge;85years\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003eReason for visit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.7353%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.82353%;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003ePain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.7353%;\"\u003e\n \u003cp\u003e9.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e15,1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.82353%;\"\u003e\n \u003cp\u003e8,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003eIssuance of a certificate of the presence of infection foci\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.7353%;\"\u003e\n \u003cp\u003e1.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e1,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e3,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.82353%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003ePreventive examination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.7353%;\"\u003e\n \u003cp\u003e11.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e12,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.82353%;\"\u003e\n \u003cp\u003e8,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003eTooth extraction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.7353%;\"\u003e\n \u003cp\u003e17.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e16,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e17,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.82353%;\"\u003e\n \u003cp\u003e41,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003eConservative treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.7353%;\"\u003e\n \u003cp\u003e15.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e15,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e18,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.82353%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003eEndodontic treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.7353%;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e6,4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e3,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.82353%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003eRemoval of dental calculus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.7353%;\"\u003e\n \u003cp\u003e11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e12,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e5,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.82353%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003eProsthetic treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.7353%;\"\u003e\n \u003cp\u003e9.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e6,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e18,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.82353%;\"\u003e\n \u003cp\u003e25,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003eTooth mobility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.7353%;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e2,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e1,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.82353%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003ePeriodontal treatment \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.7353%;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e5,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e3,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.82353%;\"\u003e\n \u003cp\u003e8,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.3235%;\"\u003e\n \u003cp\u003eThe presence of lesions on the oral mucosa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.7353%;\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e12,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.8824%;\"\u003e\n \u003cp\u003e3,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.5882%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.82353%;\"\u003e\n \u003cp\u003e8,3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5 Periodontitis stage distribution by age group\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e65-74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e74-84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026ge;85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eDiagnosis of periodontitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e53.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e53.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e52.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e58.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdvancement and complexity of periodontitis in age groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eIIB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e6.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e7.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eIIIB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e18.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eIVB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e25.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e28.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e41.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 121px;\"\u003e\n \u003cp\u003eIVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelates of functional tooth loss\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBivariate correlations between tooth count and medical or behavioural variables are summarised in Figure 1. In multivariable Poisson regression analysis, toothbrushing less than twice daily (adjusted prevalence ratio [aPR] = 1.41; 95% CI: 1.16 - 1.72; p = 0.001), irregular dental attendance (\u0026lt; 1 visit per year; aPR = 1.29; 95% CI: 1.07 - 1.55; p = 0.006), current smoking (aPR = 1.36; 95 % CI: 1.08 - 1.73; p = 0.010) and the presence of two or more systemic diseases (aPR = 1.33; 95 % CI: 1.11 - 1.59; p = 0.002) were independent predictors of functional tooth loss (\u0026lt; 20 teeth) (Table 6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 6\u003cstrong\u003e.\u003c/strong\u003e Factors associated with having fewer than 20 teeth: multivariable Poisson regression analysis (N = 327*).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"3\" cellpadding=\"0\" width=\"639\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePredictor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eaPR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e95 % CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBrushing\u0026nbsp;\u0026lt;2 \u0026times;/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.16\u0026ndash;1.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNo interdental cleaning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.04\u0026ndash;1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDentist visits\u0026nbsp;\u0026lt;1 \u0026times;/year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.07\u0026ndash;1.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCurrent smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.08\u0026ndash;1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ge;2 systemic diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.11\u0026ndash;1.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Thirty‑four edentulous charts lacked covariate completeness.\u003c/p\u003e\n\u003cp\u003eAbbreviations: aPR, adjusted prevalence ratios; CI, confidence interval; p, p -values; N, number of participants\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThese findings indicate that both behavioural and systemic health factors contribute substantially to compromised oral function in older adults. To operationalise cumulative oral health risk, we developed the Geriatric Oral Health Vulnerability Score (GOHVS), summarising five independent predictors of functional tooth loss identified in the multivariable Poisson model: toothbrushing \u0026lt;2\u0026times;/day, lack of interdental cleaning, irregular dental attendance (\u0026lt;1\u0026times;/year), current smoking, and multimorbidity (\u0026ge;2 systemic diseases). Each component contributed one point (range 0 - 5), with higher values indicating greater vulnerability. The predictive ability of the composite score for functional tooth loss (\u0026lt;20 teeth) was evaluated using receiver operating characteristic (ROC) analysis. Discrimination was considered acceptable (AUC = 0.76) Figure 2. Model calibration and goodness-of-fit were verified using the Pearson \u0026chi;\u0026sup2;/df and deviance/df statistics (both \u0026asymp; 1.0). Internal validity was tested via sensitivity analysis limited to the 65 - 74 year stratum, with \u0026lt; 5 % deviation in parameter estimates from the main model.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eConducting research on the oral health of older adults is crucial because it allows for the identification of biological, behavioral, and social factors that increase the risk of tooth loss. At the same time, this research allows for the early identification of individuals at increased risk of tooth loss - before irreversible damage occurs - and the implementation of targeted interventions that can slow the development of oral frailty, improve chewing function, and contribute to maintaining overall mobility and quality of life in seniors [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis exploratory study provides insight into why first-time older dental attendees present with extensive unmet oral health needs, rather than merely describing how many are affected. The observed periodontal burden lies between estimates from highly serviced communities such as Korea and those with lower service accessibility, including certain United States. populations [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This suggests that healthcare system configuration and preventive orientation may exert a greater influence on oral health outcomes than biological ageing alone [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Late presentation in this cohort appears to be driven by structural barriers, therapeutic nihilism, and the insidious nature of periodontal destruction.\u003c/p\u003e \u003cp\u003eAlmost half of the participants lacked a functional dentition, a condition repeatedly associated with frailty, cognitive decline and nutrition-related sarcopenia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Behavioural determinants - suboptimal plaque control and tobacco use - emerged as the most modifiable risk factors, in line with national data from Poland\u003csup\u003e11\u003c/sup\u003e and regional surveys [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Although in this study individuals with multiple chronic conditions appeared more likely to seek dental care, possibly reflecting greater awareness of their general health status [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], this tendency may decline when multimorbidity is accompanied by reduced physical functioning [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Furthermore, the observed associations between specific systemic diseases and tooth loss were weak (ρ \u0026lt; 0.10, non-significant), underscoring the need for more nuanced, disease-specific investigations. Polypharmacy warrants particular attention [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Xerostomia induced by β-blockers or antidepressants increases susceptibility to root surface caries [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] while anti-resorptive therapy elevates the risk of medication-related osteonecrosis [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The absence of a significant age-by-behaviour interaction, alongside comparable estimates obtained in the 65–74-year subgroup analysis, supports the robustness of the main findings.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEuropean context\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eAcross Europe, the proportion of older adults maintaining a functional dentition has steadily increased, yet marked East-West disparities persist. While older adults in Scandinavian countries typically retain more than 22 natural teeth, those in Central and Eastern Europe - including Poland, Bulgaria, and Hungary - average around 18–19 teeth, which closely aligns with our findings. This convergence suggests that absolute tooth retention may no longer be the primary indicator differentiating healthcare systems; instead, accessibility of services and the intensity of preventive care appear to be the key determinants of late-life oral health [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR27 CR28 CR29\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e–\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe relatively low prevalence of edentulism observed in this study (9.4%) compared with national estimates from 2014 (29%) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and 2017 (40.4%) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] likely reflects differences in methodology and sample composition. In contrast, the prevalence of edentulism among individuals of similar age in countries such as Germany, France, Denmark, Switzerland, and Sweden remains below 15% [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] which may indicate an ongoing cultural transition away from the traditional “extraction-as-cure” model. Increasing prosthetic costs and a growing preference for fixed restorations are additional factors likely contributing to this shift [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMultimorbidity, polypharmacy and xerostomia as hidden drivers\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eAlthough individual systemic diseases were only weakly correlated with tooth count, the cumulative burden of two or more chronic conditions remained an independent predictor of functional tooth loss. This aligns with previous evidence linking multimorbidity clusters to higher oral health expenditure [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Mechanistically, drug-induced xerostomia and complications related to anti-resorptive therapy represent under-recognised but clinically important contributors to oral decline. Such interactions are rarely captured in retrospective records, underscoring the need for integrated electronic health systems capable of identifying medication-related oral risks [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eBehavioural leverage points and equity in access\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eBehavioural factors - particularly inadequate plaque control and smoking - dominated the risk landscape, reflecting broader national trends [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Evidence suggests that chairside counselling can double smoking cessation rates, and that powered toothbrushes or interdental devices remain effective even among older adults with impaired dexterity [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The potential impact of behaviour-focused preventive interventions is therefore substantial. Nonetheless, systemic inequities persist [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In Poland, public funding covers primarily emergency dental services, while preventive aids remain out-of-pocket expenses [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Such financial arrangements disproportionately disadvantage lower-income seniors, a factor not directly measured in this study but widely recognised in European health equity analyses [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInterpretation of GOHVS components in light of existing evidence\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eEach component of the GOHVS represents an established determinant of oral health decline in older adults. The two hygiene-related variables - brushing frequency below twice daily and lack of interdental cleaning - were among the strongest predictors of functional tooth loss. This finding mirrors longitudinal data from European and Asian cohorts showing that inadequate plaque control accelerates periodontal attachment loss and tooth mortality, even in the absence of overt caries [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Interdental cleaning remains particularly underutilised among older adults, where dexterity limitations and low preventive awareness persist [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIrregular dental attendance (\u0026lt; 1×/year) emerged as another major behavioural driver. Previous studies indicate that preventive visits are rare in ageing populations with limited insurance coverage or mobility restrictions [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Late presentation typically coincides with advanced periodontal disease or tooth loss, suggesting that access and care-seeking behaviour - rather than biological ageing alone - determine oral outcomes in later life [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTobacco use, although less common in this cohort (13%), retained its well-documented association with periodontitis severity, impaired healing, and reduced success of prosthetic and implant therapies[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Targeted cessation counselling integrated into geriatric dental visits could therefore serve as a powerful preventive lever [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Finally, multimorbidity - defined as the coexistence of two or more chronic conditions - remained an independent systemic contributor to oral health vulnerability. Among systemic diseases, diabetes mellitus, cardiovascular disease, chronic kidney and respiratory diseases, neurological disorders, and rheumatoid arthritis have all been consistently associated with accelerated tooth loss in older adults. Diabetes exerts a particularly strong influence through chronic hyperglycaemia, which promotes dysbiosis, neutrophil dysfunction, and exaggerated inflammatory responses, ultimately leading to periodontal attachment loss and alveolar bone resorption. Cardiovascular diseases share similar inflammatory and oxidative pathways, while medications such as β-blockers or diuretics often induce xerostomia, further compromising oral homeostasis. Chronic kidney disease alters calcium-phosphate metabolism and systemic immunity, resulting in delayed wound healing and increased susceptibility to periodontitis. Likewise, chronic obstructive pulmonary disease and asthma are associated with medication-induced xerostomia, impaired hygiene, and microbial translocation between the oral cavity and airways. Neurological disorders such as Parkinson’s disease and dementia reduce manual dexterity and cognitive capacity, impeding adequate plaque control and prosthesis maintenance. Rheumatoid arthritis contributes through shared autoimmune pathways with periodontitis - particularly via Porphyromonas gingivalis-induced citrullination of proteins - and through impaired fine motor function required for daily oral hygiene.Together, these conditions exemplify the bidirectional relationship between systemic and oral health, positioning tooth loss as both a clinical endpoint and a marker of general frailty in ageing populations [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The influence of multimorbidity extends beyond shared risk factors to encompass medication-induced xerostomia, inflammation-mediated bone resorption, and functional limitations affecting oral hygiene [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Although no significant associations were observed between individual systemic diseases and tooth loss, multimorbidity itself emerged as a strong, independent predictor, reflecting the cumulative impact of chronic illness on oral health and functional dentition retention. Together, these components capture the multidimensional nature of oral frailty, spanning behavioural, systemic, and functional domains. Their integration within the GOHVS provides a pragmatic, evidence-based framework for identifying high-risk older adults in both clinical and community settings. Collectively, these findings emphasise the clinical utility of the GOHVS as a feasible screening framework that can be incorporated into preventive protocols or geriatric care pathways to identify individuals requiring intensified oral health support.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eComparison of GOHVS with existing oral health indices\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eSeveral composite instruments have been developed to assess oral health decline in older adults, including the Oral Frailty Index (OFI) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], the Oral Health Assessment Tool (OHAT) [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], the Geriatric Oral Health Assessment Index (GOHAI) [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] and Oral Health Impact (OHI) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].These tools encompass clinical, functional, and psychosocial dimensions of oral status, providing a broad perspective on oral frailty. However, they typically require clinical examination or patient-reported questionnaires, which may limit their use in routine dental or primary care settings.\u003c/p\u003e \u003cp\u003eIn contrast, the GOHVS was designed as a simplified, high-yield screening tool based on five easily obtainable variables: toothbrushing frequency, interdental cleaning, dental attendance, smoking, and multimorbidity. This minimal-data approach aligns with the pragmatic screening philosophy of geriatric medicine and public health, where time and resources are often constrained. Despite its brevity, the GOHVS achieved discrimination comparable to more comprehensive instruments (AUC = 0.76), indicating that a small set of behaviourally and systemically grounded predictors can effectively stratify risk. Rather than replacing multidimensional frailty indices, the GOHVS may serve as an initial triage tool - guiding clinicians toward more detailed assessments when elevated vulnerability is detected. External validation across diverse populations and healthcare contexts remains essential to determine its generalisability and predictive calibration [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMethodological and conceptual considerations\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eThe main methodological innovation of this study was the development of the Geriatric Oral Health Vulnerability Score (GOHVS), a simple composite index designed to capture cumulative behavioural and systemic risk factors affecting oral health in older adults. By integrating five readily measurable variables the GOHVS demonstrated acceptable discrimination for predicting functional tooth loss (AUC = 0.76). Its simplicity and reliance on routinely available data make it suitable for chairside use or integration into electronic screening tools in geriatric dentistry. However, since the GOHVS was both derived and tested within the same cohort, the possibility of overfitting cannot be excluded. External validation in larger, community-based populations, ideally incorporating socio-economic indicators and longitudinal follow-up, is required before wider clinical implementation. Moreover, temporal causality cannot be inferred, as poor hygiene behaviours may both contribute to and result from tooth loss. Future longitudinal studies are necessary to clarify these bidirectional relationships.\u003c/p\u003e \u003cp\u003eTo advance gerodontological research and facilitate clinical translation, future studies should focus on external validation of the GOHVS in community-based and longitudinal cohorts, including pilot testing in digital application formats. Incorporating salivary biomarkers could enhance the assessment of xerogenic medication effects and identify individuals at elevated risk of root caries or mucosal pathology. Mixed-methods research is also warranted to explore cultural and attitudinal factors underlying delayed dental attendance among older adults, while evaluations of cost-effectiveness and accessibility of mobile or rural outreach dental models -particularly within the Polish healthcare context - could inform equitable service delivery. Collectively, these actions would help reposition oral health as a cornerstone of healthy ageing rather than an elective or aesthetic service [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePolicy priorities should include expanding domiciliary and teledentistry services for the oldest-old to address barriers related to mobility and transportation, integrating personalised hygiene coaching and adaptive oral care devices at every patient contact - especially for those with limited dexterity - and implementing the five-item GOHVS as a simple triage tool to identify high-risk individuals for preventive intervention. Although the GOHVS demonstrated fair discrimination (AUC = 0.76), its development and validation within a single cohort necessitate further testing across diverse populations before broader clinical adoption.\u003c/p\u003e \u003cp\u003eThe study’s main strengths include a well-defined first-visit geriatric cohort, rigorous examiner calibration with standardised data extraction, and robust statistical modelling supported by sensitivity analyses. Limitations include its single-centre design, which may introduce referral bias, retrospective data collection that limits causal inference, and the absence of socio-economic variables restricting generalisability. Additionally, possible survivor bias among participants aged 85 years and older and the lack of a comparison group of regular dental attenders should be considered when interpreting the findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOlder adults attending dental care for the first time often present with preventable oral diseases that are closely linked to modifiable behaviours and the presence of multimorbidity. The GOHVS, which integrates five key risk factors - low brushing frequency, non-use of interdental cleaning devices, infrequent dental attendance, smoking, and multimorbidity - offers a practical framework for identifying individuals at greatest risk of oral health deterioration. Early, targeted prevention based on these determinants could substantially reduce disease burden, improve retention of functional dentition, and enhance overall quality of life in ageing populations. By facilitating risk stratification and guiding personalised interventions, the GOHVS supports the integration of oral healthcare into broader healthy ageing strategies and aligns with global public health objectives promoting longevity with preserved function and well-being. Because the GOHVS relies exclusively on routinely collected behavioural and medical information, it may be particularly useful as a low-burden screening tool in diverse healthcare settings, including primary care and community-based geriatric services. Due to the cross-sectional design of the study, causal relationships between the identified risk factors and functional tooth loss cannot be inferred.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGOHVS - Geriatric Oral Health Vulnerability Score\u003c/p\u003e\u003cp\u003eaPR - adjusted prevalence ratio\u003c/p\u003e\u003cp\u003eCI - Confidence Interval\u003c/p\u003e\u003cp\u003eROC - Receiver Operating Characteristic\u003c/p\u003e\u003cp\u003eAUC - Area Under the Curve\u003c/p\u003e\u003cp\u003eWHO- World Health Organization\u003c/p\u003e\u003cp\u003eOFI - Oral Frailty Index\u003c/p\u003e\u003cp\u003eOHAT - Oral Health Assessment Tool\u003c/p\u003e\u003cp\u003eOHI - Oral Health Impact\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e This study's protocol was reviewed and approved by the Bioethics Committee of the Pomeranian Medical University in Szczecin, Poland (KB 0012/14/2022). All the protocols were followed in accordance with the 1964 Helsinki Declaration and its later amendments.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNone\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRS conceived and designed the study, collected the data, interpreted the results, drafted the manuscript, and approved the final version. NT contributed to data collection and literature review. KKJ contributed to the literature review and manuscript drafting.MMR contributed to the study design, performed the statistical analyses, and contributed to manuscript drafting. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eManuscript preparation was supported during Harvard Medical School’s Polish Clinical Scholars Research Training Program, organised by the Agencja Badan Medycznych (ABM, English: Medical Research Agency, Warsaw, Poland)\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe study datasets are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUnited Nations. World Population Ageing 2019. New, York. 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Folia Med Cracov. 2022;62(2):5\u0026ndash;16. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.24425/fmc.2022.141697\u003c/span\u003e\u003cspan address=\"10.24425/fmc.2022.141697\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ageing, functional dentition, multimorbidity, oral hygiene behaviours, tooth loss, GOHVS","lastPublishedDoi":"10.21203/rs.3.rs-8507381/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8507381/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eOral health is a critical component of healthy ageing, yet many older adults postpone dental visits until oral diseases reach an advanced stage. This study aimed to describe the oral health status, multimorbidity, and hygiene behaviours among first-time dental attendees aged 65 years and older. Furthermore, it sought to identify predictors of functional tooth loss, defined as having fewer than 20 teeth, and to develop a composite risk index - the Geriatric Oral Health Vulnerability Score (GOHVS) - to facilitate early identification of individuals at increased risk of oral health decline.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eRecords of 361 patients (mean age 69.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9 years; 61.8% female) presenting for their first dental visit at a university clinic were retrospectively analysed. Data on systemic conditions, hygiene practices and periodontal status were extracted. Multivariable Poisson regression with robust variance estimated adjusted prevalence ratios (aPR) for functional tooth loss. Model discrimination was assessed using receiver operating characteristic (ROC) analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eHypertension (58%) and diabetes (20%) were the most common comorbidities. Periodontitis affected 54% of participants, and 48% lacked a functional dentition. Toothbrushing\u0026thinsp;\u0026lt;\u0026thinsp;2\u0026times;/day (aPR\u0026thinsp;=\u0026thinsp;1.41, p\u0026thinsp;=\u0026thinsp;0.001), absence of interdental cleaning (aPR\u0026thinsp;=\u0026thinsp;1.27, p\u0026thinsp;=\u0026thinsp;0.019), irregular dental attendance (\u0026lt;\u0026thinsp;1\u0026times;/year; aPR\u0026thinsp;=\u0026thinsp;1.29, p\u0026thinsp;=\u0026thinsp;0.006), smoking (aPR\u0026thinsp;=\u0026thinsp;1.36, p\u0026thinsp;=\u0026thinsp;0.010) and multimorbidity (\u0026ge;\u0026thinsp;2 chronic diseases; aPR\u0026thinsp;=\u0026thinsp;1.33, p\u0026thinsp;=\u0026thinsp;0.002) were independent predictors. The GOHVS, integrating these five factors, demonstrated acceptable discrimination for functional tooth loss (AUC\u0026thinsp;=\u0026thinsp;0.76).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003ePoor oral hygiene behaviours and multimorbidity are key determinants of functional tooth loss in older adults. The GOHVS offers a simple, data-driven tool for identifying high-risk individuals and guiding preventive interventions in geriatric dentistry.\u003c/p\u003e","manuscriptTitle":"Development of a Geriatric Oral Health Vulnerability Score (GOHVS) and Its Association with Functional Tooth Loss in Older Adults: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 12:24:34","doi":"10.21203/rs.3.rs-8507381/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-07T09:18:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-23T04:47:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-21T06:44:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-20T06:26:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-18T09:15:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T05:03:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T03:04:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T21:59:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325407499735303616976379441712330482054","date":"2026-02-13T21:53:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T11:59:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253914476592297105878902601508968681828","date":"2026-02-13T09:24:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65357430084442357991278479758738731874","date":"2026-02-12T17:49:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"323472340056362804539990565081571338295","date":"2026-02-12T16:37:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"144175434955903618908225838657400570681","date":"2026-02-12T02:28:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"337815852404382581667667610505515900095","date":"2026-02-11T18:59:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-11T08:23:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65706264601668926525285953127700941958","date":"2026-02-11T07:27:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62213329570102672401418872967118835626","date":"2026-02-11T03:27:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75559631106429961530876754961490862900","date":"2026-02-06T22:26:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-04T10:36:07+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-03T07:25:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-13T08:23:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-11T14:00:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2026-01-11T13:54:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1a24b7d0-8f20-46f0-99f5-6bd857c55345","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-07T09:18:21+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T09:25:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 12:24:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8507381","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8507381","identity":"rs-8507381","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}