Independent Variables and Outcome Variable

Activities of Daily Living (ADL), Oral health literacy (OHL), and sociodemographic and oral health-related behavior variables.

Trained reviewers used the Thai Barthel ADL index22 to evaluate the capability of daily living activities, including grooming, eating, dressing, transfer, mobility, use of stairs, bathing, use of toilets, and bowel and bladder functions. The sum of scores from 0 to 20 was classified into three categories as follows: (1) the dependent group with 0 to 4 ADL scores; (2) the most-likely-independent group with 5 to 11 ADL scores; and (3) the independent group with ≥ 12 ADL scores. Higher ADL scores were indicated as independent living.23 We encouraged elderly Thai individuals with scores ≥12 to enroll in this study.

The trained interviewers collected OHL data using the Thai version of the Health Literacy in Dentistry questionnaire (HeLD‐Th). The HeLD‐Th comprises 14 questions with a total possible sum of scores of 56, and a higher score on the HeLD‐Th represents a higher degree of OHL.21 The HeLD-Th comprises the following subscales: Communication, Understanding, Receptivity, Support, Utilization, Economic Barriers, and Access; the HeLD-Th was validated in the Thai language and had favorable psychometric properties for measuring OHL among Thai adults with mild-to-moderate disabilities.21 The HeLD-Th was tested for content validity by an expert panel that showed an appropriate item objective congruence index (IOC) value of 0.76.21 Regarding reliability testing, we established a pilot study among 30 older adults from Yaring district, a nearby community; the HeLD‐Th produced acceptable internal consistency with a total Cronbach alpha coefficient of 0.945.

Information regarding sociodemographic and oral health-related behaviors was obtained by a modified self-reported questionnaire from the 8th Thailand Oral Health Survey 2017 (Th-OHS).16 Sociodemographic data were as follows: age (≤74 years/>74 years), sex (male/female), marital status (married/other), educational level (≤ primary school/> primary school), monthly income (<15,000 BAHT ($475)/≥15,000 BAHT). Oral health-related behavior data: toothbrushing frequency (< twice daily/> twice daily), toothbrushing duration (< 2 minutes/> 2 minutes), and regular dental visit (yes/no).

Number of remaining teeth (NRT)

A trained examiner evaluated the NRT based on the Th-OHS criteria.16 The examiner took a comprehensive approach for assessing dental status. A trained assistant recorded the data in sequence from one tooth to the nearby tooth or edentulous area; a permanent tooth was counted as the remaining tooth when the whole part of the dental crown was visible.16 When the crown was destroyed or only the root remained, the tooth was considered absent since it would not have masticatory function.

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