Association between patient satisfaction with complete dentures and oral health-related quality of life: two-year longitudinal assessment

Denture care and oral health-related quality of life among complete denture wearers in Eastern Province of Saudi Arabia

INTRODUCTION

This study aimed to evaluate denture care and hygiene and oral health-related quality of life (OHRQoL) among complete denture (CD) wearers in the Eastern Province of Saudi Arabia.

METHODOLOGY

This cross-sectional study was conducted on CD wearers in the Eastern Province of Saudi Arabia. A pre-tested questionnaire was administered among study participants. Questionnaire was divided in three sections: (1) patients' demographic data, (2) awareness and maintenance of CD and (3) OHRQoL. Independent sample t-test and one-way ANOVA test were performed.

RESULTS

The study included data of 300 participants with 71% of males and 28% of females. Majority of participants (82.7%) cleaned CD daily, removed CD while sleeping (88.0%) and knew that unhygienic dentures can cause oral infection (92.7%). Only 19.3% used denture cleansing tables, 41% used toothpaste, and 60.7% rinsed CD with water. Regarding OHIP-DENT domains, highest score was for functional limitation domain (2.20 ± 1.67) and the lowest for handicap domain (0.94 ± 1.09). The mean OHIP-DENT score of the sample was 12.02 ± 8.52. Females (p = 0.006), participants below 65 years of age (p = 0.029), non-Saudis (p = 0.042), those with university education (p = 0.030) and low monthly income (p = 0.045) and participants who visited dentist due to problem with CD (p = 0.041) demonstrated significantly higher mean OHIP-DENT score.

CONCLUSION

Majority of participants demonstrated appropriate denture care behaviours because they were aware of the importance of denture care and hygiene. Female gender, age below 65 years, non-Saudi nationality, university education, low monthly income and visiting dentist due to problem were related to poor OHRQoL.

Complete denture rehabilitation for a patient with Parkinson's disease using clinical strategies: A case report

OBJECTIVE

To present clinical strategies for prosthetic rehabilitation with complete dentures (CDs) of a Parkinson's disease patient.

CASE REPORT

An 82-year-old patient sought the Department of Dentistry at UFRN, reporting retention dissatisfaction and hamper to the mandibular CD adaptation. Patient-reported a dry mouth sensation, and exhibited disordered mandibular movements, tremors, and resorbed mandibular ridge. Aiming retention and stability, double molding with zinc enolic oxide impression paste, neutral zone technique, and non-anatomic teeth were proposed as clinical strategies. At delivery, identification and relief in the supercompression areas were performed to facilitate the acceptance and use of the new dentures.

CONCLUSION

The strategies promoted patient satisfaction regarding retention, stability, and comfort. This treatment may be considered for the rehabilitation of Parkinson's disease patients, favoring the adaptation process.

Single-Implant Overdentures Retained by a Novel Attachment: A Mixed Methods Crossover Randomized Clinical Trial

INTRODUCTION

Single-implant mandibular overdentures (SIMOs) are one of the least invasive implant treatments for edentulism. The new Novaloc attachment system can improve the clinical performance of implant-retained overdentures but has not been tested for SIMOs.

OBJECTIVES

To compare Novaloc and a gold standard system (Locator) for SIMOs in an edentate elderly population in terms of patient-reported outcomes and device- and treatment-related complications.

METHODS

In this single-center crossover randomized clinical trial (RCT), 10 edentulous participants received an implant in the lower midline and had their lower complete dentures converted to SIMOs. The participants received each attachment system for 3 mo in a randomized order, followed by measurement of patient satisfaction and oral health-related quality of life via the McGill Denture Satisfaction Questionnaire and the Oral Health Impact Profile for Edentulous People questionnaire, respectively. Complications were registered throughout the RCT. Patients were interviewed for their experiences with SIMOs and preference for one of the attachment systems. Quantitative analysis employed mixed linear models and chi-square tests (α = 0.05), whereas interview data underwent thematic analysis and, in turn, integration into quantitative data (mixed methods explanatory design).

RESULTS

All 10 randomized participants completed the trial. Mean ± SD general satisfaction was 92% ± 8% with Novaloc versus 85% ± 13% with Locator (mean difference, 9%; 95% CI, 1% to 17%). For specific McGill Denture Satisfaction Questionnaire items, only denture stability was significantly increased for Novaloc. Seven participants preferred Novaloc over Locator at the end of the RCT (chi-square, P = 0.045). No difference was found between the attachments in terms of oral health-related quality of life based on the Oral Health Impact Profile for Edentulous People and complications. Thematic analysis revealed high patient satisfaction with SIMOs, with denture stability the main criterion for their satisfaction and attachment preference.

CONCLUSION

Among elderly edentulous patients wearing SIMOs, Novaloc led to increased patient satisfaction and preference. Better patient-perceived denture stability may explain this result. The attachment systems exhibited similar short-term maintenance needs.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT03126942 (first registered on April 13, 2017). Secondary identifiers: A03-M07-17A (McGill University, Institutional Review Board) and 2018-3873 (McGill University Health Centre, Research Ethics Board).

KNOWLEDGE TRANSFER STATEMENT

The results of this mixed methods study can be used by clinicians when choosing which attachment system to use for SIMOs. Results suggest that edentulous patients prefer attachments with a better-defined seating position, such as that of the Novaloc system, as opposed to the nylon matrix on metallic abutment of the Locator system.

Exploratory analysis of demographic data, tobacco habits, and oral health-related quality of life among complete denture patients

Aim

The present study assessed the impact of demographics and tobacco habits on oral health related quality of life (OHRQoL) among complete denture patients.

Setting and Design

Prospective cohort study design.

Materials and Methods

Two hundred and eighty four edentulous patients, aged above 30 years, were chosen as the sample for the study after taking informed consent. Information regarding demographic data and smoking status was obtained from each participant. OHRQoL was evaluated using the Oral Health Impact Profile Edentulousness (OHIP EDENT) quantifying various domains, namely functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap.

Statistical Analysis Used

Data were analyzed using the Statistical Package for the Social Sciences version 23.0 (IBM; Chicago, Illinois, USA). Mann-Whitney U test was applied to find significant differences in OHRQoL between gender, age, and smoking status. P < 0.05 was considered to be statistically significant.

Results

It was seen that complete denture wearers above 65 years had higher OHIP EDENT scores as compared to younger counterparts suggesting the compromised quality of life in the functional domain which was statistically significant. Psychological discomfort was greater in females while physical disability seemed higher in males. Smoking was found to be a factor associated with decreased OHRQoL.

Conclusion

Older age groups, female gender, and smoking were factors associated with decreased OHRQoL among complete denture patients.

The Effect of Several Factors on the Patient's Satisfaction with the Complete Dentures and the Correlation with the Adaptation Period

OBJECTIVE

A great number of patients are completely satisfied with a regular denture, on the other hand, numerous patients are still not satisfied with their denture functions despite proper denture manufacture in relation to prosthetic standards.

AIM

To estimate the parameters of satisfaction for patients to improve the health care quality of patients and evaluate the effect of the adaptation period.

MATERIALS AND METHODS

A total of 136 patients who participated in this study were patients with complete dentures (CD), after placement of the CD, the patients were asked some questions (about esthetics, phonetics, comfort, quality of fit, and the masticatory efficiency) and the satisfaction of patients was evaluated by using Likert's scale, then recorded four readings, first at the placement visit, second after 1 month, third after 45 days, and last after 2 months.

RESULTS

The female patients' satisfaction related to phonetics was about 37.8% at the placement visit, but about 91.2% after 2 months; the male patients' satisfaction related to phonetics was about 44% at the placement visit, then 94.6% after 2 months; the female patients' satisfaction as related to esthetics was about 56.6% at the placement visit, but was about 89.8% after 2 months; the male patients' satisfaction as related to esthetics was about 68% at the placement visit, but about 89.4% after 2 months.

CONCLUSION

The satisfaction of the patient with their CD is affected by many factors such as phonetics, esthetics, comfort levels, the quality of fitness of the denture, and the mastication. The differences between gender in satisfaction in all parameters were non-significant, that is, p > 0.001. The adaptation period has an effect on the satisfaction rate of the completely edentulous patient with their CD.

Factors Affecting Patient Satisfaction with Complete Dentures

Background

Rehabilitation of the edentulous patients has always been a challenge. The success of conventional complete denture therapy might be affected by several factors such as patients' age, personality, previous denture wearing experience, expectations, aesthetics, residual ridge form and anatomy, denture quality, the method of its construction, dentist experience, and dentist-patient relations.

Objectives

The aim of this study was to compare patient satisfaction with complete dentures provided by fourth and fifth year dental students and prosthodontists with a minimum of 5 years' experience at the University of Jordan Hospital 8 weeks after insertion.

Methods

Questionnaires were distributed to a total of 60 completely edentulous patients who received complete maxillary and mandibular dentures. Besides demographic questions, the questionnaire included questions that probed the patient's satisfaction with his maxillary and mandibular dentures in general using two types of scales.

Results

Results indicated that dentist experience does not affect patients' satisfaction with their complete dentures. Our results also indicated that patients who had previous dentures could adapt more easily and were generally more satisfied with their newly inserted dentures especially with regard to their chewing ability and comfort with their mandibular dentures. Gender also influenced patient satisfaction with complete dentures especially the part related to psychological and social disability.

Conclusions

Results of this study will help in further understanding factors influencing patient satisfaction with their complete dentures.

Patient-reported outcomes of implant-assisted removable partial dentures with magnetic attachments using short implants: A prospective study

PURPOSE

Implant-assisted removable partial dentures (IARPDs) with short implants improve the oral functions of removable partial dentures (RPDs). This study aimed to compare the patient-reported outcomes of RPDs and IARPDs with short implants retained by magnetic attachments.

METHODS

We recruited 30 participants with mandibular Kennedy Class I or II and distal extension defects of three or more teeth. RPDs, IARPDs with a healing cap, and IARPDs with a magnetic attachment were evaluated across stages using patient-reported outcomes. All participants completed questionnaires (oral health-related quality of life [OHRQoL], patient general satisfaction, and patient's denture assessment [PDA]) at each stage. The OHRQoL was evaluated using the Oral Health Impact Profile-J 54 (OHIP-J 54) score. The general patient satisfaction was evaluated using a 100 mm visual analog scale. The Wilcoxon signed-rank test and Bonferroni correction were used to evaluate differences between the groups (α=0.05).

RESULTS

The OHRQoL of IARPDs was significantly higher than that of RPDs. IARPDs with a magnetic attachment had significantly better patient general satisfaction and PDA than IARPDs with a healing cap.

CONCLUSIONS

The OHRQoL, patient general satisfaction, and PDA were improved by IARPD with a short implant using a magnetic attachment.

The association between denture self-satisfaction rates and OHRQoL - a follow-up study

Backgroud

The objectives of this study were to try to identify the key dimension in satisfaction from the combination of satisfaction clusters, and its effect on the change of OHRQoL(Oral Health-related Quality of Life) of elderly denture users.

Methods

This follow-up study was conducted in subjects aged 65 years and over. All participants (n = 2128) completed questionnaires before and approximately 6 months after receiving complete denture. Information obtained by questionnaire included demographic characteristics, patients’ self-satisfaction rate and OHRQoL. The 6 satisfaction dimensions (including speaking, stability, esthetic, chewing, doctor and general dimensions) were classified as 5 cluster groups, which is the group of not at all satisfied in all dimensions (NAS); only satisfied with doctor and general dimensions(SDG); moderate satisfaction group(MS); quite satisfied group(QS); the highly satisfied group(HS) by an analysis of PCA (Principle component analysis) and CA (cluster analysis). Multiple linear regression was adapted to estimate the association between satisfaction and the responsiveness of OHIP-7T (Oral Health Impact Profile).

Results

When compared to the cluster “NAS”, the greatest improvement of OHRQoL after treatment was found in the group “HS” (β = 7.31(6.26–8.36), followed by group “QS” (β = 4.71(3.54–5.87)), group “MS” (β = 4.33(2.92–5.74)) and group “SDG” (β = 3.25(2.10–4.41)). An increasing trend was detected in patient-rating satisfaction and OHRQoL. The satisfaction cluster group is an important factor of OHRQoL after adjusting for other confounders.

Conclusion

Psychological-related aspects is the greatest impacting dimension on OHRQoL among denture wearers in Taiwan elderly. Better communication from the dental professional team with denture patients would improve their OHRQoL.

How peoples’ ratings of dental implant treatment change over time?

Objectives

Dental implant treatment (DIT) improves peoples’ oral health-related quality of life (OHQoL). Assessment of longitudinal changes in OHRQoL may be undermined by response shift (RS). RS is the process by which quality of life changes, independent of health status as a result recalibration, reprioritization or reconceptualization. Thus, this study aimed to describe RS in the OHRQoL and perceived oral health of individuals receiving DIT and to compare the then-test, a self-anchored scale and the classification and regression trees (CRT) approaches for assessing RS.

Methods

OHRQoL was assessed in 100 patients receiving DIT using the OHIP-Edent (n = 100) and a self-anchored scale (n = 45) before placement of the final restoration and 3 to 6 months after treatment was completed. The OHIP-Edent was also used as a retrospective assessment at follow-up. CRT examined changes in the OHIP-Edent total score as a dependent variable with global changes in oral health and each OHIP-Edent subscale score as independent variables.

Results

OHRQoL and perceived oral health improved after treatment. The OHIP-Edent score decreased from 36.4 at baseline to 12.7 after treatment. On average, participants recalibrated their internal standard downwards (− 4.0 OHIP-Edent points). CRT detected downwards recalibration in 5% of participants and upwards in 15%. Reprioritization was observed in the social disability and psychological discomfort aspects of OHRQoL.

Conclusions

RS affects longitudinal assessments of OHRQoL in DIT, reducing the apparent magnitude of change. The then-test and CRT are valid and complementary methods to assess RS.

Effect on patient satisfaction of mandibular denture tooth arrangement in the neutral zone

STATEMENT OF PROBLEM

The effect of the neutral zone (NZ) technique on different functional aspects (masticatory performance, speech, and muscle activity) has been studied objectively. Subjectively, some studies reported that their participants felt that NZ dentures were more stable, retentive, and comfortable than conventionally fabricated dentures. These studies, however, lacked a measurable assessment scale or a specifically designed questionnaire.

PURPOSE

The purpose of this within-subject, crossover clinical trial was to investigate patient satisfaction levels in edentulous patients after rehabilitation with dentures fabricated using the NZ concept as compared with conventional dentures using a specific, question-oriented patient satisfaction questionnaire.

MATERIAL AND METHODS

The clinical trial included 52 participants. Each received one set of conventional dentures and another fabricated based on the NZ concept with a 1-month wash-out period. Participants randomly chose 1 of 2 closed opaque envelopes with 2 denture sequences, either conventional then NZ or NZ then conventional. Hence, participants were blinded to the dentures they wore. Patient satisfaction with each denture type was assessed 6 weeks after insertion by a blinded staff member using a 5-scale questionnaire developed for the most important functional aspects (esthetics, masticatory ability, retention, stability, speech, and comfort). The Wilcoxon Signed Rank test was used to compare the satisfaction scores of the 2 denture types (α=.05).

RESULTS

Patient satisfaction scores were significantly higher with the NZ dentures than with the conventional dentures in all aspects; P=.001 for question 2 (opinion of denture appearance) and P<.001 for all other questions.

CONCLUSIONS

NZ dentures offer significantly higher levels of patient satisfaction than conventional dentures in all functional aspects (retention, stability, masticatory ability, and speech) as well as in comfort and appearance.

Impact of shortened dental arch on oral health-related quality of life over a period of 10 years - A randomized controlled trial

OBJECTIVES

To compare oral health-related quality of life (OHRQoL) in patients with either molar replacement by partial removable dental prostheses (PRDP) or with restored shortened dental arches (SDA) over a period of 10 years.

METHODS

In this multi-center RCT, a consecutive sample of 215 patients with bilateral molar loss in at least one jaw was initially recruited in 14 prosthodontic departments. Of those patients, 150 could be randomly allocated to the treatment groups (SDA: n = 71; PRDP: n = 79), received the allocated treatment, and were available for follow-up assessments. OHRQoL was assessed using the 49-item version of the Oral Health Impact Profile (OHIP) before treatment (baseline) and at follow-ups after treatment (4-8 weeks and 6, 12, 24, 36, 48, 60, 96, and 120 months). To investigate the course of OHRQoL over time, we longitudinally modelled treatment and time effects using mixed-effects models.

RESULTS

OHRQoL substantially improved from baseline to first follow-up in both groups indicated by a mean decrease in OHIP scores of 20.0 points (95%-CI: 12.5-27.5). When compared to the SDA group, OHRQoL in the PRDP group was not significantly different (-0.6 OHIP points; 95%-CI: -7.1 to 5.9) during the study period when assuming a constant time effect. OHRQoL remained stable over the 10 years with a statistically insignificant time effect (p = 0.848).

CONCLUSIONS

For patients requesting prosthodontic treatment for their lost molars, treatments with SDA or PRDP improve clinically relevantly OHRQoL and maintain it over a period of 10 years with no option being superior to the other.

CLINICAL SIGNIFICANCE

Since there was no significant difference between the two treatment options over the observation period of 10 years, and since results have stayed stable over time, patients can be informed that both treatment concepts are equivalent concerning OHRQoL.

Technical Quality of Complete Dentures: Influence on Masticatory Efficiency and Quality of Life

PURPOSE

To evaluate the effect of the technical quality of conventional complete dentures (CD) on masticatory efficiency and quality of life (QoL) of denture wearers during a 1-year follow-up.

MATERIALS AND METHODS

A prospective clinical trial with 32 edentulous patients (mean age of 60.2 years) wearing mandibular and maxillary dentures was conducted. All patients were evaluated wearing their preexisting dentures and after 3, 6, and 12 months postinsertion of new dentures. A reproducible method for objective evaluation of the technical quality of CDs was employed. Masticatory efficiency was evaluated by the colorimetric method using beads as artificial testing food. The oral health impact on patient QoL was measured using the OHIP-EDENT (Oral Health Impact Profile in Edentulous Adults) questionnaire. The nonparametric Wilcoxon test was applied to reveal any differences in technical quality between the preexisting and new dentures. The Friedman test was used to detect differences in masticatory efficiency and oral health impact on QoL. Spearman's correlation was applied to reveal correlation between the variables.

RESULTS

Comparing preexisting and new dentures, significant improvement was found in technical quality between the dentures (p < 0.001). There was no statistically significant difference in masticatory efficiency. A significant decrease was found in the total OHIP-EDENT scores after denture replacement. A positive correlation was found between technical quality and OHIP in the new denture wearers (p = 0.011).

CONCLUSIONS

According to the results of this study, denture quality significantly improved patients' oral health-related QoL; however, insertion of new dentures did not influence masticatory efficiency.

Cost-effectiveness analysis of two impression methods for the fabrication of mandibular complete dentures

OBJECTIVES

To compare the cost and to evaluate cost-effectiveness of fabricating mandibular complete dentures (CDs) using two different impression methods.

METHODS

A crossover randomized controlled trial including 27 edentulous participants was performed. Mandibular CDs were fabricated using two different impression methods, as follows: (i) conventional method using a custom tray border moulded with impression compound and silicone and (ii) simplified method using a stock tray and alginate. Cost analysis was performed from a clinical practitioner's perspective. The total cost included labor cost, which was calculated using the time spent by dentists and technicians in fabricating CDs and their hourly wages, and the material costs, which were calculated using purchase prices. To evaluate cost-effectiveness, we used general patient satisfaction as an indicator of effectiveness and calculated the incremental cost effectiveness ratio (ICER). ICER represents the cost per one unit of effectiveness.

RESULTS

The trial was completed by 24 participants. The total cost was 43,904 Japanese Yen (JPY) (330.91 EUR / 395.78 USD) for the conventional method and 39,792 JPY (299.93 EUR / 358.70 USD) for the simplified method, and this difference was statistically significant (p<0.001). The ICER showed a cost of 633 JPY (4.77 EUR / 5.70 USD) for every one point change in general patient satisfaction.

CONCLUSIONS

The results indicated that the total cost of the conventional method was significantly higher than that of the simplified method (p<0.001).

CLINICAL SIGNIFICANCE

The conventional impression method for fabricating mandibular CDs, which took additional 633 JPY (4.77 EUR / 5.70 USD) for improvement of general satisfaction, is supposed to be clinically meaningful¹.

Patients' Values in Clinical Decision-Making

OBJECTIVE

Shared decision-making involves the participation of patient and dental practitioner. Well-informed decision-making requires that both parties understand important concepts that may influence the decision. This fourth article in a series of 4 aims to discuss the importance of patients' values when a clinical decision is made.

METHODS

We report on how to incorporate important concepts for well-informed, shared decision-making. Here, we present patient values as an important issue, in addition to previously established topics such as the risk of bias of a study, cost-effectiveness of treatment approaches, and a comparison of therapeutic benefit with potential side effects.

RESULTS

We provide 2 clinical examples and suggestions for a decision tree, based on the available evidence.

CONCLUSION

The information reported in this article may improve the relationship between patient and dental practitioner, resulting in more well-informed clinical decisions.

A randomized controlled trial of the different impression methods for the complete denture fabrication: Patient reported outcomes

OBJECTIVES

To compare the effect of conventional complete dentures (CD) fabricated using two different impression methods on patient-reported outcomes in a randomized controlled trial (RCT).

METHODS

A cross-over RCT was performed with edentulous patients, required maxillomandibular CDs. Mandibular CDs were fabricated using two different methods. The conventional method used a custom tray border moulded with impression compound and a silicone. The simplified used a stock tray and an alginate. Participants were randomly divided into two groups. The C-S group had the conventional method used first, followed by the simplified. The S-C group was in the reverse order. Adjustment was performed four times. A wash out period was set for 1 month. The primary outcome was general patient satisfaction, measured using visual analogue scales, and the secondary outcome was oral health-related quality of life, measured using the Japanese version of the Oral Health Impact Profile for edentulous (OHIP-EDENT-J) questionnaire scores.

RESULTS

Twenty-four participants completed the trial. With regard to general patient satisfaction, the conventional method was significantly more acceptable than the simplified. No significant differences were observed between the two methods in the OHIP-EDENT-J scores.

CONCLUSIONS

This study showed CDs fabricated with a conventional method were significantly more highly rated for general patient satisfaction than a simplified.

CLINICAL SIGNIFICANCE

CDs, fabricated with the conventional method that included a preliminary impression made using alginate in a stock tray and subsequently a final impression made using silicone in a border moulded custom tray resulted in higher general patient satisfaction.

TRIAL REGISTRATION

UMIN000009875.

Clinical strategies for complete denture rehabilitation in a patient with Parkinson disease and reduced neuromuscular control

The dentist has a large role in geriatric health care for the ever increasing elder population with associated physical and neurological disorders. The Parkinson disease is progressive neurological disorder with resting tremor, bradykinesia, akinesia, and postural instability. The psychological components of disease include depression, anxiety, and cognitive deficiency. Poor oral hygiene, increased susceptibility for dental caries, and periodontal diseases predispose them to early edentulism. The number of Parkinson affected patients visiting dental clinic seeking complete denture is growing. This case report explains the steps involved in the complete denture rehabilitation of Parkinson patient. The effective prosthesis will help in alleviating functional, aesthetic, and psychological disabilities of the patient.

Impact of removable dentures on oral health-related quality of life among elderly adults in Taiwan

Background

Although the use of removable dentures can improve oral function and esthetics for elderly people, compared to those who do not wear removable dentures, those wearing removable dentures could have worse oral health related-quality of life (OHRQoL). Additional information is required to assess which factors related to denture wearing influence the OHRQoL of elderly individuals. The purpose of this study is to evaluate the association between denture wearing and OHRQoL in a sample of elderly individuals in Taiwan.

Methods

The study population included 277 elderly people wearing removable dentures (mean age = 76.0 years). Using face-to-face interviews, we collected data on the participants’ socio-demographic characteristics, dental care service usage (regular dental checkups, treatment during toothache, dental visits in the last year), and factors related to denture wearing (perceived oral pain, perceived loose denture, perceived oral ulcer, perceived halitosis, perceived dry mouth, and perceived total denture satisfaction scores). OHRQoL was measured using the Taiwanese version of the Geriatric Oral Health Assessment Index (GOHAI-T). The location and number of remaining natural teeth and the type of denture were also recorded. Hierarchical multiple regression analysis was performed using GOHAI-T scores as the dependent variable.

Results

All the predictors together accounted for 50% of the variance in GOHAI-T scores. Further, education level, number of natural teeth, denture status, perceived loose denture, perceived oral ulcer, and perceived total denture satisfaction scores had statistically significant influences on OHRQoL. When compared with other variables, factors related to denture wearing, especially perceived total denture satisfaction scores, had the greatest impact on GOHAI-T scores.

Conclusions

Of the factors analyzed in this study, denture satisfaction was the strongest predictor of OHRQoL. This suggests that denture satisfaction is useful for assessing the effect of denture treatment on the OHRQoL of elderly individuals wearing removable dentures.

Biomechanical factors related to occlusal load transfer in removable complete dentures

Owing to economic conditions, removable dentures remain popular despite the discomfort and reduced chewing efficiency experienced by most denture wearers. However, there is little evidence to confirm that the level of mucosal load exceeds the pressure pain threshold. This discrepancy stimulated us to review the current state of knowledge on the biomechanics of mastication with complete removable dentures. The loading beneath dentures was analyzed in the context of denture foundation characteristics, salivary lubrication, occlusal forces, and the biomechanics of mastication. The analysis revealed that the interpretation of data collected in vivo is hindered due to the simultaneous overlapping effects of many variables. In turn, problems with determining the pressure beneath a denture and analyzing frictional processes constitute principal limitations of in vitro model studies. Predefined conditions of finite element method simulations should include the effects of oblique mastication forces, simultaneous detachment and sliding of the denture on its foundation, and the stabilizing role of balancing contacts. This review establishes that previous investigations may have failed because of their unsubstantiated assumption that, in a well-working balanced occlusion, force is only exerted perpendicular to the occlusal plane, allowing the denture to sit firmly on its foundation. Recent improvements in the simulation of realistic biomechanical denture behavior raise the possibility of assessing the effects of denture design on the pressures and slides beneath the denture.

Reliability and validity of a questionnaire for self-assessment of complete dentures

BACKGROUND

Demand for complete denture treatment is expected to rise over several decades. However, to date, no questionnaire on complete dentures, as evaluated by edentulous patients, has been shown to be reliable and valid. This study sought to assess the reliability and validity of Patient's Denture Assessment (PDA), which provides a multidimensional evaluation of dentures among edentulous patients.

METHODS

Patients, who had new complete dentures fabricated at the University Hospital of Dentistry, Tokyo Medical and Dental University through 2009 to 2010, were enrolled. The reliability of the PDA was determined by examining internal consistency and test-retest reliability. Internal consistency for all of the question items and the six subscales was measured using Cronbach's α and average inter-item correlation coefficients among 93 participants. For 33 of these participants, test-retest reliability was determined at a 2 month-interval using the interclass correlation coefficients (ICCs) and 95% confidence interval for the summary scores and the six subscale scores. The PDA was validated in 93 participants by examining the difference in the summary score and the six subscale scores of the PDA before and after replacement with new dentures by the paired t-test. Ability to detect change was also tested in 93 patients using effect size.

RESULTS

The Cronbach's α for the PDA ranged from 0.56 to 0.93. The average inter-item correlation coefficients ranged from 0.28 to 0.83. ICCs for the PDA ranged from 0.37 to 0.83. The paired t-test showed a significant difference between the summary score and the six subscale scores before and after replacement with new dentures (p < 0.05) and the effect size was 0.97.

CONCLUSIONS

The PDA demonstrated good reliability by assessing internal consistency and test-retest reliability. In addition, the PDA demonstrated good validity by assessing discriminant validity. Thus, the PDA could help dentists obtain a detailed understanding of the patients' perceptions in using their dentures.

The association of responsiveness in oral and general health-related quality of life with patients' satisfaction of new complete dentures

PURPOSE

The objective was to determine the responsiveness properties of the Oral Health Impact Profile (OHIP) short-forms and 36-item Short-Form (SF-36) in complete denture treatment, and further to evaluate the association between patients' satisfaction and improvements in oral and general health-related quality of life (OHRQoL and HRQoL) after fitting of new, complete dentures.

METHODS

Study data were obtained from the 'Dentures for the Elders through Public Funding' study conducted in Kaohsiung County. A total of 224 subjects received denture treatments with 6-month follow-up and pre-/post-treatment interviews by questionnaire. The OHIP and SF-36 were used to measure OHRQoL and HRQoL. In addition, specific questions investigating seven aspects of patients' satisfaction were used to measure the patients' perceptions of complete denture success. The responsiveness of all outcome measures and their dimensions were assessed by effect size (ES). Multivariable analysis was used to examine the association between patients' satisfaction and OHIP/SF-36 while adjusting for demographic characteristics.

RESULTS

There were improvements with regard to the 'physical pain' (ES = 0.19) and 'psychological discomfort' (ES = 0.42) dimensions of the Taiwanese short-form OHIP (OHIP-14T) after new complete denture treatment, but only improvement in the 'general health' (ES = 0.17) dimension in the SF-36 measure. Patients satisfied with 'comfort' and 'ease of cleaning' of their new dentures were significantly associated with the improvement of the OHIP-49 and OHIP-14T.

CONCLUSIONS

This study suggests that denture treatments are associated with improvements of OHRQoL, but not in HRQoL. Furthermore, patients' satisfaction was significantly associated with responsiveness of OHRQoL but less significantly associated with responsiveness of HRQoL.

Association between self-assessment of complete dentures and oral health-related quality of life

The purpose of this study was to determine which factors related to patient self-assessment of dentures are associated with changes in oral health-related quality of life (OHRQoL) among edentulous patients after replacement of complete dentures, and to determine whether masticatory performance as determined using an objective method affects the changes in OHRQoL among edentulous patients. As a preliminary study, the existing questionnaire regarding self-assessment of dentures consisting of 39 question items, measured with a 100-mm visual analogue scale, was analysed by factor analysis. Then a questionnaire, composed of 22 question items, was developed containing six subscales of 'function', 'lower denture', 'upper denture', 'expectation', 'aesthetic and speech' and 'importance'. Final participants in the present study comprised 93 edentulous patients requiring new conventional complete dentures (44 men, 49 women; mean age, 75·0 years). These patients were asked to complete the Japanese version of the Oral Health Impact Profile (OHIP)-EDENT, comprising 19 question items for assessment of OHRQoL in edentulous patients, along with the developed questionnaire regarding self-assessment of dentures. Moreover, masticatory performance was measured using a colour-changeable chewing gum. The questionnaire and measurement were completed twice; before and after replacement of complete dentures. Stepwise multiple regression analysis identified 'lower denture' and 'aesthetic and speech' as significant independent variables besides OHIP-EDENT scores before replacement. These results suggest that sufficient retention of lower dentures and appropriate appearance may lead to improved OHRQoL in edentulous patients.