New paradigms in prosthodontic treatment planning: a literature review

Parkinson's disease - The dentist's role as part of the healthcare team

Parkinson's disease is a neurodegenerative disease that results in patients exhibiting uncontrolled movements, changes in saliva production, and difficulty in swallowing and speech. Understanding the staging of the disease and the available therapies allows dentists to treat these patients safely and with compassion to meet their oral health care needs for an optimal quality of life. This appraisal discusses Parkinson's disease as it relates to clinically relevant facts to manage and treat the oral health care needs of these patients in the short and long term including general dental care recommendations. Important observations related to Parkinson's disease include disease causation,; stages, pharmacologic treatment, the effects on saliva, mastication, dysphagia, and aspiration pneumonia. Dental recommendations are made for the dentate, the partially edentulous, and the completely edentulous Parkinson's patients with a focus on late-stage concerns. Optimizing dental health will help maintain the quality of life as the disease progresses. In late stages of Parkinson's disease, dental treatment should focus on keeping the patient comfortable and out of pain.  While benign neglect is an often-used term, compassionate therapy in the late stages of Parkinson's disease is a more compelling term for defining the patient's needs.  Since dysphagia in Parkinson's patients has been underdiagnosed, neurologists must be aware of the important part that dentists play in the early diagnosis for these patients.  Early referral to a dentist is vital to mitigate the unfortunate consequence of the need for extensive dental care in late-stage patients.

Sociodemographic Factors and Implant Consideration by Patients Attending Removable Prosthodontics Clinics

Objective. This study is aimed at investigating the treatment options offered to and chosen by patients attending a student prosthodontics clinic and to investigate the effect of the sociodemographic background of participants on implant consideration. Material and Methods. A cross-sectional descriptive study was conducted on 200 participants including their socioeconomic background, treatment options presented, treatment preferences, and implant consideration. Bivariate tests (unpaired $t$ -test, chi-square, and Mann–Whitney test) and Spearman correlation were used for comparison of different socioeconomic groups according to treatment preferences (implant consideration versus conventional removable prosthesis). Results. Treatment options presented by dental students include 63.5% complete denture, 32% implants/removable dentures, and partial denture 4.5%. Conventional removable prostheses were mostly chosen due to low income. Implants were only considered by 26% of participants. Age and implant consideration had a significant negative correlation. No significant difference in gender and residency area on implant consideration was found. The chi-square test showed a significant difference between implant consideration and conventional removable prostheses in the various occupation groups. Conclusions. Low income is the main factor prohibiting patients from considering dental implants. Age and educational level may play a considerable role in considering dental implants. There should be more emphasis on dental students’ treatment planning education to include and explain dental implants as a treatment option for their patients in the prosthodontics clinic.

Informed Consent from a Historical, Societal, Ethical, Legal, and Practical Perspective

Informed consent is often perceived as a regulatory obligation without recognizing its educational potential in the dynamic provider/patient relationship. This article discusses the complex interaction of ethics, society, and law through a historical and practical perspective. The purpose is to provide general dentists and specialists with a comprehensive understanding of the complexity and practical dimensions of informed consent.

Improving Esthetics of Removable Partial Dentures Using Palatal Retentive Arms

A well-designed removable partial denture can replace the loss of hard and soft tissues, restore masticatory function and maintain arch integrity. It is relatively simple, non-invasive and economical compared to other treatment options. Removable partial denture is therefore a common option among various treatment replacing missing teeth. A removable partial denture replacing anterior missing teeth can improve esthetics and hence the patient’s quality of life. However, metal components of a removable partial denture may be visible and affects patient satisfaction. Esthetics of a removable partial denture can often be improved with some modifications to traditional designs. This article reported the use of a cobalt-chromium-based removable partial denture to replace a missing maxillary lateral incisor and molars. Palatal retentive arms were employed as the retentive components on the premolars to avoid the metal component being seen when speaking and smiling. The indications and design of the removable partial dentures with palatal retentive arms are also discussed.

An artificial-intelligence-based method for assessing service quality: insights from the prosthodontics sector

Purpose

The prosthodontics sector is facing major challenges because of scientific and technological advances that imply a clearer definition of lines of action and decision making processes. Measuring quality of service in this sector is a complex decision problem since the perceptions of three main players need to be considered: patients, dentists and dental technicians. This study sought to develop an artificial-intelligence-based (AI-based) method for assessing service quality in the dental prosthesis sector.

Design/methodology/approach

Using strategic options development and analysis (SODA), which is grounded on cognitive mapping, and the measuring attractiveness by a categorical based evaluation technique (MACBETH), a constructivist decision support system was designed to facilitate the assessment of service quality in the dental prosthesis sector. The system was tested, and the results were validated both by the members of an expert panel and by the vice-president of the Portuguese association of dental prosthesis technicians.

Findings

The methodological process developed in this study is extremely versatile and its practical application facilitated the development of an empirically robust evaluation model in this study context. Specifically, the profile analyses carried out in actual clinics allowed the cases in which improvements are needed to be identified.

Originality/value

Although already applied in the fields of AI and decision making, no prior work reporting the use of SODA and MACBETH for assessing service quality in the prosthodontics sector has been found.

Prevalence and Clinical Effects of Certain Therapy Concepts among Partially Edentulous Serbian Elderly

PURPOSE

This study was conducted to identify the prevalence of partially edentulous individuals in Serbia and to identify prosthodontic treatment used for their rehabilitation as well as to compare prosthodontic treatment concepts among Serbian elderly participants who answered closed-format questionnaires.

MATERIALS AND METHODS

The study was conducted at the Clinic for Dental Prosthetics, University of Belgrade, Military Medical Academy and the Department of Prosthodontics of Home Centre Belgrade; the study consisted of 120 participants. A questionnaire with closed-format questions regarding the influence of applied therapy concepts for participants with Kennedy Class I partial edentulism was created. Statistical software SPSS 11.5 was used for data analysis. Chi-square tests were performed, and p-values were calculated for each parameter.

RESULTS

A total of 1081 people were examined; 730 participants were partially edentulous in at least one jaw. Five hundred forty-one participants wore Kennedy Class I maxillary or mandibular removable partial dentures (RPDs). Ninety percent of the patients were restored with RPDs; 60% of participants were unrestored, had shortened dental arches, and requested alternative therapeutic solutions. Significantly lower needs for new treatments were identified in participants with fixed dental prostheses (7.5%).

CONCLUSIONS

Kennedy Class I was the most common type of partial edentulism among Serbian elderly, usually treated with RPDs. Elderly participants with the applied shortened dental arch and RPD therapy concepts requested alternative therapeutic solutions more often than those rehabilitated with fixed partial dentures.

Oral diagnosis and treatment planning: part 7. Treatment planning for missing teeth

Although more people are retaining increasing numbers of their natural teeth into older ages, approximately 30-40% of persons over the age of 75 years in Western countries are edentulous. The causes and significance of tooth loss vary widely among individuals and cultures, and missing teeth may be replaced by a variety of means for functional, social and psychological reasons, rather than for significant physical health benefits. Therefore, it is essential to determine what the loss of teeth means to patients and what their expectations are for the outcomes following tooth replacement by various methods.

Dental esthetics and its impact on psycho-social well-being and dental self confidence: a campus based survey of north Indian university students

To evaluate the subjects perceived satisfaction of their dental appearance and to compare it with a various attitudes and practices which may affect social and psychological behavior and dental self confidence. This was a questionnaire based cross-sectional study done in the campus of Aligarh Muslim University, Aligarh (India). 426 students participated in the study. Questions were pooled in from various components of psychosocial impact of dental esthetics questionnaire (PIDAQ) for various attitudes and practices. Quantitative analysis was done using descriptive analysis and Chi square test using SPSS software. Majority of subjects (57.7 %) was highly satisfied with their smile, more than one-third (37.3 %) were satisfied and there were only 4.9 % subjects who were not satisfied with their smile. Tooth color was the most common (27.9 %) smile component causing dissatisfaction amongst the subjects. More than two-fifth (42.5 %) liked to show their teeth, one-half (49.5 %) liked to see their teeth in mirror, photographs and videos, almost one quarter (23.9 %) subjects used to hide their teeth while smiling. As compared to females, significantly higher proportion of males was conscious of opposite sex while smiling. The proportion of subjects which was highly satisfied with their smile was significantly higher for the item 'like to show their teeth and who liked to see their teeth in mirror, photographs and video' whereas for all the other items the proportion of respondents which was not satisfied with their smile was significantly higher. Self perceived satisfaction of dental esthetics has positive impact on person's social and psychological behavior and dental self confidence.

A sociodental approach in prosthodontic treatment decision making

A critical problem in the decision making process for dental prosthodontic treatment is the lack of reliable clinical parameters. This review discusses the limits of traditional normative treatment and presents guidelines for clinical decision making. There is a need to incorporate a sociodental approach to help determine patient's needs. Adoption of the evidence-based clinical practice model is also needed to assure safe and effective clinical practice in prosthetic dentistry.

Discriminant analysis of patients' reasons for choosing or refusing treatments for partial edentulism

The aim of the study was to explore partially edentulous patients' reasons for choosing or refusing prosthodontic treatment with removable partial dentures (RPD), fixed partial dentures (FPD) and implant partial dentures (IPD). Clinical and oral health-related quality of life measures were collected from 165 partially edentulous patients undergoing treatment. Patients' preferences were recorded and reasons for choosing or refusing treatments were measured with 32 questions using a five-point Likert scale. Descriptive statistics, chi-square and multiple logistic regression were used to compare patients' preferences according to clinical variables. Discriminant analysis was used to examine the impact of each reason for a patient's decision to choose or refuse treatment options. Results showed that older patients (P < 0.001) and with greater oral-related quality of life impacts (P < 0.05) were more likely to choose RPD. IPD were preferred by patients with higher education levels (P < 0.01). Discriminant functions revealed that the desire to have a fixed or removable denture had great impact on preferences. Removal of tooth structure was the main reason for refusing FPD and financial cost had a great impact on refusing IPD. Overall agreement between observed patients' decisions and those predicted by the discriminant function was >90% for all treatments. Reasons vary greatly among patients, and the role of individual perception of potential reasons for treatment selection was the most important determinants of patients' decisions. The main reasons for choosing or refusing treatments focused in this study can be used to guide shared decision-making, providing treatments that better match patients' expectations and desires.

Assessing perceived potential outcomes of prosthodontic treatment in partial and fully edentulous patients

The aim was to develop an instrument to measure and to explore the perception of potential outcomes of prosthodontic treatment in partial and fully edentulous patients, including benefits, risks and consequences of non replacement of missing teeth. It was also aimed to assess the influence of clinical and socio-demographic variables on the perception of potential outcomes. Using a two-phase data collection (open-ended and closed-form), a scale was developed containing 41 statements to measure subject's perception scores in a 5-point Likert-type scale (1, strongly disagree; 2, disagree; 3, neutral; 4, agree; 5, strongly agree). In the second phase 126 partially or fully edentulous subjects were interviewed. Influence of age, gender and clinical variables on perceived outcomes were tested using one-way anova, independent t-test and two-way anova (general linear model). Respondents' mean age was 51.8 years (s.d.=12.3), and 74% were female. Cronbach's alpha coefficient of the scale and subscales ranged from 0.70 to 0.90. Patients' mean scores ranged from 2.37 to 4.88 (mean=4.25; s.d.=0.65), indicating that subjects tended to agree with the proposed affirmatives (scores 4 and 5). Perception scores were influenced by age, gender, edentulous spaces and use of prosthodontics. Older subjects, female, those with higher number of missing teeth and who have been previously treated had greater perception of benefits and risks of prosthodontic treatment. It was concluded that the proposed instrument was suitable for measuring subjects' perception of potential outcomes of prosthodontic treatment.

What are the prevalence and incidence of tooth loss in the adult and elderly population in Europe?

OBJECTIVE

The purpose of this review was to study the prevalence and incidence of edentulism and tooth loss in European countries.

MATERIAL AND METHOD

A literature search was performed by means of Medline/PubMed using various combinations of keywords concerning prevalence and incidence of tooth loss and edentulism, complemented by a hand search. Inclusion criteria were cross-sectional and longitudinal clinical and questionnaire studies of representative or random samples of >/=100 subjects at the initial examination. Sixty articles were identified; the hand search gave 13 more references.

RESULTS

This literature review demonstrated that there is a lack of epidemiological studies on edentulism and tooth loss in many countries in Europe. The quality of available data varied considerably. There is a documented decline of edentulism with still great differences in prevalence between countries, between geographical regions within countries and between groups with various backgrounds. The mean number of lost teeth increases with age. In several countries many dentate subjects aged 60 years and over still have reduced dentitions possibly needing prosthodontic treatment. The incidence of tooth loss is low but with geographical variation between age groups, and there is a trend for decreasing incidence over the last decades. A great number of variables are associated with tooth loss, and there is no consensus whether dental disease related or socio-behavioural factors are the most important risk factors. Institutionalised elderly people have, in general, more compromised oral health, including fewer teeth, than those at the same age living freely.

CONCLUSION

Tooth loss and edentulism are declining at least in those European countries where reliable data are available. However, the WHO goal of retaining at least 20 teeth at the age of 80 years has not yet been met but is being approached in some countries.

Patients' self-perceived impacts and prosthodontic needs at the time and after tooth loss

Studies on self-perception have demonstrated that tooth loss is associated with esthetic, functional, psychological and social impacts for individuals. However, not all subjects seek treatment immediately after tooth loss, even when desire for replacement is strongly expressed. The aim of this study was to evaluate the perception of patients submitted to tooth extraction about factors associated with tooth loss and prosthodontic treatment, at the time and after extraction. A convenience sample of 211 consecutive patients were clinically evaluated and answered to a questionnaire about perceived impacts and prosthodontic treatment needs. Data were collected at the time of extraction and after a 3-month time interval. Perceived impacts were high (21 to 76% at the time and 35 to 87% after extraction). From 72.5% patients who expressed intention of immediate replacement of edentulous spaces, only 8.1% had actually been treated. Financial limitation was considered the most important factor that restricted access to treatment. Bivariate statistical analysis showed association between immediate dental replacement and anterior tooth loss (p=0.00) and extension of edentulous space (p=0.01). Position of lost teeth was associated to perceived functional limitation (p=0.03). Worsened appearance was associated to tooth loss in the maxillary arch (p=0.02), and desire of prosthodontic treatment was associated to the extension of edentulous space (p=0.05). Perceived impacts were more frequent in women than men. It was concluded that although patients usually expressed prosthodontic treatment needs, clinical and financial issues are determinant factors for tooth replacement.