A structural equation model relating objective and subjective masticatory function and oral health-related quality of life in patients with removable partial dentures

Association between masticatory performance and oral conditions in adults: A systematic review and meta-analysis

OBJECTIVES

To give an overview of the evidence on the associations between oral condition factors and masticatory performance of adults, and to evaluate the direction and level of the associations.

DATA/SOURCES

Medline (PubMed), Embase (Ovid) and CINAHL Plus (EBSCOhost) were searched up to May 2022 for cross-sectional studies on oral conditions and masticatory performance in adults. Methodological quality of the included studies was independently evaluated based on the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Data on the associations between oral condition factors and masticatory performance were extracted. Meta-analysis was conducted on correlation coefficients.

STUDY SELECTION

Of the 8,035 records identified, 97 articles (88 studies) were included in the qualitative synthesis, and 18 studies were included in the meta-analyses. Among the oral condition factors that had associations with masticatory performance, the number of natural/remaining teeth or functional tooth pairs was reported by the largest number of studies, followed by perioral muscle status, dental prosthetic status, oral moisture status and periodontal status. Results of the meta-analyses showed that the positive association with the number of natural/remaining teeth was the strongest (pooled correlation coefficient: 0.51, 95%CI: 0.48 to 0.54), followed by the number of functional tooth pairs, maximum tongue force/pressure, while the association with the oral moisture status was the weakest.

CONCLUSIONS

Number of natural/remaining teeth and functional tooth pairs, perioral muscle status, oral moisture status, dental prosthetic status and periodontal status are the main oral condition factors influencing masticatory performance. Based on the limited evidence available, among these factors, the number of natural/remaining teeth has the strongest positive association, with a very low quality of evidence.

CLINICAL SIGNIFICANCE

This study provides valuable information on the oral condition factors associated with masticatory performance, which would be important for policymakers and clinical practitioners when deciding on the strategies for improving the masticatory performance of adults. This review highlights the need for standardization of measures and classifications of masticatory performance and oral conditions.

REGISTRATION

PROSPERO (registration number: CRD42021256824).

Tissue Surface Adaptation and Clinical Performance of CAD-CAM Milled versus Conventional Implant-Assisted Mandibular Overdenture

Purpose

To evaluate the surface adaptation and maximal biting force of CAD-CAM milled mandibular overdenture (CAD-CAM MOD) compared to conventional compression mold mandibular overdenture (CC MOD).

Materials and Methods

Ten completely edentulous subjects with persistent complaints of their complete mandibular dentures were received four dental implants in the anterior mandible. Three months after osseointegration, subjects were randomly received either conventional compression mold or CAD-CAM MOD in a crossover design. To assess tissue surface adaptation, the fitting surfaces of each denture base were scanned and placed on the reference master cast. Three and six months after each overdenture was inserted, clinical performance in the form of maximum biting force was evaluated.

Results

The results of this study indicated that the tissue surface adaptation of the CAD-CAM MOD bases was significantly better than the conventional (compression mold technique) processed bases where (P=0.0001). Regarding clinical performance (maximum biting force), the CAD-CAM MOD exhibited better clinical performance (P=0.0001).

Conclusions

In denture processing methods, the CAD-CAM overdenture delivered more precise adaption and clinical performance than the compression mold technique.

Quality of Life in Menopausal Women with Dental Restorations and Implants

Aim:

This multicenter study examined the relationship, possible interactions, and intermittent effects that dental implants and prostheses can have on menopausal women’s quality of life as well as provided information regarding the possible side effects of therapeutic regimens on menopause and osteoporosis or osteopenia.

Materials and Methods:

Questionnaires consisted of selected quality of life questions based on specific and additional medical and dental (mainly prosthodontic) questions, which were administered to 100 Greek menopausal/post-menopausal women (Age: Mean Value=63,62 years old) with osteopenia or with or without osteoporosis, with dental implants and implant restorations, or conventional prosthetic restorations visiting two University Hospitals. Menopausal/post-menopausal status was judged on the basis of either secondary, definitive amenorrhoea or based on follicular stimulation hormone ​​(FSH) values, estradiol, and clinical risk factors.

Results:

Participants had a statistically significantly better “functional” and “psychological” feeling after prosthodontic rehabilitation with and without implants. Three out of four reported that their dentist informed them of the possible implant problems that might arise from osteoporosis and its treatment (medications). Moreover, osteopenia was found to be associated with a very lower problem percentage. The bisphosphonate treatment had the highest rate (80%) of reported implant problems than non-bisphosphonate treatment (30%). The hormone replacement therapy (HRT) for menopause was reported to be more associated with problems in implant placement (19%) than in those without treatment (27.3%).

Conclusion:

The questionnaires revealed a significant improvement concerning women’s life quality and well-documented information about the problems their dental implants and restorations may cause in association with menopause and/or osteoporosis.

Comparison of the Accuracy between Denture Bases Produced by Subtractive and Additive Manufacturing Methods: A Pilot Study

Today, two different types of CAD-CAM fabrication methods for complete denture bases are available besides the conventional protocols: a subtractive milling process from a prepolymerized block of polymethylmethacrylate and an additive manufacturing process that built the denture base using a light-cured liquid in a VAT-polymerization process. The aim of this study was to evaluate and to compare the accuracy and precision of denture prosthetic bases made with subtractive and additive manufacturing technologies and to compare them with a denture base with the conventional method in muffle. From the results obtained, 3D printing dentures show a statistically significant higher accuracy than milled prosthetic bases. Milled prosthetic bases have similar accuracy than conventional fabricated dentures.

Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) Complete Dentures for Atrophic Alveolar Ridges: Workflow Combining Conventional and Novel Techniques

Extreme residual ridge resorption is a challenging clinical situation for the fabrication of complete dental prostheses. Computer-aided design and computer-aided manufacturing (CAD/CAM) complete dentures have been shown to have superior fit and material strength to conventionally fabricated dentures, but no clinical protocols have been described for cases of extreme residual ridge resorption. This report describes a workflow combining conventional and novel techniques for CAD/CAM complete dentures fabrication for atrophic alveolar ridges and demonstrates that a CAD/CAM workflow is an effective tool for solving this complex situation.

Evaluation of the clinical performance of dentures manufactured by computer-aided technology and conventional techniques: A systematic review

STATEMENT OF PROBLEM

The introduction of computer-aided design and computer-aided manufacturing (CAD-CAM) technology for complete denture fabrication may have improved clinical outcomes compared with conventional techniques. However, systematic reviews comparing these techniques are lacking.

PURPOSE

The purpose of this systematic review was to identify, compare, and synthesize the outcomes of published clinical studies related to complete denture fabrication, with respect to the differences between CAD-CAM technology and conventional techniques.

MATERIAL AND METHODS

A comprehensive search of studies published up to March 16, 2020, was conducted by using the PubMed/MEDLINE, Web of Science, Cochrane Library, SciELO, and Embase databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement criteria and was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID 42020202614). The population, intervention, comparison, and outcome (PICO) question was: Do CAD-CAM complete dentures have a similar functional performance to those fabricated by conventional techniques? The quality of publications was appraised by using the Critical Appraisal Skills Program (CASP) checklists.

RESULTS

Of the 1232 titles, 6 articles were selected. The studies reported better retention of digitally manufactured complete dentures without denture adhesives than that of conventional complete dentures with or without denture adhesives. Other studies reported that dentures manufactured with digital systems were better adapted to tissue surfaces, required less clinical time, were lower in cost, and provided better experience and satisfaction to patients.

CONCLUSIONS

The assessment of CAD-CAM planning and manufacturing through clinical studies is ongoing. However, preliminary results indicate better clinical performance and lower overall costs of digital complete dentures than conventional dentures.

Assessment of Age-Related Changes on Masticatory Function in a Population with Normal Dentition

This study aimed to investigate the influence of changes in age-related physiological muscular and dental factors on masticatory function. This study was conducted in 211 healthy participants divided into four different age groups: 20–45 years (Gr1); 45–60 years (Gr2); 61–70 years (Gr3); and ≥71 years (Gr4). For objective evaluation of masticatory function, the masticatory performance, bite force, posterior bite area (PBA), functional tooth units (FTUs), the number of remaining teeth, tongue pressure, masseter muscle thickness (MMT), and handgrip strength were examined. Food intake ability (FIA) and the Oral Health Impact Profile-14 score were assessed subjectively using questionnaires. A significant decrease in the number of remaining teeth, FTUs, handgrip strength, and FIA was found in Gr4, and a significant decrease in the tongue pressure, PBA, and bite force was found in those aged ≥61 years. In groups 1 and 3, an association of the PBA with masticatory performance was observed. However, there was no significant decreasing trend in the MMT with respect to masticatory performance with aging. With sufficient FTUs and posterior tooth support, although age-dependent decreases in the bite force, tongue pressure and handgrip strength were observed, masticatory performance was maintained. Establishing the PBA by improving occlusion through dental treatment is thought to be important for masticatory function.

Consensus on the terminologies and methodologies for masticatory assessment

A large number of methodological procedures and experimental conditions are reported to describe the masticatory process. However, similar terms are sometimes employed to describe different methodologies. Standardisation of terms is essential to allow comparisons among different studies. This article was aimed to provide a consensus concerning the terms, definitions and technical methods generally reported when evaluating masticatory function objectively and subjectively. The consensus is based on the results from discussions and consultations among world‐leading researchers in the related research areas. Advantages, limitations and relevance of each method are also discussed. The present consensus provides a revised framework of standardised terms to improve the consistent use of masticatory terminology and facilitate further investigations on masticatory function analysis. In addition, this article also outlines various methods used to evaluate the masticatory process and their advantages and disadvantages in order to help researchers to design their experiments.

A new masticatory performance scale to integrate food biting, comminution and mixing ability in removable partial denture wearers

BACKGROUND

The existing masticatory performance (MP) tests cannot comprehensively evaluate objective masticatory function.

OBJECTIVES

We aimed to examine the construct validity and responsiveness and determine the clinically minimum important difference (MID) and related factors of a newly developed MP scale to integrate food biting, comminution and mixing ability in patients with removable partial dentures (RPDs).

METHODS

Masticatory performance tests using gummy jelly, peanuts and colour-changeable gum were performed before and 3 months after RPD treatment in 248 partially dentate patients. A 10-point ordinal subscale was created for each MP test based on the distributions of MP values, and the three subscales were integrated into a single scale (iMP scale). We analysed the correlations between MP values and iMP scores and determined the effect size for RPD treatments and the MID on the basis of patient perception of chewing ability.

RESULTS

iMP scores exhibited moderate correlations with the three MP values (|ρ| = 0.73-0.79, p < .001) and with the change scores (|ρ| =0.61-0.64, p < .001). The mean iMP score significantly increased after RPD treatment (p < .001), and the effect size was 0.35. Of the 248 patients, 55 (22%) reported a slight improvement in chewing ability with a mean iMP score change of 2.1 points. Sex and the number of missing teeth were significantly associated with iMP scores (p < .05).

CONCLUSIONS

The iMP scale comprehensively evaluated objective masticatory function, including food biting, comminution and mixing ability in RPD wearers, and an increase of two points on the iMP scale was considered to be the MID in RPD treatments.

Responsiveness of methods to evaluate objective masticatory function in removable partial denture treatments

PURPOSE

The aim of this study was to examine the responsiveness of chewing tests after removable partial denture (RPD) treatment in this prospective cohort study.

METHODS

Pre- and post-RPD treatment, objective masticatory function was evaluated in 248 patients via chewing tests involving peanuts, a gummy jelly, and a color-changeable gum. A statistical comparison was performed between the pre- and post-treatment scores, and the standardized response mean (SRM) was determined as the treatment effect size (ES).

RESULTS

After RPD treatment, the median particle size in the sieving method using peanuts significantly decreased, and the glucose concentration in the gummy jelly method significantly increased (P < 0.001). The ESs of the sieving and gummy jelly methods were larger (|SRM| = 0.3-0.4) than that of the gum method (|SRM| = 0.1). In the subgroup analysis, the sieving and gummy jelly methods resulted in a broader effective range (|SRM| ≥ 0.3) than the gum method. In patients without pre-treatment dentures, the ES was medium in the sieving method (|SRM| = 0.6) and weak in the gummy jelly and gum methods (|SRM| = 0.3-0.4). The pre-treatment level of masticatory function was significantly correlated with ES (ρ = 0.93, P < 0.001).

CONCLUSIONS

These results suggest that the sieving and gummy jelly methods are more responsive than the gum method for RPD treatment and that the pre-treatment scores affect the responsiveness.

Accuracy of Intraoral Scanners for Recording the Denture Bearing Areas: A Systematic Review

PURPOSE

To systematically review clinical and laboratory studies that investigated the accuracy of intraoral scanners in recording denture bearing areas.

MATERIALS AND METHODS

Electronic and manual searches were conducted to identify all the available clinical and laboratory studies reporting the accuracy of digital impressions for recording denture related soft tissues. After the application of predetermined inclusion and exclusion criteria, the final list of articles was reviewed to meet the objective of this study.

RESULTS

The inclusion criteria were met by 18 studies out of which 8 were clinical and the rest were laboratory investigations. The eligible studies assessed the accuracy of intraoral scanners in recording both the denture supporting structures and the peripheral mobile tissues. The accuracy results were different among the various intraoral scanners. Likewise, the effect of several influencing factors, such as artificial markers, scanner head size, scanning strategy, and the operator's experience, were evaluated.

CONCLUSION

While the accuracy of intraoral scanners was comparable to the conventional techniques in recording bony structures with attached mucosa, they were not capable of accurately registering the mobile tissues. In addition, factors such as presence of a marker, larger scanner head size and specific scanning techniques appeared to improve the accuracy of the digital impression.

Responsiveness of methods to evaluate chewing ability after removable partial denture treatments

BACKGROUND

The ability of an instrument to detect a clinically important change in patient-reported outcomes following prosthetic treatment is critical for its use in clinical practice and research settings.

OBJECTIVES

This study aimed to examine the responsiveness of instruments in evaluating patient perception of chewing ability after removable partial denture (RPD) treatment in a prospective cohort.

METHODS

A single 100-mm visual analogue scale (VAS), 20-item food intake questionnaire (FIQ) and 6-point chewing difficulty scale (CDS) were administered to 248 partially edentulous patients to evaluate chewing ability pre- and post-RPD treatment. We conducted a statistical comparison between the pre- and post-treatment scores and determined the effect size (r) of RPD treatment for the instruments.

RESULTS

A significant improvement in chewing ability after RPD treatment was identified by VAS and CDS (P < .05), but not by FIQ (P = .16), which identified an improvement after controlling for sex, age, the number of missing teeth and presence/absence of existing removable dentures. The effect size was medium for VAS (r = .54), weak for CDS (r = .14-.17) and absent for FIQ (r = -.09). The increase in r was significantly associated with impaired chewing ability before treatment (ρ = -0.87, P < .001).

CONCLUSIONS

These results suggest that the 100-mm VAS, followed by CDS, is the most responsive instrument to detect an improvement in chewing ability after RPD treatment. Pre-treatment impairment of chewing ability was associated with better responsiveness of the instruments.

Dysphagia and masticatory performance as a mediator of the xerostomia to quality of life relation in the older population

Background

The impact of poor oral health on older adults’ quality of life is a public health problem. In this study, the mediating effects of dental status, occlusal condition, dysphagia, and masticatory performance on the association between xerostomia and oral health-related quality of life (OHRQoL) were assessed in the older adult population.

Methods

Stratified cluster sampling was used to recruit 1076 community-dwelling adults aged 65 years and older from Kaohsiung, Taiwan. Community care centers were randomly selected according to their geographic classifications (urban, rural, or mountainous areas). Assessments of dental status and occlusal condition were performed by dentists. Information on demographics, physical function, xerostomia, dysphagia and depression was collected through face-to-face interviews. Masticatory performance was evaluated using color-changeable chewing gum. OHRQoL was measured using the Geriatric Oral Health Assessment Index. Hierarchical regression models were used to assess the relationships between OHRQoL and physical function, dental status and oral function in older adults. Path analysis was used to estimate direct and indirect pathways between xerostomia and OHRQoL.

Results

Participants with xerostomia exhibited a 0.20 OHRQoL reduction (p < .001) compared with patients with no xerostomia, and the direct effect accounted for 83.3% of the total effect. Dysphagia and masticatory performance were found to exert significant mediating effects on the association between xerostomia and OHRQoL (βs = 0.20 and − 0.12, respectively; both p < .001; βs = 0.06 and − 0.09, respectively; both p < .05). Moreover, potential mediating effects of the number of functional teeth (βs = − 0.11 and − 0.43, respectively; both p < .001) and occlusal condition (βs = 0.09 and 0.13, respectively; both p < .05) on the relationship between xerostomia and masticatory performance were noted.

Conclusions

Dysphagia and masticatory performance may serve as pathways through which xerostomia affects quality of life. Early oral function intervention may be a valuable and actionable target for older adults to maintain quality of life. Our results further suggest that checkup and screening for oral dysfunction are essential to prevent or delay the onset of complications.

A Comprehensive Approach Limiting Extractions under General Anesthesia Could Improve Oral Health

Access to dental treatment could be difficult for some patients due to dental phobia or anxiety, cognitive or sensorial disabilities, systemic disorders, or social difficulties. General anesthesia (GA) was often indicated for dental surgery, and there is almost no available data on adapted procedures and materials that can be applied during GA for maintaining functional teeth on the arches and limiting oral dysfunctions. This study evaluates changes in oral health-related quality of life and mastication in a cohort of uncooperative patients treated under GA according to a comprehensive and conservative dental treatment approach. Dental status, oral health-related quality of life, chewed bolus granulometry, kinematic parameters of mastication, and food refusals were evaluated one month preoperatively (T0), and then one month (T1) and six months post-operatively (T2). One hundred and two adult patients (mean age ± SD: 32.2 ± 9.9 years; range: 18–57.7) participated in the preoperative evaluation, 87 were treated under GA of which 36 participated in the evaluation at T1 and 15 were evaluated at T2. Preoperative and postoperative data comparisons demonstrated that oral rehabilitation under GA helped increase chewing activity and oral health-related quality of life. The conditions for providing dental treatment under GA could be arranged to limit dental extractions in uncooperative patients.

Assessment of the Effect of Oral Health on Quality of Life and Oral-Health Indicators among ESRD Patients in Southwest Florida: A Pilot Study

Purpose

To determine and compare OHRQoL (oral-health-related quality of life) using the Geriatric Oral Health Assessment Index (GOHAI-12) and Oral Health Impact Profile (OHIP-14) among patients receiving hemodialysis (HD).

Methods

Face-to-face interviews and intraoral examinations were conducted among 70 patients. Mann-Whitney U test and Kruskal-Wallis test were used to compare each item score with demographics and dental and overall health status.

Results

The mean number of years on dialysis was 4.7 ± 7.5 yrs; the mean number of teeth present was 19.7 ± 11.04; median values of OHRQoL using GOHAI-12 and OHIP-14 were 52 and 64. Within GOHAI-12, limiting food (p 0.043), uncomfortable eating in front of people (p 0.045), limiting contact with people (p 0.046), and eating without discomfort (p 0.011) were significantly associated with females. Being worried (p 0.040) and self-conscious (p 0.048) were significant for age groups ≤65 years. Prevented from speaking was associated with >20 teeth (p 0.016). Being worried about oral health was associated with number of years on dialysis (p 0.042). Within OHIP-14, speech was associated with number of teeth present (p 0.024). Total inability to function was significantly associated with race (p 0.018), number of teeth (p 0.028), and edentulousness (p 0.031).

Conclusions

GOHAI-12 was more effective than OHIP-14 in assessing OHRQoL. However, most subjective experiences did not correlate with clinical findings. Systemic health issue like end-stage renal disease affecting QoL might have taken precedence over dental problems. Clinical assessments should be inherent in oral-health evaluation and there should be cooperation between nephrologists and dentists in promoting oral health and treating systemic conditions among HD patients.

Which variables should be controlled when measuring the granulometry of a chewed bolus? A systematic review

The distribution of food particles in a chewed bolus characterizes the food destruction after food oral processing (FOP). Previous reviews report that it could be affected by a lot of parameters as the number of chewing strokes, the dental status, but the conditions for producing reproducible data allowing inter-studies comparison have not been clearly described yet. This systematic review aims to identify the variables that can affect bolus granulometry determination, and to calculate their relative weights in the median particle size (D₅₀ ) variations. The systematic review focuses on granulometry expressed as D50 of the most used foods (peanuts, carrots, and almonds) and materials (Optosil and Optocal). Based on 58 studies, 5 variables among 60 being extracted could explain the D₅₀ variations. Conceptual differences between the conditions for FOP should be considered. After Chewing-test, the bolus is collected after a predefined number of strokes and its granulometry characterizes the effects of the dental and muscular apparatus on food destruction, while after Mastication-test the bolus is collected at the swallowing threshold, and its granulometry reflects the outcome of the abilities of the subject to adapt his/her mastication behavior to food texture. Experimental conditions related either to physical sieving or image analysis used to analyze the collected boluses impact the D₅₀ values. Finally, when type of test, sieving conditions, type of food or material, number of chewing strokes, and the oral status of the subjects are controlled, mean D₅₀ values are reproducible and could be used for inter-studies comparisons. PRACTICAL APPLICATIONS: This review provides tables that could be useful to control mean D₅₀ variations in further research.

Relationship between gerotranscendence and oral health-related quality of life

OBJECTIVES

The purpose of our cross-sectional study was to investigate the relationship between gerotranscendence and oral health-related quality of life (OHR-QOL). To our knowledge, this is the first study to investigate the relationship between gerotranscendence and OHR-QOL.

METHODS

Participants (total n = 1969; 70-year-old group, n = 999; 80-year-old group, n = 970) were drawn from resident lists in four areas of Japan: one urban area and one rural area in each of two geographical regions. OHR-QOL was measured using the Geriatric Oral Health Assessment Index (GOHAI). Measurement of occlusal force was performed using pressure-sensitive sheets. Gerotranscendence was assessed with the Japanese Gerotranscendence Scale Revised (JGS-R). We used multiple linear regression analysis to examine the relationships among OHR-QOL and other variables.

RESULTS

Geriatric Oral Health Assessment Index score was significantly correlated with occlusal force, number of teeth, financial status and JGS-R score on linear regression analysis.

CONCLUSION

Degree of gerotranscendence was significantly and independently correlated with degree of OHR-QOL in our sample.

CAD/CAM produces dentures with improved fit

OBJECTIVES

Resin polymerisation shrinkage reduces the congruence of the denture base with denture-bearing tissues and thereby decreases the retention of conventionally fabricated dentures. CAD/CAM denture manufacturing is a subtractive process, and polymerisation shrinkage is not an issue anymore. Therefore, CAD/CAM dentures are assumed to show a higher denture base congruence than conventionally fabricated dentures. It has been the aim of this study to test this hypothesis.

MATERIALS AND METHODS

CAD/CAM dentures provided by four different manufacturers (AvaDent, Merz Dental, Whole You, Wieland/Ivoclar) were generated from ten different master casts. Ten conventional dentures (pack and press, long-term heat polymerisation) made from the same master casts served as control group. The master casts and all denture bases were scanned and matched digitally. The absolute incongruences were measured using a 2-mm mesh.

RESULTS

Conventionally fabricated dentures showed a mean deviation of 0.105 mm, SD = 0.019 from the master cast. All CAD/CAM dentures showed lower mean incongruences. From all CAD/CAM dentures, AvaDent Digital Dentures showed the highest congruence with the master cast surface with a mean deviation of 0.058 mm, SD = 0.005. Wieland Digital Dentures showed a mean deviation of 0.068 mm, SD = 0.005, Whole You Nexteeth prostheses showed a mean deviation of 0.074 mm, SD = 0.011 and Baltic Denture System prostheses showed a mean deviation of 0.086 mm, SD = 0.012.

CONCLUSIONS

CAD/CAM produces dentures with better fit than conventional dentures.

CLINICAL RELEVANCE

The present study explains the clinically observed enhanced retention and lower traumatic ulcer-frequency in CAD/CAM dentures.

Short-term changes in chewing efficiency and subjective evaluation in normal dentate subjects after insertion of oral appliances with an occlusal flat table

Oral appliances with an occlusal flat table are used as treatment dentures. However, the short-term effect of insertion of such oral appliances on chewing has not been reported. This study aimed to determine whether experimental and continuous insertion of oral appliances with an occlusal flat table has an effect on chewing efficiency and Oral Health Impact Profile (OHIP) in healthy participants. Ten participants each in the oral-appliance and control (no oral-appliance insertion) groups attended six data collection sessions for 5 consecutive days. Participants answered the OHIP questionnaire and underwent the chewing efficiency test. For each parameter, intergroup differences were investigated in terms of change from baseline to immediately after oral-appliance insertion (0 hour; P < .05) and from 0 hour to 24, 48, 72 and 96 hours after oral-appliance insertion (P < .05). There were significant differences between groups in the degree of change in chewing efficiency and OHIP scores for functional limitation, physical pain, physical disability and handicap from baseline to 0 hour (all, P < .001); among these, only OHIP scores for functional limitation and physical pain demonstrated significant differences in degree of change between the two groups at 96 hours after appliance insertion (P = .477 and .275, respectively). Differences between the two groups in the degree of change in other parameters were not significant. Insertion of oral appliances caused a decrease in chewing efficiency and an increase in OHIP scores. Continuous insertion improved functional limitation and physical pain within 96 hours.

Mastication and oral health-related quality of life in removable denture wearers with Alzheimer disease

STATEMENT OF PROBLEM

Alzheimer disease (AD) can affect masticatory function, affecting oral health-related quality of life (OHRQoL). Whether oral rehabilitation with conventional removable prostheses can restore masticatory function and improve OHRQoL in these individuals is unknown.

PURPOSE

The purpose of this clinical study was to evaluate the influence of oral rehabilitation with removable prostheses on masticatory efficiency and OHRQoL in elders with and without AD.

MATERIAL AND METHODS

Thirty-two elders with mild AD (n=16, mean age=76.7 ±6.3 years) or without AD (n=16, mean age=75.2 ±4.4 years) were recruited. All participants first underwent masticatory efficiency and OHRQoL evaluations, and 2 months after insertion of new removable prostheses, the variables were reassessed. Masticatory efficiency was determined using the sieving method, and OHRQoL was measured by applying the Geriatric Oral Health Assessment Index (GOHAI). The data from the baseline and after insertion of the new removable prostheses were compared by paired t test. Group differences at each time point were assessed by t test (α=.05).

RESULTS

After insertion of the new removable prostheses, masticatory efficiency and OHRQoL improved in both the elders with AD and the control. At baseline, elders with AD had lower masticatory efficiency and higher OHRQoL than controls (P<.05). After removable prosthesis insertion, elders with AD continued to show lower masticatory efficiency values than controls, but their OHRQoL was similar.

CONCLUSIONS

Oral rehabilitation with new removable prostheses improved the masticatory efficiency and OHRQoL of elders with and without AD, although masticatory efficiency did not reach control levels in elders with AD.

Shortcomings of prosthodontic rehabilitation of patients living in long-term care facilities

Removable dentures are a non-invasive, cost-effective prosthodontic solution for the reduced dentition. Their intended purpose is the rehabilitation of harmonious oral function and aesthetics on a long-term basis. The prevalence of removable dentures among patients of advanced age is high and the quality of the dentures is often poor. The aim of this study was to find the most important shortcomings of removable dentures and address the main targets for improving the quality of prosthodontic rehabilitation. The records from dental check-ups in Austrian residential homes were analysed retrospectively. Dental anamnesis questionnaires and data from the clinical examinations of 105 denture wearers were analysed. The functional condition and retention of 192 dentures had been assessed, as well as the impact of the dentures on the intra-oral tissues. Insufficient denture retention was very common, particularly in the lower jaw (56·0%). Problems with the masticatory function were reported by 26.7% of the denture wearers, 11·4% were dissatisfied with the denture aesthetics, and 4·8% had difficulties with phonetics. Traumatic ulcers were found in 18·1%. Cracks, broken pieces (6·3%) or missing denture teeth (2·1%) were rare. It may be assumed that the findings of the present study also apply to a great percentage of community-dwelling seniors. The most important issues in prosthodontic rehabilitation with removable dentures are denture retention and masticatory function. Regular dental check-ups, denture adjustment and, when necessary, relining can maintain the primary denture quality and prevent damages of the oral tissues caused by ill-fitting dentures.

Alteraciones de la masticación en usuarios de prótesis dental removible. Revisión sistemática

Resumen:Tras el paso de los años, la pérdida de dientes genera la necesidad de recurrir al uso de prótesis dental. Específicamente, las alteraciones en el proceso de masticación en usuarios de prótesis dental removible se consideran un problema no sólo en relación a las modificaciones a nivel morfofuncional, sino que también en la propia satisfacción en cuanto a la masticación y funcionalidad de este proceso. El propósito de esta revisión es compilar y analizar los artículos científicos sobre la relación de la masticación y prótesis dental removible en adultos y adultos mayores. Se realizó una búsqueda integrativa de artículos en las bases de datos SCIELO, LILACS y PUBMED, seleccionando artículos publicados entre el año 2005 a 2014. Los artículos de revisión incluyeron estudios que identificaran la relación entre el uso de prótesis dental removible y la masticación en adultos usuarios de dicha prótesis dental. En la búsqueda se encontraron 21 documentos para potencial revisión. Finalmente, aplicando criterios de inclusión y exclusión se seleccionaron11artículos, los cuales tomaban diferentes variables de estudio, entre ellas, nivel de satisfacción, rendimiento, eficiencia y parámetros masticatorios. La satisfacción, el rendimiento, la eficiencia y los parámetros masticatorios fueron las variables que se encontraban afectadas en usuarios de prótesis dental removible.

Dental Implant Supported Restorations Improve Quality of Life in Osteoporotic Women

Introduction. The aim of this study is to compare the quality of life (QoL) in partially edentulous osteoporotic women who have missing teeth restored with dental implant retained restorations with those who do not and, secondarily, to report the rate of osteonecrosis in this sample. Methods. 237 participants completed the Utian QoL survey, a 23-question document measuring across psychosocial domains of well-being including occupational, health, emotional, and sexual domains which together contribute to an overall score. The subset of participants having dental implant supported prosthesis (64) was compared to the subset having nonimplant supported fixed restorations (47), the subset having nonimplant supported removable restorations (60), and the subset having no restoration of missing teeth (66). Results. ANOVA showed significant difference in all QoL domains between the four subsets (p < 0.05). Although 134 reported oral bisphosphonate and 51 reported IV bisphosphonate use, no signs of ONJ were identified in any participants. Conclusion. These findings show implant retained oral rehabilitation has a statistically significant impact over nonimplant and traditional fixed restorations, removable restorations, and no restoration of missing teeth in far reaching areas including occupational, health, emotional, sexual, and overall QoL. These findings also support future examination of psychosocial outcomes associated with oral rehabilitation and the incorporation of oral health into women's health promotion.

The influence of social support on quality of life of men who have sex with men in China: a preliminary study

The quality of life (QOL) of men who have sex with men (MSM) has received increasing attention in recent years. Our study surveyed the QOL and explored the influence of social support on QOL in Chinese MSM. A cross-sectional survey was conducted from September 2013 to March 2014 of 438 MSM in Huludao and Zhengzhou City, China. The results of univariate analysis showed that higher QOL scores were associated with receiving psychosocial counseling, higher health education, younger age and marital status of being single or unmarried p < 0.05). The structural equation model fitted well, with χ2 = 2083.47 (p < 0.05), RMSEA = 0.07, and GFI = 0.88. Among the latent factors, social support, with a factor load of 0.47, had greater impact on QOL than demographic characteristics. Within social support, the item loads for psychosocial counseling and health education were 0.17 and 0.29, respectively. Basic demographic characteristics also influenced social support, with a factor load of -0.65. For demographic characteristics, the greatest item loads were for marital status and age (0.77 and 0.71, respectively). These findings suggest that strengthening social support, especially for older and married individuals, would improve QOL in MSM in China.

A structural equation model relating oral condition, denture quality, chewing ability, satisfaction, and oral health-related quality of life in complete denture wearers

OBJECTIVES

To investigate the relationship between mandibular ridge form, stability and retention of mandibular complete denture, accuracy of jaw relation recording, patients' perception of chewing ability, satisfaction with dentures and oral health-related quality of life (OHRQoL) in complete denture wearers.

METHODS

A total of 183 edentulous patients, who visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures, were recruited. Oral examination was performed. Cawood and Howell's method was used to grade the mandibular ridge form. The stability and retention of the mandibular complete denture were assessed using Kapur method. Accuracy of jaw relation recording was evaluated using a newly developed jaw relation index. Patients' perception of chewing ability was rated using a food intake questionnaire. Patients' satisfaction with complete dentures was assessed on a 100-mm visual analogue scale. OHRQoL was measured using the Japanese version of the Oral Health Impact Profile for edentulous subjects. A structural equation model was constructed based on the hypothesis that oral condition and denture quality would be related to chewing ability, satisfaction and OHRQoL.

RESULTS

Significant relationships were found between mandibular ridge form, stability of mandibular complete denture, accuracy of jaw relation recording, perceived chewing ability, satisfaction and OHRQoL. Various fit indices were within acceptable limits.

CONCLUSIONS

Oral condition and denture quality were related to patients' perception of chewing ability, satisfaction with dentures and OHRQoL in complete denture wearers.

CLINICAL SIGNIFICANCE

A favourable oral condition and denture quality are important for successful complete denture therapy.

The relationship between oral conditions, masticatory performance and oral health-related quality of life in children

OBJECTIVE

To evaluate the association between oral conditions, masticatory performance (MP) and oral health-related quality of life (OHRQoL) in 8-12 year-old children.

DESIGN

150 Brazilian scholars were examined for caries and malocclusions. MP was evaluated based on the ability to comminute an artificial test food followed by the determination of the median particle size (X50) and particle distribution in different-sized sieves ("b"). OHRQoL was measured using the Brazilian versions 8-10 and 11-14 of the child perceptions questionnaire (CPQ), considering the following domains: oral symptoms (OS), functional limitations (FL), emotional well-being (EW) and social well-being (SW). Higher scores indicated worse OHRQoL. Data were submitted to Spearman's correlation test and multiple linear regression analysis.

RESULTS

There were significant positive correlations between the psychosocial and OS domains scores of the CPQ8-10 and the number of decayed and missing teeth, respectively. The number of decayed teeth positively correlated with the number of missing teeth and the CPQ11-14 scores. The number of decayed and missing teeth was significantly associated with higher CPQ8-10 scores. Higher CPQ11-14 overall scores were associated with female gender, higher FL domain scores were associated with the number of missing teeth, and higher X50 values and EW domain scores were associated with female gender and the number of decayed teeth.

CONCLUSIONS

A higher number of missing teeth correlated with an inferior MP in older children. Children with a higher number of caries rated their oral health less favourably. Older females and those who broke the test material into smaller sizes were also more likely to report a worse OHRQoL, suggesting that the time allowed to reduce food appears to be a more influential factor on children' perception of oral health than their ability to break down the test material into smaller sizes. Moreover, the subjectivity of functional domain and artificial nature of chewable test material could have influenced the test sensitivity.