Perception and significance of dental appearance: the case of missing teeth

Volumetric Evaluations of Full-Arch Implant Supported Restorations and Their Role on Patients’ Quality of Life: A Mixed-Model Analysis

Introduction

Full-arch, implant-supported hybrid restorations, employing tilted implants, can offer an efficient way of treating edentulous patients. Several factors, such as the timing of implant placement and the inclination of the fixture, can have a detrimental effect on their stability. This retrospective study is aimed at discerning the role played by those factors.

Materials and Methods

Patients treated with full-arch, implant supported restorations were selected for this study; cone-beam computed tomography (CBCT) images, taken 3 months and 3 years after delivery of the final restoration, as well as peri-implant values, were obtained and compared; bone loss was measured on four sites for each implant and then averaged. These patients were recalled, and the OHIP-5 questionnaire was administered.

Results

21 patients, with a mean age of 53 years, were included in the present analysis. 108 implants were placed, and 25 Toronto prostheses were delivered. According to a mixed-model analysis, tilted implants (0.51, p < 0.001) had a higher rate of bone loss, while implants placed in a healed ridge suffered less bone loss than immediate implants (-0.21, p < 0.001). Patient-level variables have a significant effect on this variable, as implants coming from the same subject share a similar risk of bone loss. The mean response to the self-administered OHIP-5 questionnaire was 1.53 ± 0.29; other variables did not have a statistically significant effect on this outcome. Discussion/Conclusions. The results of the present study show that Toronto bridges prostheses are an efficient procedure for treating edentulous patients, as their oral-related quality of life is reported as satisfactory even 7 years after delivery of the restoration. Tilted and immediate implants are more at risk of bone loss. Implants coming from the same subject share a similar risk of bone loss.

Evaluation of an oral health scale of infectious potential using a telematic survey of visual diagnosis

Objective: To compare the results of a subjective estimation of oral health through review of a set of intraoral photographs with those of an objective oral health scale of infectious potential. Method: The pool of patients was made up of 100 adults. Using an infectious-potential scale based on dental and periodontal variables, we assigned 1 of the 4 grades of the scale (range, 0 to 3; 0 corresponds to an excellent oral health status and 3 to the poorest oral health status) to each subject. A total of 20 representative subjects were selected from the pool of patients, 5 subjects for each one of the grades of the scale, and a standardized photographic record was made. One thousand dentists practicing in Spain were sent the survey by e-mail and 174 completed forms were received. We then calculated the concordance of the oral health status indicated by the respondents after visualising the photographs on comparison with the results of the oral health scale of infectious potential; concordance was termed correct grade allocation (CGA). Results: The majority of respondents (69.1%) achieved a CGA in 8 to 12 cases and none achieved more than 15 CGAs. The poorest CGA rates were found with grades 1 and 2, with a mean of 1.74 ± 1.09 and 1.87 ± 1.18, respectively, out of a maximum of 5. The concordance in terms of CGA was high for grade 0 (70.5%), very low for grade 1 (10.8%), low for grade 2 (37.3%), and moderate for grade 3 (42.6%). Conclusion: In comparison with visual examination of the oral cavity, the use of objective scale that establishes a reliable diagnosis of oral health in terms of infectious potential was found to be advantageous.

Key words:Diagnosis, intraoral photographies, oral health scale, objective estimation, visual examination.

Determinants and promotion of oral hygiene behaviour in the Caribbean and Nepal

The purpose of this study was to identify predictors of oral hygiene behaviour (OHB) based on the Theory of Planned Behaviour (TPB) among dental care seekers in two cultural different regions: the Caribbean (Aruba/Bonaire) and Nepal. In addition, measures of oral health knowledge (OHK) and the expected social outcomes of having healthy teeth (ESO) were investigated. The main effects of the predictors as well as their interactions with region (Caribbean vs. Nepal) were examined. The interaction term contributed significantly to the amount of explained variance. In the Caribbean, OHB was determined by Attitude and Social Norms, and in Nepal by Perceived Behaviour Control and ESO. On the basis of these findings, quite different oral health care interventions are called for in developing and underdeveloped countries.

Oral health and social and emotional well-being in a birth cohort of Aboriginal Australian young adults

Background

Social and emotional well-being is an important component of overall health. In the Indigenous Australian context, risk indicators of poor social and emotional well-being include social determinants such as poor education, employment, income and housing as well as substance use, racial discrimination and cultural knowledge. This study sought to investigate associations between oral health-related factors and social and emotional well-being in a birth cohort of young Aboriginal adults residing in the northern region of Australia's Northern Territory.

Methods

Data were collected on five validated domains of social and emotional well-being: anxiety, resilience, depression, suicide and overall mental health. Independent variables included socio-demographics, dental health behaviour, dental disease experience, oral health-related quality of life, substance use, racial discrimination and cultural knowledge.

Results

After adjusting for other covariates, poor oral health-related items were associated with each of the social and emotional well-being domains. Specifically, anxiety was associated with being female, having one or more decayed teeth and racial discrimination. Resilience was associated with being male, having a job, owning a toothbrush, having one or more filled teeth and knowing a lot about Indigenous culture; while being female, having experienced dental pain in the past year, use of alcohol, use of marijuana and racial discrimination were associated with depression. Suicide was associated with being female, having experience of untreated dental decay and racial discrimination; while being female, having experience of dental disease in one or more teeth, being dissatisfied about dental appearance and racial discrimination were associated with poor mental health.

Conclusion

The results suggest there may be value in including oral health-related initiatives when exploring the role of physical conditions on Indigenous social and emotional well-being.

Social Perceptions of Individuals Missing Upper Front Teeth

Although it is assumed that there are negative social consequences for individuals missing visible front teeth, no study of the way in which edentulous individuals were perceived in a social context and the potential social repercussions could be located. This initial study concerned college students' perceptions of individuals missing visible upper front teeth. 200 volunteers, 19 to 50 years of age ( M = 20.6, SD = 4.4), rated five photographs depicting tooth presence or absence, from a full dentition to missing as many as four upper front teeth, on social traits including attractiveness, health status, educational attainment, satisfaction with life, active social life, aggressiveness, intelligence, trustworthiness, amount of caring, friendship, dating, and likelihood to live as a neighbor. Analysis suggested a person missing visible teeth was more negatively perceived on all social traits than a person with full dentition. Results were strongest when students were proposed to be linked to the edentulous individual in a personal way, i.e., dating or living as neighbor. Men and women agreed on perceptions of social traits and dentition condition. These results suggest the presence of strong Western cultural values, whereby those who are missing teeth may experience significant barriers to personal and social success.

Implants in conjunction with removable partial dentures: a literature review

Although the benefits of implant-borne removable prostheses are readily apparent for the fully edentulous patient and have been well documented, there is a paucity of studies concerning the combination of implants with removable partial dentures in partially edentulous patients. The aim of this article is to review the literature regarding implants with removable partial dentures and evaluate the evidence for this clinical approach. A MEDLINE/PubMed search from 1990 to 2006, focusing on the use of implants with removable partial dentures and related features, was supplemented with a hand search to identify relevant peer-reviewed English articles published in dental journals and textbooks on removable partial dentures.

Satisfaction With Dental Appearance Among Diverse Groups of Dentate Adults

Objectives: To quantify (a) the prevalence of dissatisfaction with dental appearance in a diverse sample of dentate adults and (b) the associations between dissatisfaction with dental appearance, sociodemographic factors, and other measures of oral health. Methods: Data were taken from the Florida Dental Care Study , a population-based longitudinal cohort study of oral health and related behaviors. The sample included 873 participants at baseline. Descriptive analysis and logistic regression were conducted to analyze the baseline data in the current report. Results: Females, problem-oriented dental attenders, and participants who had not completed high school were significantly more dissatisfied with their dental appearance than their respective counterparts. Dissatisfaction with dental appearance was also independently associated with six specific clinical and self-reported measures of oral health. Discussion: Dissatisfaction with dental appearance was common in this population-based sample of middle-aged and older adults, and was significantly associated with key sociodemographic and oral health factors.

Specifications provided by practitioners for fabrication of removable acrylic prostheses in Tanzania

This study aimed at determining the standard of communication between practitioners and dental laboratory technicians in fabrication of removable acrylic prosthetic appliances using written prescriptions. Three hundred and seventy-nine prescriptions submitted to the Dental Laboratory of Muhimbili National Hospital (January 1998-May 2004) were assessed for their instructive quality. Only specifications necessary for the fabrication of a removable acrylic prosthesis were considered. Analysis was according to type of appliances and indicated specifications by practitioners. EPI 6 was used with chi-square test for statistical analysis at a 0.05 level of significance. All 379 prescriptions had designation of practitioner and type of appliance indicated and most were authorized by doctors (67%; n = 254) and for partial dentures (86.5%; n = 328). The majority of the complete dentures (13.5%; n = 51) were authorized by students (49%; n = 25) in comparison with partial dentures (86.5%; n = 328) that were authorized mainly by doctors (71.9%; n = 236). Teeth required (83.4%; n = 316) was the most indicated specification and interns were the most instructive of practitioners. For complete dentures, the only significantly indicated specification was appointment date for occlusal registration. The most significantly indicated specifications for partial dentures was teeth required followed by appointment date for fitting, shade, claSPS and secondary impression. The standards of communication between practitioners and dental laboratory technicians in the fabrication of removable acrylic prostheses are generally inadequate as most required specifications were not indicated by practitioners. Work undertaken by technicians should be accompanied by a detailed written prescription, completion of work authorization be included in the curriculum and Dental Laboratory Vouchers in use be evaluated.

Welfare dental intervention improves employment and quality of life

Chronic, untreated oral disease adversely affects one's systemic health, quality of life, and economic productivity. This study evaluated the effect of rehabilitative dental treatment on the oral-health-related quality of life and employment of welfare recipients. Three hundred and seventy-seven participants in a novel welfare dental program received oral examinations, questionnaires, and rehabilitative dental treatment. Seventy-nine percent of participants exhibited improvement in their oral-health-related quality-of-life scores following dental treatment. Improved OHIP-14 change scores were associated with being Caucasian or African-American, initial poor general health, severity of treatment urgency, worse baseline oral-health-related quality-of-life scores, subsequent patient satisfaction with the Dental Program, and resolution of their chief complaint (all p < 0.04). Those who completed their dental treatment were twice as likely to achieve a favorable/neutral employment outcome (OR = 2.01, 95%CI = 1.12, 3.62). Thus, oral health improved the quality of life and employment outcome for this welfare population.

Anterior dental extractions among Dinka and Nuer refugees in the United States: a case series

Few U.S. adults today experience life without permanent anterior teeth and know little about how an incomplete anterior dentition affects adult well-being. Sudanese refugees, who had resettled in the U.S. and who had six mandibular anterior teeth ritually extracted during youth, provided an opportunity to examine the significance of the effect of this partial edentulism. The authors interviewed five adult refugees whose anterior dentition was restored using dental implants. Factors considered before and after restoration included incisal ability, food item recognition, food consumption patterns and related social factors. Before restoration of the anterior dentition, participants could not incise typical foods eaten in the U.S. and expressed embarrassment about their dental status, which limited smiling, speaking and social interaction. This case series offers insight into the bio-cultural importance of the anterior dentition for all populations living with a visible gap in the lower jaw.

An Evaluation of the San Francisco Department of Human Services Welfare Dental Program

OBJECTIVE

To evaluate the welfare-to-work San Francisco Personal Assisted Employment Services (PAES) Dental Program.

METHODS

A cohort of 377 study participants in the novel PAES Dental Program were followed through their baseline examination, rehabilitative dental treatment, follow-up exam, and completion of patient satisfaction survey. A framework of structure, process, and outcome measures was used to evaluate the success of the Dental Program. Chi square test, logistic regression, and paired t-test were used to analyze the levels of participation and satisfaction in the program.

RESULTS

Of the 377 study participants, 265 (70%) completed their rehabilitative dental treatment. Those who completed their dental treatment had more missing teeth and fewer decayed teeth at baseline than those who did not complete their treatment. High levels of patient satisfaction were reported for the Dental Program. Ninety-seven percent of 173 respondents felt that they had been treated with respect, 92% were satisfied with the scheduling of their appointments, 91% were satisfied with their Dental Program experience, and 90% felt that their chief complaint had been solved.

CONCLUSION

The PAES Dental Program provided high levels of patient satisfaction for process and outcome measures.

The effect of prosthodontic treatment on alveolar bone loss: a review of the literature

STATEMENT OF PROBLEM

Complete, fixed partial, removable partial, and implant-supported dentures have been used to comfortably and esthetically replace missing teeth. However, it is not certain what effect these prostheses have on the residual ridge.

PURPOSE

This article compares various prosthetic treatments to restore completely and partially edentulous mouths for their ability to preserve residual alveolar bone.

MATERIAL AND METHODS

A review of the literature was performed to discuss the effects of tooth replacement on residual alveolar bone.

RESULTS

The literature seems to indicate that the presence of a dental prosthesis affects the size and form of the residual alveolar ridge and bone.

CONCLUSION

An implant-supported fixed prosthesis to restore missing teeth in partially or completely edentulous jaws seems to be the best means of preserving residual alveolar bone.

Associations between selected demographic parameters and dental status: potential implications for orodental rehabilitation

PURPOSE

This pilot study evaluated potential relationships between dental status and various sociodemographic variables in the age group segment of the United States population at greatest risk for the disruption of dental function due to treatment of an oral cavity cancer.

METHODS

The Dental Health Supplement of the 1989 National Health Interview Survey was used to evaluate the self-reported status of natural dentition and prior dental rehabilitation among the population of persons 45 years or older.

RESULTS

Sociodemographic variables, which showed a significant association with status of natural dentition, were level of income and occupation at lower income levels (p < 0.05). Increased levels of prior dental rehabilitation were significantly associated with lower age, female gender, increased level of income, and occupation (p < 0.05). Occupations that required social interaction had the highest levels of both status of natural dentition and prior dental rehabilitation (p < 0.05).

CONCLUSIONS

Overall dental status after treatment of oral cancer may be related to the occupational status of many persons. Sociodemographic factors that influence the dental rehabilitation needs of individual patients after treatment of an oral cancer should be considered in policy decisions affecting accessibility of dental rehabilitative care. A follow-up, survey study that would further define the identified relationships between a person's demographic status and dental rehabilitation needs is recommended.

A 6-year follow-up study of oral function in shortened dental arches. Part II: Craniomandibular dysfunction and oral comfort

In this clinical 6-year follow-up study subjects with shortened dental arches (SDA, n = 55), characterized by the absence of molar support, are compared with subjects with complete dental arches (CDA, n = 52) with respect to items concerning craniomandibular dysfunction and oral comfort. In addition, a small group of subjects with SDA and removable partial dentures in the lower jaw (SDA + RPD, n = 19) is included in this study. Oral comfort is defined using the following criteria: (i) absence of pain and distress, meaning the absence of signs and symptoms of craniomandibular dysfunction: (ii) chewing ability; and (iii) appreciation of the appearance of the dentition in relation to absent posterior teeth. Additionally, complaints about the free-end RPD are described. It is concluded that: (i) a SDA (consisting of 3-5 occlusal units, OU) is not a risk factor for CMD and is able to provide long-term sufficient oral comfort; and (ii) free-end RPD (in the lower jaw) in SDA do not prevent CMD and do not improve oral function in terms of oral comfort.

Comparisons between dentist ratings and self-ratings of dental appearance in an elderly population

Little is known about dental appearance in terms of the elderly population. The purpose of this paper is to compare self-reported dental appearance with dentist-rated appearance for individuals over 65. The subjects (N = 550) were participants in the Los Angeles based Medicare Screening and Health Promotion Trial. Most were female (57.3%), white (89.0%), and married (62.0%), with a mean age of 74.5 years. About one-third had incomes greater than $25,000. Results are based on a 45 minute telephone interview and onsite dental screening. Findings show that 40% of the self-ratings on a five point scale were higher than the dentist ratings, and 22% were lower. Bivariate analyses showed that both sets of ratings were related to dental status variables, self-reported health, and education. High self-ratings were also associated with being white and having a positive mental health status, while high dentist ratings were associated with patients who were younger, married, and who had higher income and social network scores. Comparison of results from two multiple regressions showed unique predictors for the self-ratings (marital status and GOHAI scores) and for the dentist ratings (sex and income). These discrepancies can raise barriers to effective treatment planning in the elderly, which could affect utilization and satisfaction.

Understanding the value of teeth to older adults: influences on the quality of life

Understanding the value of teeth to older adults is important in marketing dental services and motivating patients to care for their teeth. The authors surveyed more than 1,000 older adults in North Carolina to determine how teeth affect the quality of their lives.