Impact of new prostheses on the oral health related quality of life of edentulous patients

Agreement between self-rated denture condition and clinical examination in older adults

OBJECTIVES

This study aimed to compare differences between complete denture conditions self-rated by older adult wearers and clinically exanimated by a professional based on standardised aesthetics and functional criteria.

MATERIALS AND METHODS

Complete denture clinical examination was based on the functional (stability, retention, occlusion and articulation, vertical dimension of occlusion) and aesthetics criteria. Data on self-rated complete denture conditions were measured using the Patient's Denture Assessment (PDA) questionnaire based on standardised aesthetic and functional criteria (n = 122). Prevalence rates of clinical and self-rated complete denture condition, sensitivity, specificity, positive and negative predictive values, and absolute and relative bias were calculated.

RESULTS

The highest sensitivity (66.7% [95% CI 55.3-76.7]) was obtained for aesthetic criterion, whereas occlusion revealed the lowest sensitivity (14.9% [95% CI 6.2-28.3]). Stability had the highest specificity (91.3% [95% CI 72.0-98.9]) and aesthetics the lowest (21.4% [95% CI 8.3-41.0]). Stability also yielded the highest positive predictive value (83.3% [95% CI 51.6-97.9]), and vertical dimension of occlusion the lowest (26.3% [95% CI 9.1-51.2]). The vertical dimension of occlusion yielded the highest negative predictive value (71.2% [95% CI 58.7-81.7]). Self-rated data underestimated the complete denture condition in 6.5% compared with clinical examinations when the aesthetic criterion was excluded from the analysis and 7.6% when added.

CONCLUSIONS

Older adult wearers better identified the condition of their complete denture when the aesthetic criterion was excluded from examination. In contrast, considering functional criteria (retention, stability, occlusion and vertical dimension of occlusion), self-rated complete denture conditions underestimated clinical examination.

CLINICAL RELEVANCE

Using standardised aesthetic criteria in epidemiological studies for assessing complete denture conditions self-rated by wearers could avoid underestimating or overestimating the information regarding the use or need for dental prostheses.

Expected and perceived burdens in patients receiving mandibular overdentures retained by one or two implants

PURPOSE

This study aimed to assess patients' expected burdens before treatment and their perceived burdens after the surgical and prosthodontic procedures of mandibular overdenture treatment and to evaluate factors influencing patients' perceptions.

METHODS

Data were collected from 47 participants enrolled in a randomized clinical trial comparing mandibular overdentures retained by one or two implants. A 20-item questionnaire measured on a four-point Likert scale covering the surgical and prosthetic treatment procedures was used to assess the patients' perception of the procedural burdens before (expected burdens) and immediately after (experienced burdens) each procedure. Operators' perceptions of intercurrences associated with the procedures were also assessed as an independent variable.

RESULTS

Low levels of perceived burdens were observed both before and after treatment. The mean overall scores of 1.65 ± 0.46 and 1.53 ± 0.33 for expected and experienced burdens, respectively, indicated that most items ranged between "not burdensome at all" and "somewhat burdensome." Significant differences between expected and experienced burdens were found for eight items (p < 0.001). Considering the treatment stages, expected burdens scored higher in the pre-surgical, surgical, and prosthetic stages and lower in the post-surgical phase than experienced burdens. Overall, the experienced burdens were significantly affected by the expected burdens (p < 0.001) and operator's perceived burdens (p = 0.045).

CONCLUSIONS

Treatments were associated with low levels of perceived burdens related to surgical and prosthodontic procedures and were highly correlated with the expected burdens before treatment. However, patients tend to overestimate the expected burdens before treatment, especially for surgical procedures.

Challenges faced by edentulous patients (EDPs) during complete denture prostheses (CDP) service delivery in Fiji - a qualitative study

BACKGROUND

Edentulism is a state of having no teeth in the oral cavity, an irreversible condition popularly known as the marker of disease burden on the oral health. For edentulous patients (EDPs) Complete Denture Prostheses (CDP) is a means to improve oral health. Due to limited studies in this area, this research aimed to explore the challenges faced by the EDPs during CDP service delivery in Fiji.

METHODS

A directed descriptive qualitative study was conducted among EDPs attending Dental Prosthetic Clinics (DPCs) at the four centres in Fiji under purposive sampling. A semi-structured questionnaire with open ended questions was used for in-depth interview with EDPs who had worn CDP for 1 year via telephone. Participant responses were recorded, transcribed verbatim and analyzed manually using thematic analysis.

RESULTS

A total of 30 EDPs participated in the study. Six themes were identified as challenges faced by the EDPs during CDP service delivery in Fiji: lack of information, non-compliance, overwhelmed by illness, reduction on quality of life (QoL) financial barriers to CDP treatment care and personal acceptance. 77% of EDPs felt they did not receive adequate information on CDP when attending DPCs which indicated the non-compliance nature irrespective of using and cleaning CDP on a daily basis. The Dental Professionals (DPs) at the DPCs gave their full support in attending to the CDP challenges faced by the EDPs in Fiji during the review clinics.

CONCLUSION

The EDPs expressed a variety of challenges that was faced while seeking appropriate CDP services in Fiji. The findings demonstrate the need to explore approaches to develop patients' engagement practices during CDP service delivery by the Dental professionals (DPs), which leads to effective oral health promotion in Fiji for CDP wearers.

Health-related quality of life in edentulous patients

This study aimed to assess Oral Health-Related Quality of Life (OHQoL) and satisfaction in patients who had complete denture treatment and were diagnosed with systemic diseases. Eighty edentulous patients using new complete dentures were separated into four groups according to their diseases [diabetes mellitus (DM)/osteoporosis (OP)/hypertension (HP)/healthy (control)]. The groups answered the Turkish version of the United Kingdom-Oral Health-Related Quality of Life (OHQoL-UK) and Visual Analog Scale (VAS) questionnaire four weeks after treatment. OHQoL-UK scores were slightly higher for females regardless of the type of disease. Compared with the control participants (57.95±5.33), the scores of the OHQoL-UK were not significantly different in OP and HP groups except for the DM group (58.7±5.37, 58.9±6.44, 45.3±5.19 respectively). DM was significantly associated with the increase of OHQoL values (p<0.05). Patients in all groups reported significantly higher "physical health" scores than other subdomains of OHQoL-UK, although positive correlations were determined among them. Presence of disease had no relationship to the VAS scores. This study shows that systemic diseases might not affect and predict patients' satisfaction with their complete dentures and OHQoL. DM is an independent risk factor for oral health. Satisfaction with the prosthesis might concern a patient's level of OHQoL.

Do ball-type attachment systems for overdenture result in better patient-satisfaction? A systematic review of randomized crossover clinical trial

Objective

This review is to compare patient-satisfaction with ball-type overdenture attachment systems with others attachment systems.

Material and methods

This study was registered in PROSPERO (CRD42018097234) and adheres the PRISMA guidelines. Electronic searches on PubMed/MEDLINE, Scopus, Cochrane, and Web of Science databases for published articles were performed before October 2020. The PICO question was: “Do patients with a ball-type overdenture retention system have greater satisfaction, when compared to other attachment systems?” The evaluation of risk of bias was performed using the Cochrane risk of bias tool.

Results

After searching the databases, seven articles were selected out of a total of 2583. A total of 312 implants were placed in 139 patients, with a mean age of 65.9 years. The risk of bias in the included studies varied according to the different domains in a risk of uncertain bias or low bias risk. No difference was found between the ball attachment systems and the others systems, with respect to patient-satisfaction. The meta-analysis revealed no statistically significant difference between the ball systems and another systems (P = 0.11; MD: 10.90; 95% CI: −2.55 to 24.35).

Conclusions

Regarding patient general satisfaction, it was not possible to determine differences between the ball system and another types of attachment system for overdenture. The ball-type system was statistically superior only to the magnet system.

GOHAI and OHIP-EDENT Evaluation in Removable Dental Prostheses Users: Factorial Analysis and Influence of Clinical and Prosthetic Variables

PURPOSE

To assess the degree of satisfaction and quality of life of patients with removable prostheses using the Geriatric Oral Health Assessment Index (GOHAI) and Oral Health Impact Profile in Edentulous Adults (OHIP-EDENT), in addition to evaluating the questionnaires for their validation.

MATERIALS AND METHODS

Eighty patients participated in the study after completing prosthetic rehabilitation treatment. Patients were evaluated using the OHIP-EDENT and GOHAI questionnaires to assess the criteria for quality of life, esthetics, phonetics, masticatory function, stability, comfort, and alteration of taste and pain related to the completed prostheses. The results were subjected to the chi-squared test, Fisher's exact test, and a multinomial logistic regression model, with a significance level of 5%.

RESULTS

The most commonly used removable prosthesis was mandibular removable partial denture (RPD) (n = 43, 53.8%), followed by maxillary RPD (n = 42, 52.5%), maxillary complete denture (CD) (n = 33, 41.3%), and mandibular CD (n = 31, 38.8%). Most patients had to have one (n = 29, 36.3%), two (n = 21, 26.3%), or none (n = 18, 23.8%) adjustments in their prostheses. Five (6.3%) patients' prostheses required three adjustments, and six (7.5%) required four or more adjustments. All reported improvement in esthetics after using the prostheses (p < 0.05). The validation of the questionnaire proved to be more viable when completed without the presence of specific domains.

CONCLUSION

The results of this study indicated that removable prostheses improved the quality of life of rehabilitated patients. The questionnaires used need to be answered and evaluated in their entirety for validation.

Examining the associations between oral health and social isolation: A cross-national comparative study between Japan and England

In Western countries, the most important part of the face in communication is the mouth, whereas it is the eyes in Asian countries; thus oral health could be more important in social interactions in Western countries. Our aim was to examine differences in the association between oral health status and social isolation among older people by comparing Japan and England. We used cross-sectional information obtained from adults aged 65+ in two ongoing prospective cohort studies: The Japan Gerontological Evaluation Study (JAGES, N = 120,195) and the English Longitudinal Study of Ageing (ELSA, N = 3,958). The dependent variable, social isolation score (SIS) was calculated from five factors (marital status, social support from children, social support from family, social support from friends, and social participation). The independent variables were self-reported number of remaining teeth (0, 1-9, 10-19, ≥20) and denture use (≥20 teeth, 10-19 teeth with denture, 10-19 teeth without denture, 0-9 teeth with denture, 0-9 teeth without denture), while the covariates in the model were: sex, age, educational attainment, self-rated health, number of comorbidities, household annual equivalized income, mental health status, daily living activities, and smoking status. We examined associations between oral health status and SIS by applying an ordered logit model by country. Compared to England, more Japanese participants were socially isolated (1.4% vs. 5.8%), but fewer were edentulous (13.1% vs. 7.7%). In both countries, poorer oral health further increased the odds of being socially isolated. Pooled analysis of the ordered logit model with an interaction term showed that the association of number of remaining teeth with SIS was stronger in edentulous participants and in England (odds ratio = 1.50, 95% Confidence interval:1.26-1.80). In both countries, oral health was associated with social isolation; this association could be stronger in England than in Japan.

Efficacy of denture adhesives in complete denture wearers compared to denture wearers not using denture adhesives. A systematic review

AIM

The objective of this systematic review was to evaluate the efficacy of denture adhesives (DAs) in completely edentulous denture wearers compared to not using DAs.

METHODS AND RESULTS

PubMed, Web of Science, Cochrane Library, and EMBASE were searched from the database inception up to 6 February 2020 for Randomized Controlled Trials (RCTs) involving patients with complete dentures in both arches where the use of DAs was compared to no use of DAs. A total of 497 abstracts were reviewed, resulting in inclusion of 10 RCTs. Outcomes reported in the included trials were thoroughly reviewed and tabulated. The Cochrane risk of bias tool was used. All 10 studies were assessed at unclear (10%) or high risk of bias (90%). Studies showed DAs improved mainly retention/stability, and masticatory/chewing ability/performance, compared to no adhesives.

CONCLUSION

Most studies showed favorable results for DAs on retention and stability of complete dentures, masticatory performance, patient's comfort and satisfaction. Due to the heterogeneity of the outcomes, unclear/high risk of bias and small sample sizes, the quality of the evidence was very low. More high-quality research is needed with improved blinding and use of standardized methods to evaluate the efficacy of DAs.

Comparison of psychometric properties of GOHAI, OHIP-14, and OHIP-EDENT as measures of oral health in complete edentulous patients aged 60 years and more

OBJECTIVES

To compare the psychometric properties of three OHRQoL indicators (GOHAI, OHIP-14, and OHIP-EDENT) in a group of complete edentulous subjects and to explore the ability of these instruments to distinguish between individuals with different prosthetic and oral health status.

METHODS

This was a cross-sectional study. Edentulous individuals aged 60 years and more were recruited between January 2019 and February 2020 in a medical and dental care centers. The Lebanese versions of GOHAI, OHIP-14, and OHIP-EDENT were used. External and internal consistencies were assessed using intraclass correlation coefficient (ICC) and Cronbach alpha, respectively. The concurrent validity was evaluated by testing the indicators against a proxy measure of a similar concept. To test their discriminative abilities, the ADD (GOHAI and OHIP) and SC (GOHAI and OHIP) scores were dichotomized according to the 25th and 75th percentile, respectively, and multivariate analyses were performed using sociodemographic, clinical, and subjective health parameters as explanatory variables.

RESULTS

Two hundred and two edentulous subjects (age: 72.94 ± 7.378 years) were included. The proportion of subjects with no impact was lower for OHIP-EDENT (7.9%) compared to GOHAI (28.2%) and OHIP-14 (38.6%). Reproducibility was satisfactory for all OHRQoL tools since they were able to reproduce the results consistently in time (ICC > 0.80). The Cronbach alpha values were greater than 0.8 indicating acceptable internal consistency. The concurrent validity of the three tools was acceptable since subjects with lower OHRQoL score were less satisfied with their dentures and reported a higher need for self-rated therapy. Concerning the discriminant validity, OHIP-EDENT was more discriminant than OHIP-14 and GOHAI, since it was more able to identify patients with poor prosthetic issues or using instable denture.

CONCLUSION

The OHIP-EDENT was more effective in identifying edentulous individuals with oral and prosthetic problems. Our results can help decide which dental instrument to use to assess the perception of oral health in edentulous individuals. More prospective studies are required to compare their evaluative properties.

A questionnaire study on the impact on oral health-related quality of life by conventional rehabilitation of edentulous patient

Purpose

This study aimed to determine whether complete dentures improve the oral health-related quality of life (OHRQoL) of edentulous patients, and to assess any associations related to age, gender, and OHRQoL.

Material and methods

Hundred edentulous patients who required conventional complete denture treatment were selected for this study. The following inclusion criteria were established: edentulous in both jaws with no previous history of denture treatment and no significant medical history. The patients were selected who satisfied the criteria associated with the class I prosthodoctic diagnostic index. OHRQoL of the patients were assessed twice, once pre treatment (at the first visit) and once post treatment (8 weeks post insertion of dentures) using an instrument called OHIP-EDENT-N. Significant differences in the OHIP-EDENT-N scores between pre treatment and post treatment were calculated using the Wilcoxon Signed-Rank test. Gender differences were assessed using the Mann–Whitney test.

Results

After provision of new complete dentures, all domains of the OHIP-EDENT-N showed significant improvements except physical pain and social disability.

Conclusions

The results of this study indicated that conventional complete denture improved the OHRQoL of edentulous patients.

Masticatory Adaptation to Occlusal Changes

This review deals with the frequent wide variability of masticatory capacity/incapacity. Neither researchers nor clinicians have taken sufficient account of this variability despite its implications for nutrition. Mastication in normal healthy oral conditions is first described, followed by a short presentation of the mechanisms of masticatory adaptation in the nervous system. Capacity, incapacity, and successful compensatory adaptation of mastication are then defined, along with the different methods used for their evaluation. Examples of adaptation needs are given, such as those concomitant with dental wear or occlusal changes. Finally, given its vital importance for deeply impaired mastication/deglutition function, the impact of masticatory adaptation processes on nutrition is examined.

Multicenter Retrospective Analysis of Implant Overdentures Delivered with Different Design and Attachment Systems: Results Between One and 17 Years of Follow-Up

PURPOSE

To analyze implant and prosthetic survival rates, complications, patient satisfaction, and biological parameters of patients rehabilitated with implant overdentures (IOV) on splinted and nonsplinted implants and different attachment systems, in function for one to 17 years.

METHODS

This retrospective study evaluated data collected from patients rehabilitated with implant overdentures between January 2001 and December 2016 in nine different centers. Outcome measures were implant and prosthetic success rates, mechanical complications, marginal bone loss (MBL), oral health impact profile (OHIP), bleeding on probing, and plaque index.

RESULTS

A total of 581 implants were installed in 194 patients. Patients were followed for a mean period of 60.6 months (range 6⁻206). Eighty-nine patients received 296 low profile attachment (OT Equator), 62 patients received 124 ball attachments, and 43 patients received 107 Locator attachments. In eighty-three patients the implants were splinted with computer aided design/computer aided manufacturing (CAD/CAM) or casted bar. At the last follow-up, 10 implants failed in eight patients. Statistical significance was found for failed prostheses (P = 0.0723) and complications (P = 0.0165), with better values for splinted implants. No statistically significant differences were found in proportion of implant and prosthetic failure (P > 0.05). At a five-year follow-up, proportion of complications (P = 0.0289) and failed prostheses (P = 0.0069) were statistically higher for IOV on Locator attachments. No difference was founded in MBL at one- and two-year follow-up between different attachment systems (P > 0.05). Statistically significant improvement in all the OHIP categories was reported in all the patients, after one year of function.

CONCLUSIONS

Implant overdenture showed high implant and prosthetic survival rates, low complications, high patient satisfaction, and good biological parameters in the long-term follow-up. Splinting the implants may reduce number of mechanical complications. Locator attachments showed higher number of complications. Further studies are needed to confirm these preliminary results.

Validation and comparison of the Arabic versions of GOHAI and OHIP-14 in patients with and without denture experience

BACKGROUND

The assessment of oral heath related quality of life (OHRQoL) for complete denture wearers according to a participant's subjective perception may provide an indication of the adaptive capacity of the individual. The aim of this study was to compare and assess the validation of two quality of life measures, the Oral Health Impact Profile-14 (OHIP-14) and Geriatric Oral Health Assessment Index (GOHAI), in patients with and without previous denture experience.

METHODS

A total of 69 elders (36 male and 34 female; mean age, 63 years) from Dental Clinics of the University of Khartoum and the National University in Sudan, with and without previous denture experience, were included in the study. OHRQoL was assessed using two Arabic-translated questionnaires (OHIP-14 and GOHAI) before and after complete denture therapy. Global self-ratings of oral and general health were obtained, and denture satisfaction was assessed using the Denture Satisfaction questionnaire.

RESULTS

Both tools had significant correlations with self-rating oral health in patients without denture experience (P < 0.05). However, no significant correlations were found in patients with denture experience. There were significant differences between pre-and post-treatment total scores with both the GOHAI and OHIP-14 (P < 0.001). Responsiveness to treatment using GOHAI and OHIP-14 revealed overall mean effect size higher in patients without (1.49) and (0.83) than those with previous denture experience (0.89) and (0.60), respectively. However, neither tool could detect significant differences between patients with and without denture experience (P > 0.05).

CONCLUSION

Greater improvements of OHRQoL after complete denture therapy were observed in participants without than those with previous denture experience. The Arabic-translated versions of GOHAI and OHIP-14 can be regarded as effective measures for assessing treatment outcomes of complete denture therapy.

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.

Oral Health-related Quality of Life among Patients after Complete Denture Rehabilitation: A 12-month Follow-up Study

Introduction:

Complete edentulism is an eventual oral health outcome and results from the combined pathology of dental caries, periodontal disease, or faulty method of rehabilitation due to reduced cost. Complete edentulism has a significant concern and leads to reduced quality of life (QoL) along with impact on general health. However, it has been observed that due to wider and better oral health services globally, edentulism rate is decreasing every decade. Edentulism is directly related to masticatory and nutritional problems, and some authors regard it as a good mortality indicator.

Methodology:

The sample population consisted of 100 individuals comprising 63 males and 37 females who fulfilled the inclusion criteria. Geriatric oral health assessment index (GOHAI) was administered by a single investigator at baseline (preinsertion) and also 6 and 12 months postdenture insertion. Sociodemographic data, including age and gender, were also collected.

Results:

It was observed that the overall oral health-related QoL (OHRQoL) scores of the sample improved significantly at 6 and 12 months postinsertion (P < 0.001) when compared to baseline scores. When GOHAI scores were compared individually for males and females (pre- and post-insertion), it was observed that there was statistically significant improvement in OHRQoL (male – pre = 25.02 ± 1.34 and post-12 months = 8.84 ± 1.26, P < 0.001, female – pre = 25.19 ± 0.88 and post-12 months = 9.05 ± 1.20, P < 0.001) postinsertion of denture in both the groups.

Conclusion:

OHRQoL in patients improved after complete denture rehabilitation. There was an upward shift in score for each item in GOHAI from preinsertion to 6 and 12 months postinsertion of dentures, reflecting improvement in OHRQoL of the sample.

How fast can treatment with overdentures improve the masticatory function and OHRQoL of atrophic edentulous patients? A 1-year longitudinal clinical study

OBJECTIVES

The aim of this prospective clinical study was to evaluate the masticatory function (MF) and subjective perception of patients with poor denture-bearing tissue in relation to change and the time required to identify an improvement in these parameters after rehabilitation with mandibular overdentures (MO) by two narrow-diameter two-piece implants.

MATERIAL AND METHODS

Twenty-three edentulous patients were selected for MO installation. The masticatory function (MF) was evaluated with the masticatory performance (MP) and swallowing threshold (ST) tests. In the MP test, each volunteer was instructed to masticate a portion of Optocal (standardized artificial test food) for 40 masticatory cycles. During the swallowing threshold test, the patients were instructed to chew a new portion of Optocal cubes until they felt the desire to swallow. The MF tests were performed while complete denture (CD) wearers (baseline) and 1, 3, 6, and 12 months after MO loading. In addition, the subjective perception was assessed through the questionnaires Dental Impact on Daily Living (DIDL), Geriatric Oral Health Assessment Index (GOHAI), and Oral Health Impact Profile in Edentulous (OHIP- EDENT) at the baseline and 3, 6, and 12 months after MO loading.

RESULTS

A significant improvement in masticatory function (p < .05) was observed already in the first month of loading. Three months after MO loading, a significant improvement (p < .05) was found in the subjective perception of patients. The effect size indicates that the MO had the greatest impact on the domains related to function and comfort of all questionnaires and in relation to psychosocial domain of the GOHAI. The level of patient satisfaction increased significantly after the MO loading and reached >90% satisfied patients at 12 months.

CONCLUSION

The MO improved both the MF of the patient and their oral health-related quality of life and satisfaction regarding the prosthesis in a short time period.

Influence of the renewal of removable dentures on oral health related quality of life

Background

The renewal of removable dentures is often suggested to denture wearers subject to discomfort. However, the impact of this rehabilitation on patients’ oral health related quality of life and their removable dentures related satisfaction is still unknown. This study was aimed at assessing these patient-centered outcomes and the potential impact of different factors.

Methods

A cohort of 116 patients in need of removable dental prostheses rehabilitation was recruited at a dental hospital over a period of 1 year. The subjects were separated into two groups according to their prosthesis experience (group in need of removable dentures renewal/group needing an removable dentures for the first time). Subjects were asked to answer the “Geriatric Oral Health Assessment Index” (GOHAI) and the “McGill Denture Satisfaction Instrument” before and after a prosthesis integration period (9–12 weeks).

Results

GOHAI scores were slightly higher for patients with removable dentures renewal (from 40.6 ± 10.3 to 47.1 ± 10.0, p < 0.001), independently of the type of prosthetic rehabilitation. However, the scores of the GOHAI functional field did not change. Subjects with no removable dentures experience presented an increase in their functional GOHAI score (p < 0.001). Regarding patient removable dentures related satisfaction, only the “Esthetic” (p < 0.001), “Chewing efficiency” (p < 0.001) and “Oral condition” (p < 0.01) items increased after prosthesis renewal.

Conclusions

This study showed that renewing removable dentures only moderately improved the oral health related quality of life and removable dentures related satisfaction of patients, regardless of age, gender or type of rehabilitation. Other tasks are necessary such as the analysis of physiological parameters and qualitative research on patient’s expectations.

Epidemiological Data and Survival Rate of Removable Partial Dentures

INTRODUCTION

The use of removable partial denture (RPD) is considered as low-cost and common treatment option to rehabilitate edentulous areas.

AIM

This study aimed to investigate the epidemiological data of patients rehabilitated with removable partial denture (RPD) in order to assess treatment survival rate and failures.

MATERIALS AND METHODS

Epidemiological data and medical records of patients treated with RPD between 2007 and 2012 at the RPD discipline of a Brazilian University (Aracatuba Dental School- UNESP) were evaluated as well as dental records of patients who underwent RPD treatments (fabrication or repairs) between 2000 and 2010. Factors such as gender, age, presence of systemic disease, main complaint, edentulous arch, period and cause of denture replacement and the prosthesis characteristics were recorded. The chi-square test was used to assess the differences between the variables and the Kaplan Meyer to assess the survival of the RPDs evaluated.

RESULTS

A total of 324 maxillary RPD and 432 mandibular RPD were fabricated. Most of the patients were women aging 41 to 60-year-old. The number of mandibular RPD Kennedy class I (26%) was statistically higher for the maxillary arch (p<.05). There was no association between main complaint to gender or the presence of systemic disease. The lingual plate was the most common major connector used in the mandible (32%). The main reason for altering the design of replaced RPDs were changes during treatment plan.

CONCLUSION

The number of patients who require RPD is large; most of RPDs are Kennedy Class I. A good treatment plan is very important for achieving a positive treatment outcome, and it is strictly related to the survival rate.

Effects of Salivary Oxidative Markers on Edentulous Patients' Satisfaction with Prosthetic Denture Treatments: A Pilot Study

Objectives

The purpose of this study was to assess relationships among periodontal conditions, salivary antioxidant levels, and patients’ satisfaction with their prostheses.

Methods

This study was conducted at the Division of Prosthodontics, Department of Dentistry, Taipei Medical University Hospital. The periodontal condition of patients was based on an assessment of the plaque index (PI) and gingival index (GI). The pH value, flow rate, and buffer capacity of the saliva were estimated. The salivary total antioxidant status (TAS) and superoxide dismutase (SOD) level were also determined. Patients’ satisfaction with prosthetic treatments was evaluated using the Chinese version of the short-form Oral Health Impact Profile (OHIP-14C). A multivariate regression model was used to determine whether patients’ satisfaction with prosthetic treatment was affected by their oral health status.

Results

In total, 35 edentulous patients were recruited. In the Spearman correlation analysis, salivary pH (r = -0.36, p = 0.03) and the buffer ability (r = -0.48, p<0.01) were associated with OHIP-14C scores. In the multivariate analysis, patients who had a higher GI also had a higher score of physical disabilities (β = 1.38, p = 0.04). Levels of SOD increased with the scores of psychological discomfort (β = 0.33 U/g protein, p = 0.04).

Conclusions

This study suggested that both the GI and SOD levels were associated with patients’ satisfaction with prosthetic treatments. To the best of our knowledge, this is the first study to elucidate the relationship between OHIP scores and salivary oxidative markers in edentulous patients.

Oral health-related quality of life and related factors among residents in a disaster area of the Great East Japan Earthquake and giant tsunami

Background

Oral health is one of the most important issues for disaster survivors. The aim of this study was to determine post-disaster distribution of oral health-related quality of life (OHRQoL) and related factors in survivors of the Great East Japan Earthquake and Tsunami.

Methods

Questionnaires to assess OHRQoL, psychological distress, disaster-related experiences, and current systemic-health and economic conditions were sent to survivors over 18 years of age living in Otsuchi, one of the most severely damaged municipalities. OHRQoL and psychological distress were assessed using the General Oral Health Assessment Index (GOHAI) and the Kessler Psychological Distress Scale (K6), Japanese version, respectively. Among 11,411 residents, 1,987 returned the questionnaire (response rate, 17.4 %) and received an oral examination to determine number of present teeth, dental caries status, and tooth-mobility grade, and to assess periodontal health using the Community Periodontal Index. Relationships between GOHAI and related factors were examined by nonparametric bivariate and multinomial logistic regression analyses using GOHAI cutoff points at the 25^th and 50^th national standard percentiles.

Results

GOHAI scores were significantly lower in the 50–69-age group compared with other age groups in this study and compared with the national standard score. In bivariate analyses, all factors assessed in this study (i.e., sex, age, evacuation from home, interruption of dental treatment, lost or fractured dentures, self-rated systemic health, serious psychological distress (SPD), economic status, number of teeth, having decayed teeth, CPI code, and tooth mobility) were significantly associated with OHRQoL. Subsequent multinomial logistic regression analyses revealed that participants of upper-middle age, who had received dental treatment before the disaster, who had lost or fractured dentures, and who had clinical oral health problems were likely to show low levels of OHRQoL. In addition, perceived systemic health and SPD were also related with OHRQoL.

Conclusions

OHRQoL of disaster survivors was associated with oral problems stemming from the disaster in addition to factors related to OHRQoL in ordinary times such as clinical oral status and perceived systemic health. Furthermore, SPD was also associated with OHRQoL, which suggests the disaster’s great negative impact on both oral and mental health conditions.

Association between dental prosthesis need, nutritional status and quality of life of elderly subjects

PURPOSE

To determine the effect of prosthesis need on nutritional status and oral health-related quality of life (OHrQoL) in elderly and to check the disparity between prosthesis need and prosthesis want in the Indian elderly.

METHODS

A total of 946 geriatric participants reporting to a geriatric medicine clinic were recruited in the study. Mini-nutritional assessment (MNA), geriatric oral health assessment (GOHAI) indices, prosthesis need according to WHO criteria, and prosthesis want was recorded along with age, gender, socioeconomic status and posterior occluding pair.

RESULTS

Significant associations exist between prosthesis need and age (p = 0.005), MNA (p = 0.006) and GOHAI (p = 0.000). Prosthesis demand too was influenced by age (p = 0.004), posterior occluding pairs (p = 0.000), MNA (p = 0.012) and GOHAI (p = 0.000). GOHAI was negatively correlated with upper (r = -0.445) and lower prosthesis need (r = -0.460). Participants with some prosthesis need had significantly lower MNA and GOHAI scores as compared to those with no prosthesis need. Though prosthesis need was high (79.7 %), demand was low (39.3 %).

CONCLUSION

Prosthesis need affects nutritional status and OHrQoL in elderly, and a wide gap exists between need and want of prosthesis.

Short-Term Assessment of the OHIP-14 Scale on Denture Wearers Using Adhesives

PURPOSE

The purpose of this study was to assess differences of the Oral Health Implant Profile-14 (OHIP-14) scale over a month and determine association with gender, supporting tissues (KIS), and denture base (KID) among patients wearing complete dentures using denture adhesives.

MATERIALS AND METHODS

Sixteen denture wearers, candidates for a new set of complete dentures, were selected. OHIP-14 scores were recorded at the beginning of the study, 6 weeks after fitting of the new set (T0 ), 15 days (T1 ), and finally 30 days (T2 ) after daily use of a denture adhesive as instructed. The KIS and KID were clinically examined and rated according to the Kapur Index. Statistical analyses were based on repeated-measures ANOVA, Mann-Whitney test, regression analysis, and Friedman test at a = 0.05.

RESULTS

The OHIP-14 scale was found to have a high reliability (alpha = 0.847) and a high test-retest consistency (ICC = 0.889); however, domain 1 had the lowest item-total correlation (rho = 0.144) and item 7 a negative one (rho = -0.414). Trend analysis indicated a significant negative linear trend over time (slope = -3.156, p = 0.002), while repeated-measures ANOVA showed differences in OHIP-14 between T2 and T1 (p = 0.003) or T0 (p = 0.005) intervals. OHIP-14 groups were found to be positively associated with KIS (p = 0.010) and negatively with KID (p = 0.047) groups, but not with gender (p = 0.272).

CONCLUSIONS

The study shows that OHIP-14 has a high internal reliability and consistency when applied to new denture wearers, and its score decreases if denture adhesives are used for at least 15 days. Low KIS and high KID contributes to this trend. Some OHIP-14 items are more associated than others with the total score trend over time.

Comparison of chewing ability, oral health related quality of life and nutritional status before and after insertion of complete denture amongst edentulous patients in a Dental College of Pune

BACKGROUND

The relationship between tooth loss and nutritional intake is important. As people age, their diminished physical capacity and decreased income adversely affect their ability to maintain their teeth. The aim of the study was to assess and compare the chewing ability, oral health related quality of life and nutritional status before and after fabrication and insertion of complete denture amongst edentulous participants in a dental college.

MATERIAL AND METHODS

Non Randomized Intervention study. The study population consisted of 42 participants (16 females and 26 males), aged 50 years and above. Prior to commencement of the study, informed consent was obtained and validation and reliability test of the questionnaire were done. The data for chewing ability, GOHAI and nutritional status assessment was recorded at baseline, 3(rd), 6(th) and 12(th) month after denture fabrication and insertion. The statistical comparisons were performed by repeated measure ANOVA and Chi-square test. P value<0.05 was considered as statistically significant.

RESULTS

Chewing ability, GOHAI, BMI (Body Mass Index) and data from Food-intake questionnaire showed statistically significant improvement from baseline to 6(th) month but no statistically significant improvement was observed from 6(th) month to 12(th) month. Nutritive value of food (protein, energy and fat) showed no significant difference over a period of 12 months (p<0.05).

CONCLUSION

Thus, it was concluded that the intervention (denture insertion) was effective in increasing the chewing ability, body weight, food-intake, and oral health related quality of life.

The impact of implant treatment on oral health related quality of life in a private dental practice: a prospective cohort study

BACKGROUND

Very few studies on the impact of implant therapy on Oral Health Related Quality of Life (OHRQoL) in partially edentulous patients have been published.

AIM

This study aimed at analysing the improvement of OHRQoL of patients who underwent dental implant treatment using the "functional", "psychosocial" and "pain and discomfort" categories of the Geriatric Oral Health Assessment Index (GOHAI).

METHODS

Within a prospective cohort of patients rehabilitated with Straumann dental implants, the OHRQoL of 176 patients (104 women and 72 men) was assessed using the GOHAI questionnaire, at two different times, before and after implant placement. The degree of oral treatment was categorised into three classes: "Single Tooth Implant" (n = 77), "Fixed Partial Denture" (n = 75), "Fixed or Retained Full Prostheses" (n = 24). The participants' characteristics (gender, age, tobacco habits, periodontal treatment, time between both evaluations) were assessed.

RESULTS

Before treatment, the GOHAI score was lower for participants with fewer teeth (F = 19, P < 0.001). After treatment, no difference was observed between participants; significant improvements were observed in the GOHAI scores obtained (repeated measures, analysis, (F = 177, P < 0.001)) for each of the GOHAI fields studied (functional, psychosocial and pain & discomfort), regardless of the degree of treatment. The best improvement was observed in patients who needed complete treatment (P < 0.001). The presence of preliminary periodontal treatment, tobacco habits, age and gender of the participants did not have a significant impact on OHRQoL. Changing the time between the two evaluations (before and after treatment) had no impact on the changes in the GOHAI score.

CONCLUSIONS

Implants enhanced the OHRQoL of participants that needed oral treatment.

Oral health-related quality of life and satisfaction before and after treatment with complete dentures in a Dental School in Brazil

PURPOSE

The aim of this study was to evaluate the impact of treatment with new complete dentures on oral health-related quality of life and satisfaction of edentulous patients attending the Prosthodontic Department in a Dental School in Brazil.

METHODS

A total of 70 edentulous subjects (37-86 years) treated by undergradute students at the Araçatuba Dental School, University of State of São Paulo, were accessed. A specific questionnaire for edentulous patients (EDENT) based on the Oral Health Impact Profile (OHIP-EDENT) was applied to collect information on patient oral health-related quality of life. Questions related to the personal satisfaction of the edentulous patients with their complete dentures were also included. The patients were accessed before the treatment, and 3 months after receiving the new dentures.

RESULTS

After rehabilitation with new complete dentures, all domains of OHIP-EDENT showed significant improvements. There was also a significant improvement in patient satisfaction after placement of new complete dentures. Furthermore, it was possible to observe association between upper denture satisfaction and age.

CONCLUSION

Conventional complete dentures may have a positive impact on oral health-related quality of life and satisfaction of edentulous patients.

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.

Nutritional status, dietary intake and oral quality of life in elderly complete denture wearers

BACKGROUND AND OBJECTIVE

The prevalence of malnutrition increases with age because of many factors. Edentulousness leads to the avoidance of many types of foods. The aim of this study was to determine whether elderly complete denture wearers have a higher risk of malnutrition than dentate controls.

MATERIAL AND METHODS

A Mini-Nutritional Assessment (MNA) and a 3-day dietary record were compiled for a group of fully dentates (21 women and 29 men; mean age 70.1 ± 6.1) and for a group of complete denture wearers (31 women and 16 men; mean age 70.1 ± 8.1). Socio-demographic data and scores on the General Oral Health Assessment Index (GOHAI) questionnaire were collected.

RESULTS

Inter-group comparison of MNA scores showed that more subjects in the edentulous group (21.3%) risked malnutrition than in the dentate group (0%). The variability of the MNA could be explained for 22% by dental status, 7% by loneliness and 4% by the GOHAI score (regression analysis). Both groups had insufficient energy intakes and deficits in vitamins and micronutrients; moreover, edentulous subjects had lower intakes than dentate subjects.

CONCLUSION

The use of conventional dentures increases the risk of malnutrition in the elderly.

Oral Disease Prevention for Older People

This opinion paper reviews trends in oral disease and its management in older people, in response to a challenge, in an editorial in The Lancet, to the traditional curative model of dentistry and the publication of the most recent Adult Dental Health Survey. It highlights the challenge of an ageing population and its oral health needs and management. Professional issues in relation to preventive care are discussed with emphasis on the importance of identifying patient risk and providing preventive care, together with improving the uptake of dental care among older people.

Evidence-based guidelines for the care and maintenance of complete dentures: a publication of the American College of Prosthodontists

The current rates of edentulism have been estimated to be between 7% and 69% of the adult population internationally. In the United States, while the incidence of edentulism continues to decline, rapid population growth coupled with current economic conditions suggest that edentulism and conventional denture use will continue at current or higher numbers. Unfortunately, evidence-based guidelines for the care and maintenance of removable complete denture prostheses do not exist. In 2009, the American College of Prosthodontists (ACP) formed a task force to establish evidence-based guidelines for the care and maintenance of complete dentures. The task force comprised members of the ACP, the Academy of General Dentistry, American Dental Association (ADA) Council on Scientific Affairs, the American Dental Hygienists' Association, the National Association of Dental Laboratories, and representatives from GlaxoSmithKline Consumer Healthcare. The review process included the assessment of over 300 abstracts and selection of over 100 articles meeting inclusion criteria of this review. The task force reviewed synopses of the literature and formulated 15 evidence-based guidelines for denture care and maintenance. These guidelines were reviewed by clinical experts from the participating organizations and were published in February 2011 issue of The Journal of the American Dental Association for widespread distribution to the dental community. These guidelines reflect the views of the task force.

Relationship between impacts of complete denture treatment on daily living, satisfaction and personality profiles

OBJECTIVES

To investigate the association between satisfaction with conventional complete denture prostheses (CDs), impacts of CDs on daily living and personality profiles.

MATERIALS AND METHODS

Fifty-six patients (28 males and 28 females; mean age 53.79 ± 7.762 years) with fitted upper and lower removable CDs were recruited for this study. Clinical success of CDs was assessed according to specific clinical criteria. The dental impact on daily living questionnaire (DIDL) was used to measure satisfaction with CDs and their impacts on daily living. NEO five factor inventory (NEO - FFI) was used to measure patients' personality profiles. Pearson correlation test and regression models were used to analyze the collected data.

RESULTS

Females were more satisfied with appearance and less satisfied with eating and scored higher on neuroticism, and lower on extraversion and openness personality domains (p < 0.05). Older patients were more satisfied with appearance and less satisfied with oral comfort and general performance (p < 0.05). Neuroticism, extraversion, openness and agreeableness personality profiles could predict and had significant relationship with CDs impacts on daily living and satisfaction with CDs.

CONCLUSION

Psychological profiles (e.g. neuroticism, extraversion, openness and agreeableness) might play a role and explain CDs impacts on daily living and patients' satisfaction with their oral status and CD treatment, therefore, might be used to predict satisfactory outcomes of CD treatment. In this regard, technical aspects of CDs are less essential when the prosthesis is clinically successful.

CLINICAL SIGNIFICANCE

Psychological factors may play a role and also provide valuable information for the prediction of satisfactory outcomes of complete denture treatment.