Oral health-related quality of life of conventional removable partial dentures, unilateral nonmetal clasp dentures, and shortened dental arch with 2- or 3-tooth unilateral distal extension tooth loss in the mandible: A randomized, crossover, clinical trial

STATEMENT OF PROBLEM

Conventional removable partial dentures with metal clasps are still a common option for patients with distal-extension tooth loss. However, unilateral nonmetal clasp dentures fabricated by using a thermoplastic denture base resin are increasingly being used. Furthermore, the shortened dental arch concept remains controversial, in spite of being advocated for many years. Nevertheless, these treatment options remain controversial, particularly in patients with the loss of a few distal teeth unilaterally.

PURPOSE

The purpose of this randomized, crossover, clinical trial was to investigate the oral health-related quality of life of participants who requested a new dental prosthesis (unilateral nonmetal clasp dentures or conventional removable partial dentures) at a private practice.

MATERIAL AND METHODS

A 3-period, randomized, crossover design was used in a within-subject, controlled, clinical trial. Twenty-four participants (mean age 59.0 years [7 men: 62.6 {45-85} years; 17 women: 57.5 {24-75} years]) were enrolled. All experimental procedures were approved by the Ethics Committee of Nagasaki University Hospital (#15022313) and registered in the International Standard Randomized Controlled Trial Number registry (ISRCTN49105064). All participants were fully dentate in the maxilla and had unilateral distal-extension loss of 2 or 3 teeth in the mandible. Participants were allocated to 1 of 6 groups and treated with prescribed options in accordance with their allocated sequences and used a dental prosthesis or nothing for 2-week periods. At the end of each intervention, the participants were asked to answer the Oral Health Impact Profile questionnaire. Differences in Oral Health Impact Profile scores among groups were estimated with a mixed-effects model (α=.05).

RESULTS

Total Oral Health Impact Profile scores were higher for unilateral nonmetal clasp dentures (P=.002) and shortened dental arch (P=.049) than for conventional removable partial dentures, with medium and small effects. The unilateral nonmetal clasp dentures had a similar effect compared with shortened dental arch (P>.05). unilateral nonmetal clasp dentures (P=.011) and shortened dental arch (P=.005) demonstrated medium effects in the oral function dimension compared with conventional removable partial dentures. Unilateral nonmetal clasp dentures exhibited large and medium effects in the orofacial appearance dimension compared with conventional removable partial dentures (P=.001) and shortened dental arch (P=.006). In the orofacial pain dimension, shortened dental arch showed effects similar to those of conventional removable partial dentures and unilateral nonmetal clasp dentures (P>.05), and no significant differences were observed in the psychosocial impact dimension (P>.05), but the unilateral nonmetal clasp denture score was lower than the conventional removable partial denture score, with a small effect. Men had significantly lower total Oral Health Impact Profile scores for shortened dental arch than women (P=.033).

CONCLUSIONS

Unilateral nonmetal clasp dentures and shortened dental arch were better than conventional removable partial dentures for the oral health-related quality of life of individuals with unilateral distal-extension tooth loss in the mandible, and sex had a significant effect on removable prosthetic planning.

[Influence of the removable partial denture acrylic resin on oral health and quality of life]

OBJECTIVE

This study aims to evaluate dental decay incidence and DMF index, plaque index and gingival index, and to assess the satisfaction/dissatisfaction in acrylic removal partial denture wearers (ARPD) and in partial edentate no wearers. It aims to improve the therapeutic management in prosthetic oral rehabilitation in DR Congo.

MATERIAL AND METHODS

This prospective cohort interventional randomized study on 376 patients enrolled and divided into two groups (with and without denture prosthesis) was performed in University Clinics of Kinshasa, Kinshasa Medical Center and Clinic Glory during the period August 2008 to August 2010.

RESULTS

Three hundred seventy-six patients (376) with 163 men (47 ± 16 years) and 213 women (42 ± 15 years) were followed. Of the 376 patients randomized, 189 were of "prosthesis" group and 187 were in the group "without aid". Both groups were regularly reviewed every 6 months for 2 years. Ten thousand four hundred and fifty-two (10452) teeth were examined (5149 teeth to the group "prosthesis" and 5303 for the teeth "without prosthesis" group. On hundred and twenty-nine (129) teeth that presented caries, 110 (82.96 per cent) are decayed teeth in the "prosthesis" group and 19 (17.04 per cent) are in the group "without prosthesis" (p = 0.00). The index Tooth Decayed, Missing, Filled (CAD) to start of the study for each group was 0.2. Two years after the index rose to 0.3 for the group "prosthesis" and remained steady (0.2) for the group "without prosthesis". The "prosthesis" group showed plaque index (PI) and gingival index (GI) above 0.99 (SD: ± 0.28) and 1.27 (SD: ± 0.43) than normal compared to those of the "no aid" group (0.46 ± 0.15 and 0.32 ± 0.12). The differences were statistically significant for both indices between the two groups (p = 0.00). Overall satisfaction rate for the "prosthesis" group was 26.4% while for the group "without prosthesis" satisfaction rate is 80.9%.

CONCLUSION

This study shows that improved oral hygiene and regular check of the RPD acrylic resin carriers become a concern for establishing a true oral health policy.

Perception of dental esthetics: influence of restoration type, symmetry, and color in four different countries

In this study, the influence of restoration type, symmetry, and color on the perception of dental appearance was evaluated. An esthetic questionnaire was completed by 29 patients before and after esthetic rehabilitation. In addition, 94 dentists from four countries (Germany, the United Kingdom [UK], China, and Switzerland) evaluated the influence of the above factors using before-and-after rehabilitation pictures. The most invasive treatment was recommended by Chinese dentists, while German, Swiss, and UK dentists recommended comparable treatment options. As for restorative symmetry, restoration type, and color, significant differences could be found among and within the dentists of the four countries (P ± .05).

Patient satisfaction with single-tooth implant therapy in the esthetic zone

This prospective study assessed patient satisfaction before and after single-tooth implant therapy in the esthetic zone. Before implant therapy, patients wore an acrylic resin tissue-supported removable partial denture (RPD). A total of 153 patients were included. Self-administered questionnaires regarding function, comfort, and esthetics were used to measure patient satisfaction with the RPD and with the implant at 6 and 18 months post-implant placement. Overall satisfaction was explored with a visual analog scale. It was suggested that patient satisfaction with a single-tooth implant in the esthetic zone is high and it improved when compared with an RPD that patients wore before implant treatment.

[Effect of removable partial dentures restoration on oral health-related quality of life of patients with shortened dental arch]

OBJECTIVE

To assess the effect of removable partial dentures (PRD) restoration on oral health-related quality of life (OHRQOL) of subjects with shortened dental arches (SDA) using the Chinese version of the Oral Health Impact Profile (OHIP-14).

METHODS

Consecutive patients with shortened dental arches were recruited from the Department of Prosthodontics, Foshan Chancheng Hospital of Stomatology. The Chinese version of OHIP-14 was administered to each subject before treatment and after treatment. The subjective outcomes of removable partial dentures therapy on SDA were collected and the pre- and post-treatment scores of the Chinese version of OHIP-14 were compared.

RESULTS

After treatment, significant decrease in patients' total score of OHRQOL [before: 9 (6, 12) ; after: 4 (2.25, 6)] was detected, as well as physical pain subscale, physical disability subscale and handicap subscale; and the score of OHRQOL in function limitation subscale increased [before: 0(0,0); after: 2(1, 2)].

CONCLUSIONS

The main impacts of shortened dental arch with intact anterior region affecting patients' OHRQOL are physical disability.From a quality-of-life perspective, patients with SDA can perceive benefits from RPD.

Self-perceived changes in oral health-related quality of life after receiving different types of conventional prosthetic treatments: a cohort follow-up study

OBJECTIVES

To evaluate the changes in oral health-related quality of life (OHRQoL) reported by subjects treated with conventional prostheses.

METHODS

A consecutive sample of 153 patients seeking prosthodontic rehabilitation was recruited. Socio-demographic and prosthetic-related factors (Eichner Index; number of occlusal, aesthetic, and lost units) were registered. Baseline impacts on OHRQoL were collected using the OHIP-14 questionnaire. One month after treatment, the participants answered whether the prostheses had generated better, equal, or poorer effects within the 14 items of a retrospective scale (Post-OHIP). The study patients were compared with the reference population (P-population; n=123) in terms of OHRQoL. Such P-population consisted of Spanish adults wearing conventional dental prostheses who were not seeking any dental treatment. The reliability and validity of the tests applied and the factor structure of the Post-OHIP were investigated. A Poisson regression model was calculated to predict what items would change favourably after treatment.

RESULTS

Four prosthetic cohorts were established according to the types of rehabilitations performed: 1-FDPs: metal-ceramic fixed dental prostheses; 2-M-RPDs: metal-based removable partial dentures; 3-ADs: acrylic partial dentures and 4-CDs: complete dentures. Both tests confirmed adequate psychometric properties. Most items of the Post-OHIP consistently loaded on a single factor. Patients requiring ADs or CDs reported significantly lower baseline OHRQoL than those needing M-RPDs or FDPs. Pain/discomfort was the only hampering issue subsequent to removable rehabilitation. M-RPDs are expected to provide the significantly highest therapeutic improvements.

CONCLUSIONS

Patients perceived benefits in chewing ability, aesthetics and satisfaction with their mouth after receiving conventional dental prostheses.

CLINICAL SIGNIFICANCE

Conventional prosthetic therapy enhances patients' overall well-being although it can cause discomfort and chewing dysfunction in more than 20% of subjects. Metal-based removable partial dentures are the most predictable in terms of patient satisfaction. The higher the clinical impairment felt by patients, the higher the increase in OHRQoL after rehabilitation.

Oral health-related quality of life in patients with removable dentures

The purpose of this study was to determine factors that affected oral health-related quality of life (Oral Health Related Quality of Life = OHRQoL) in patients with removable dentures (RD). Quality of life was evaluated by using the Geriatric Oral Health Assessment Index (GOHAI). We analysed data of 250 patients aged 63 ± 11.6 years. After excluding patients lacking relevant analysis data, 243 patients remained in the study, including 129 males and 114 females. Relevant parameters for good OHRQoL were: patient satisfaction with their RD (r = -0.317), higher age (r = 0.222), greater number of remaining teeth (r = 0.357), higher income (r = 0.175), higher frequency of dental visits (r = -0.212), tobacco abstinence (r = -0.181), and residence in a rural area (r = -0.420). Also, marital status had an impact on OHRQoL. Widowed and married patients showed the highest values and unmarried patients the lowest. Frequently mentioned problem areas considered within the survey were: the patient's fear of further tooth loss, concerns about functional aspects such as the decrease in chewing efficiency and dissatisfaction with the aesthetics of the dental prostheses. The results showed that the OHRQoL is apparently not only influenced by dental factors, but also by psychosocial and economic factors, the relevance of which would have to be shown in further studies.

Impaired oral health-related quality of life in Hungary

OBJECTIVES

To describe the prevalence of impaired oral health-related quality of life (OHRQoL) in the adult Hungarian population and to determine population-based norms for three Hungarian versions of the Oral Health Impact Profile (OHIP-H).

MATERIAL AND METHODS

In a survey of 1059 randomly selected subjects, OHIP responses, age, gender, and denture status [natural dentition or fixed partial dentures (FPDs), removable partial dentures (RPDs), or complete dentures (CDs)] were collected. Study outcomes were item prevalence and OHIP summary score frequency ('norms').

RESULTS

The prevalence of OHIP items ranged from 2% to 43%, with a mean item prevalence of 14%. The distribution of summary scores was characterized by decile norms. Median scores for OHIP-H49, the 49-item questionnaire, were 6 OHIP units for subjects with FPDs, 10 OHIP units for subjects with RPDs, and 6 OHIP units for subjects with CDs. The median scores were 0, 0, and 1 OHIP units for the 14-item OHIP-H, and 0, 0, and 0 OHIP units for the five-item OHIP-H.

CONCLUSIONS

Our sample demonstrates substantial OHRQoL impact in the Hungarian general population. The derived norms provide a framework for interpretation of data in future studies using the Hungarian OHIP versions, as well as data on how oral conditions and cultural factors affect perceived oral health when compared with international findings.

Oral health-related quality of life of elderly Germans--comparison of GOHAI and OHIP-14

OBJECTIVE

To obtain information about the subjective oral health status of non-clinical elderly populations of urban regions of Germany, one in the East and one in the West, by using OHIP-14 and, for first time, the GOHAI, and, furthermore, to compare the results obtained by use of both instruments.

BASIC RESEARCH DESIGN

Cross-sectional.

CLINICAL SETTING

Randomly chosen, non-clinical elderly population in urban regions of Germany.

PARTICIPANTS

197 participants (51% male) born in the years 1930-1932.

MAIN OUTCOME MEASURES

GOHAI, OHIP-14.

RESULTS

Median GOHAI score was 54; median OHIP-14 score was 2. Scores indicative of severely impaired oral health were rare. The effect of living in eastern or western Germany was of minor significance. Although the internal consistency of both measures was comparable and the same positive association with psychological wellbeing, absence of dry mouth, burning mouth, and removable dentures (p < 0.05) was observed, differences occurred. In simultaneous analysis of all items, factor analysis revealed only partial overlap of the items in extracted factors. Furthermore, the extreme score indicating no impairment was five times more frequent for OHIP-14. Of those who scored zero in OHIP-14, only 20% had the GOHAI equivalent score of 60, and for some GOHAI items the answer category for highest impairment was obtained.

CONCLUSIONS

GOHAI scores for this randomly chosen non-clinical group enable comparison with scores for Germany measured in the future. The differences between GOHAI and OHIP-14 make it necessary to select the most appropriate instrument for a planned purpose and study population.

Factors influencing the provision of removable partial dentures by dentists in Ireland

Factors influencing clinical treatment of partially dentate patients are varied, and there is a need to identify factors influencing success in the provision of removable partial dentures. The aim of this study was to assess the attitudes of general dental practitioners (GDPs) in Ireland towards tooth replacement and use of RPDs, in partially dentate older adults. The sample frame was the Register of Dentists in Ireland; data were also collected from a sample of dentists practising under NHS regulations in Northern Ireland. Validated questionnaires were sent to all dentists on the Register of Dentists in the Republic of Ireland, and dentists working under NHS regulations registered with the Central Services Agency in Northern Ireland. Content of the questionnaire included details of the dentist themselves, their dental practice and the profile of partial denture provision. They were also asked to give their views on factors influencing the success or failure of an RPD, the process of providing RPDs and their attitudes to RPD provision. A total of 1,143 responses were received, a response rate of 45%. A mean number of 61 RPDs per annum were provided, with 75% of dentures provided being acrylic based. Respondents indicate their belief that cobalt-chromium based dentures had a longer prognosis than acrylic dentures, but less than half (46%) claim to design the frameworks themselves. Patients' attitudes are considered influential in the success of RPD provision, and their influence on appearance is considered the most important factor influencing success. The most important factors influencing failure are: the patient not requesting a denture; an RPD restoring unbounded saddles; and, lower RPDs. Although considered important, approximately 60% of the sample do not routinely organise follow-up appointments for patients provided with RPDs. The fee structures in the DTSS and DTBS are considered a barrier to quality in the provision of partial dentures.

[Effects of removable partial dentures on the quality of life in people with shortened dental arches]

In order to assess the enhanced value of removable partial dentures on the quality of life, patients at 2 university clinics were screened for the presence of complete or shortened dental arches. Those selected were assigned to 1 of 5 subgroups: 1) a shortened dental arch with all frontal teeth, 2) a shortened dental arch with one or more frontal diastemas, 3) a shortened dental arch with all frontal teeth, restored by a removable partial denture, 4) a shortened dental arch and several diastemas, restored by a removable partial denture, 5) a complete dental arch. The participants completed the Oral Health Impact Profile (OHIP-49) and the Short Form Health Survey (SF-36). Clinical data recorded were: whether any teeth were missing and if so which, whether or not these had been replaced by a removable partial denture, and the number of occluding pairs of (pre)molars. The results revealed that a shortenend dental arch has a certain impact on the quality of life. However, the participants only experienced benefits from a removable partial denture if the denture also replaced frontal teeth.

Effect of the quality of removable prostheses on patient satisfaction

AIM

The objective of this study was to evaluate patient satisfaction with removable prostheses and its relationship with denture quality.

METHODS AND MATERIALS

Sixty-seven patients who received 119 new removable prostheses over a period of one year at the College of Dentistry, King Saud University, were recalled for an interview with regard to their satisfaction with their dentures and a clinical examination. Prosthetic quality was determined using the California Dental Association criteria.

RESULTS

Results showed 75% and 66% of upper and lower dentures, respectively, were reported by patients as satisfactory. Of all the upper prostheses rated as being of acceptable quality, 94% were also reported by patients as satisfactory, but of those of unacceptable quality, only 52% were reported by patients as unsatisfactory. The corresponding figures for lower dentures were 91% and 71%, respectively. No significant associations were found between patient satisfaction and age, or denture experience.

CONCLUSION

Although acceptable quality of removable prostheses usually resulted in patient satisfaction, the finding that some patients were satisfied with their prostheses despite unacceptable quality suggests other factors besides quality affect outcomes.

CLINICAL SIGNIFICANCE

Patient satisfaction with removable dentures cannot be fully predicted from only the quality standards of those dentures.

[The principal components analysis--method to classify the statistical variables with applications in medicine]

Based on the eigenvalues and the eigenvectors analysis, the principal component analysis has the purpose to identify the subspace of the main components from a set of parameters, which are enough to characterize the whole set of parameters. Interpreting the data for analysis as a cloud of points, we find through geometrical transformations the directions where the cloud's dispersion is maximal--the lines that pass through the cloud's center of weight and have a maximal density of points around them (by defining an appropriate criteria function and its minimization. This method can be successfully used in order to simplify the statistical analysis on questionnaires--because it helps us to select from a set of items only the most relevant ones, which cover the variations of the whole set of data. For instance, in the presented sample we started from a questionnaire with 28 items and, applying the principal component analysis we identified 7 principal components--or main items--fact that simplifies significantly the further data statistical analysis.

Multivariate analysis of patient satisfaction factors affecting the usage of removable partial dentures

The purpose of this retrospective cohort study was to investigate patient satisfaction factors that affect the usage of removable partial dentures (RPDs) using a multivariate analysis. Sixty-seven patients, who had RPDs inserted at the Tohoku University Hospital between 1996 and 2001, participated in this study. Data were collected from patients' clinical records and a questionnaire. Of the 15 factors examined, significant associations were found between RPD usage and pain, color of the artificial teeth, and arrangement of the artificial teeth. These findings suggest that RPD usage is related to patient satisfaction with esthetics and an absence of pain.

Effect of removable partial dentures on oral health-related quality of life in subjects with shortened dental arches: a 2-center cross-sectional study

PURPOSE

To assess the value of removable partial dentures (RPDs) in subjects with shortened dental arches (SDAs) with regard to quality of life.

MATERIALS AND METHODS

Subjects from 2 university dental centers (82 men, 78 women; mean age: 54 +/- 18 years) were categorized into the following groups: (1) SDA with intact anterior regions (SDA-1, n = 44); (2) SDA and interrupted anterior region (SDA-2, n = 21); (3) SDA (intact anterior region) extended with distal-extension RPD (RPD-1, n = 25); (4) subjects with interrupted SDA and interrupted anterior region treated with RPD (RPD-2, n = 32); or (5) complete dental arches (CDA, n = 38) as a control. All subjects underwent a short clinical examination and completed 2 structured questionnaires: the Oral Health Impact Profile (OHIP-49) and the Short-Form Health Survey (SF-36). Recorded clinical variables included: teeth present (yes/no), replacement by RPD (yes/no), and number of occlusal units. Age-dependent outcomes were adjusted to outcomes for the age of 60 years. Linear regression models were used to assess differences between the groups.

RESULTS

Reliability and validity were good for all subscales. For OHIP, the investigation groups had significantly higher scores (more complaints) than CDA for the subscales "functional limitation," "psychologic discomfort," and "physical disability." Of the 4 investigation groups, SDA-1 subjects had the lowest mean scores. SF-36 scores showed less prominent and less conclusive differences between investigation groups and CDA subjects. SDA-2 subjects showed worse health, with significantly lower scores than RPD-2 subjects for "vitality," "social function," and "mental health." For pure SDA subjects (SDA-1) there was a significant positive effect for "number of occlusal units" in 5 of the OHIP subscales and 2 of the SF-36 subscales.

CONCLUSION

From a quality-of-life perspective, patients with SDAs perceive benefits from RPDs only if anterior teeth replacements are included. In contrast, in subjects with uninterrupted SDAs, where only posterior teeth were replaced by distal-extension RPDs, such benefits could not be demonstrated.

Dental impact on daily living of telescopic crown-retained partial dentures

This study aimed to analyze changes in Dental Impact on Daily Living (DIDL) scores in patients who had no prosthesis, a nonfunctioning prosthesis, or an acrylic resin prosthesis after providing them with a telescopic crown-retained partial denture. DIDL scores were recorded in 98 patients prior to and 6 to 24 months after treatment. All DIDL scores (overall and dimension scores) increased significantly after treatment. Results were only slightly affected by gender and age. Patients with fewer teeth benefited more than those with more teeth. Within the limitations of this study, the results show that a telescopic crown-retained partial denture can improve patients' oral health-related quality of life.

Evaluation of temporomandibular joint noise in partially edentulous patients

In order to evaluate the presence of TMD (temporomandibular disorder), dissatisfaction related to the use of removable partial dentures (RPD) and the effect of the treatment on temporomandibular joint noises, 13 female patients with Kennedy class I and II mandibular arch were selected. Another 13 young, asymptomatic, dentate patients, also female, were used as reference. After four years, 38.4% were found to have a moderate or severe degree of TMD. Over the four years, the degree of TMD increased in 46.15% of the patients, was not affected in 20.07%, while in 15.38% it decreased or the patients remained free from signs and symptoms. About 30% of the patients at the second year and 46% after the fourth year, had complaints regarding retention and stability. It was concluded that there is no relationship between TMD and the condition of partially edentulous Kennedy class I and II, but patient dissatisfaction increased after the second year and temporomandibular joint noise was reduced significantly with the replacement of the teeth.

Factors related to patients' general satisfaction with removable partial dentures: a stepwise multiple regression analysis

This study aimed to analyze factors related to patients' general satisfaction with removable partial dentures (RPDs), such as esthetics, retention, speech, chewing, and comfort. A total of 103 patients with Kennedy Class I RPDs (34 to 82 years old; mean age: 63; 35 men, 68 women) assessed their satisfaction with dentures. Stepwise multiple regression analysis was used to evaluate the relationship among the factors. Significant correlations were found between general satisfaction and each of the individual components (P < .05). The patients' assessment of esthetics explained almost 50% of general satisfaction in both arches (P < .05). Esthetics, chewing, and speech had significant effects on the patients' general satisfaction with dentures.

Treatment with double crown-retained removable partial dentures and oral health-related quality of life in middle- and high-aged patients

The objective of this study was to assess the change in oral health-related quality of life following treatment with double crown-retained removable partial dentures (RPDs). Sixty RPDs in 54 patients (mean age: 65 years) were fabricated and retained with either galvanoformed telescopic secondary crowns (n = 30) or conical secondary crowns (n = 30). The Oral Health Impact Profile (OHIP) was assessed pretreatment and during 6- and 12-month follow-up appointments. Patient assessment of denture-satisfaction was also recorded on a Lickert-type scale. A decrease in the OHIP-sum score was significant after treatment for both groups, but not between the experimental groups. The denture assessment showed good values for both groups. Treatment with different double crown-retained RPDs improved oral health-related quality of life.

Attitudes and practice in the provision of removable partial dentures

OBJECTIVE

To identify the factors shaping the pattern of removable partial denture (RPD) provision by dentists in England. Design Cross sectional survey of general dental practitioners.

METHODS

Details of current practice and provision, influences, attitudes and demographic details were collected using a self-completion questionnaire mailed to general dental practitioners identified through the Dental Practice Board register.

RESULTS

Three hundred and eighty-five questionnaires were returned by general dental practitioners from 62 health authorities throughout England. The most important factor reported as influencing both the GDP's decision to provide a partial denture and its subsequent success was patient desire to have a partial denture. Constructing the denture from cobalt chrome, advising the patient on aftercare, making time available to make minor adjustments and being responsible for design were all factors dentists associated with success of a RPD. However, for a number of dentists there was a reported divergence between knowledge and practice.

CONCLUSION

Overall it is clear that provision of partial dentures continues to be patient led. However, the decision making process is also influenced by a number of factors including time, cost and the NHS fee structure.

Correlations between self-ratings of denture function and oral health-related quality of life in different age groups

This study aimed to assess the correlation between self-rated denture function and oral health-related quality of life (OHRQoL) in different age groups. Subjects' OHRQoL was measured using the Oral Health Impact Profile, and self-ratings of denture function were assessed on a Likert-type scale for patients with fixed and removable partial dentures in 3 age groups (N = 253). For subjects with fixed partial dentures, all correlations were significant for the younger patients but not for higher age groups, whereas the opposite was true for subjects with removable partial dentures. The importance of self-perception of denture function in OHRQoL is different in various groups of patients, depending on age and dental status.

A comparison of oral health related quality of life between complete and partial removable denture-wearing older adults in Korea

The purpose of this study was to compare the oral health related quality of life (OHRQoL) between older Korean adults with complete and partial removable dentures using oral health impact profile (OHIP). A pool of 4250 Korean older adults was identified by random stratification by area from the sample cohort of Korean National Survey of Oral Health in the year of 2000. Out of the potential pool, 445 subjects with removable partial dentures (RPDs) or complete dentures (CDs) agreed to be interviewed by telephone. Each question in the survey was about how frequently each event was experienced during the past 12 months. To analyse the association between OHIP scores and removable denture status, bivariable analysis and multiple linear regression analysis were used. RPD users showed higher scores on eight items than CD users. They were 'breath stale', 'food catching', 'sensitive teeth', 'toothache', 'tense', 'unable to brush teeth', 'less tolerant to family members' and 'irritable with others'. RPD users might be associated with higher scores of functional limitation, physical pain and psychological discomfort than CD users. RPD users had slight tendency to be associated with higher OHIP-49 score than CD users, but it was not statistically significant. The findings of the present study confirm that there is no general OHRQoL difference between RPD and CD users. But in the items and subscales of OHIP, RPD users might experience more impaired OHRQoL than CD users.

Do patients have a preference for major connector designs?

AIM

The aim of this research was to evaluate patients' preferences for resin analogs of four major connector designs formulated to have equal rigidity once fabricated in the same alloy.

METHODS AND MATERIALS

Nineteen Kennedy Class I or II partially edentulous patients participated at two centers. The four major connector analogs (MCAs) were fabricated for each subject using light-polymerizing acrylic resin. The subjects were asked to wear each of them in the mouth for 30 seconds in six pairs in random order, and to report their preference for each pair. Based on these data, the four analogs were ranked in a descending preference order for each patient. Within-subject comparisons preferences were performed with the Friedman test, and the multiple comparisons were performed with the Wilcoxon Signed Ranks test for data of each sample independently.

RESULTS

Statistically significant and consistent preference orders were revealed for both samples, and the thin and wide design was significantly preferred to the thick and narrow design. However, a higher variation was observed for the first preference of each subject.

CONCLUSIONS

Subjects demonstrated a tendency to prefer thinner MCAs. However, the individual predilections of patients may not be an appropriate basis for an attempt to find a 'best design' applicable to all patients.

Follow-up visits as a measure of adaptation process to removable prostheses

OBJECTIVES

The paper was aimed to establish the influence of some general and local factors on adaptation process to removable prostheses (RPs). The adaptation process is a complex issue, which is often associated with painful reactions. Those complaints force patients to visit a dentist who makes alterations to reduce the patient's discomfort.

MATERIAL AND METHODS

The study involved analysis of 300 dental records of patients who visited our Department for RPs. The authors analysed the influence of gender, age, condition of general health, maintenance of the prosthetic base tissues and the kind of prostheses on the process of adaptation. It was measured by means of a number of follow-up visits of the patients to our polyclinic. The findings were analysed statistically by means of chi-squared test. The level of significance was assumed to be p < 0.05.

RESULTS AND CONCLUSIONS

Adaptation to RPs without any correction was revealed by about one-fifth of patients. Men adapted to RPs better than women. The biggest problems with adaptation to RPs were observed in patients using a complete and partial prosthesis simultaneously. The number of follow-up visits by patients who were treated with RPs for the first time or had been treated before was almost the same. Adaptation of RPs on an atrophic muco-osseous ridge was associated with more multiple visits than in the case of a well-preserved ridge. Healthy patients adapt to RPs better than patients with systemic disorders. Taking into account the limitations of the study, the number of follow-up visits may be used as a helpful indicator of the adaptation process.

Quality of life and masticatory function in denture wearers

Successful prosthodontic treatments for a patient with removable partial dentures including maxillofacial prostheses hopefully brings about psychological wellbeing as well as improved health. The purpose of this study was to investigate the relationship between quality of life (QOL) and the various aspects of denture function. At first, a questionnaire with a visual analog scale with 16 question items concerning denture and/or eating problems, the present state of health, psychological and physical wellbeing, life satisfaction, and QOL was developed. To discuss the validity and reliability of the questionnaire, 48 outpatients who wore a denture were asked to fill it out. Next, to discuss the difference in QOL of the patient with various kinds of dentures and conditions, 103 outpatients were asked to complete the newly developed questionnaire. The questionnaire which contained four factor areas with eight questions for denture patients was developed by factor analysis with Varimax rotation. The reliability of the QOL scale was confirmed by reliability analysis (Cronbach's alpha = 0.784). The QOL score of edentulous patients with a complete denture having some trouble chewing was significantly lower than that of other denture patients. It was suggested that the wearing of a denture significantly affected the QOL of elderly persons.

Determining 'need' for a Removable Partial Denture: a qualitative study of factors that influence dentist provision and patient use

OBJECTIVE

To identify factors that influence Removable Partial Denture (RPD) provision, and patient use of RPDs in the UK.

DESIGN

Exploratory qualitative interview study.

SUBJECTS AND METHODS

SUBJECTS

There were two sample groups. A purposive sample of 16 male and female dentists was categorised in terms of level of RPD provision, experience, and practice characteristics. A purposive sample of 17 male and female partially dentate patients was categorised in terms of RPD use and demographic characteristics.

DATA COLLECTION

Semi-structured in-depth interviews.

RESULTS

For dentists, RPD provision was indicated by patient demand and physical function of the remaining teeth, but was mediated by NHS fee structures and professional satisfaction. For patients, RPD use was influenced by the trade-off between improved appearance and the unpalatable presence of an RPD in their mouth. The location of the gap(s) was important, but other issues were relevant such as ability to "manage" without the RPD.

CONCLUSION

When defining "need" for an RPD, dentists focused on physical function of the teeth whereas patients focused on social meanings of the mouth. These differing priorities may improve understandings of patient non-compliance in RPD use. Further research on the relationship between denture use and social identity could be beneficial.

The impact of tooth loss on general health related to quality of life among elderly Pomeranians: results from the study of health in Pomerania (SHIP-O)

PURPOSE

It is important to know whether tooth loss has an impact on an individual's quality of life, since tooth loss is common. The aim of this study was to determine whether oral status is associated with general health and related to quality of life.

MATERIALS AND METHODS

Data of 1,406 subjects aged 60 to 79 years were taken from the Study of Health in Pomerania (SHIP). Sociodemographic (age, sex, and education level) and medical information (including the most common diseases in Germany) were gathered through an interview, and income data were obtained from a self-administered questionnaire. The prosthetic status in the maxilla and mandible was classified into complete denture or removable partial denture or with > or = 10 natural teeth including teeth replaced with fixed prosthodontics (> or = 10T) or with < or = 9 natural teeth including fixed prosthodontics (< or = 9T). The health-related quality of life was measured using the Short Form (SF-12) questionnaire. Multiple linear logistic regression analyses were used to identify the nonstandardized beta coefficient using physical and psychologic indices from the SF-12 as dependent variables and sociodemographic information, prosthetic status, and disease state as independent variables.

RESULTS

Prosthetic status is related to the physical scale of the SF-12. Additionally, we found that < or = 9T had a significant effect on the physical index of general health-related quality of life.

CONCLUSION

Reduced dentition without replacement of missing teeth by removable or fixed prosthodontics reduces the physical index of quality of life to the same extent as cancer or renal diseases.

Problems reported by patients before and after prosthodontic treatment

PURPOSE

This study sought to investigate problems reported by patients before and after prosthodontic treatment.

MATERIALS AND METHODS

Patient-reported problems were studied using the item list contained in the German version of the Oral Health Impact Profile in a convenience sample of 107 prosthodontic patients before (T0), 1 month after (T1), and 6 to 12 months after treatment (T2). "Frequently reported" problems were defined as impacts experienced fairly often or very often. The prevalence of frequently reported problems was compared among treatment groups and across appointments.

RESULTS

At baseline, the most prevalent frequently reported problems were "difficulty chewing" (31%), "take longer to complete a meal" (28%), "food catching" (26%), "uncomfortable to eat" (24%), and "unable to eat (because of dentures)" (23%). At T2, the most prevalent frequently reported problems were "sore spots" (5%), "painful gums" (4%), "discomfort (because of dentures)" (3%), and "sore jaw" (2%). The number of reported problems decreased from 18.0 (T0) to 7.5 (T1), and further to 4.5 (T2). The decrease was the fastest in fixed partial denture wearers and the slowest in removable partial denture wearers. Some problems emerged during or after prosthodontic treatment. The kind of pre- and posttreatment problems differed substantially.

CONCLUSION

The number of problems decreased substantially after prosthodontic treatment. Fixed partial dentures more effectively influenced the problems reported before treatment than did removable partial or complete dentures.

Oral health impact in patients wearing removable prostheses: relations to somatization, pain sensitivity, and body consciousness

PURPOSE

Previous studies investigating associations between patient personality traits and complaints related to wearing dental prostheses have been inconclusive. From the perspective of cognitive behavioral theory, the current study investigated whether pain sensitivity, body consciousness, and somatization affected the oral health of patients wearing removable dentures.

MATERIALS AND METHODS

Eighty-eight patients were supplied with removable partial and complete dentures. The Oral Health Impact Profile (OHIP), with six subscales measuring oral health impairment and disability during daily living, the Pain Sensitivity Index, the Private Body Consciousness scale, and the Somatization Scale of the SCL-90-R, were used.

RESULTS

The variables pain sensitivity, body consciousness, and somatization correlated significantly with all six OHIP subscales in removable denture wearers. In multiple hierarchic regression analyses, patient personality accounted for 38.0% of functional limitation and 41.5% of physical pain.

CONCLUSION

Pain sensitivity and bodily preoccupation might be important factors in explaining the subjective oral health effects of removable denture wearing.

Oral health-related quality of life in patients treated with fixed, removable, and complete dentures 1 month and 6 to 12 months after treatment

PURPOSE

This study described oral health-related quality of life (OHRQoL) before and after treatment in patients with fixed, removable, and complete dentures.

MATERIALS AND METHODS

OHRQoL was measured using the German version of the Oral Health Impact Profile (OHIP-G) in a convenience sample of 107 prosthodontic patients at baseline and 1 and 6 to 12 months after treatment. The sum of OHIP-G item responses (OHIP-G49, range 0 to 196) characterized OHRQoL impairment in 42 patients treated with fixed prosthodontics, 31 patients treated with removable dentures, and 34 patients treated with complete dentures. OHIP-G49 medians were compared with the OHRQoL level in a general population sample (n = 2,026). A multivariable binomial regression analysis, controlling for the effects of baseline OHRQoL and follow-up wave, was used to compare the level of impaired OHRQoL in different prosthodontic treatment groups at follow-ups.

RESULTS

OHRQoL improved in 96% of the subjects. OHIP-G49 medians reached the level of OHRQoL in the general population 1 month after treatment (fixed prosthodontics patients 6 OHIP-G units; general population subjects 5 units; removable denture patients 23 units, 15 units in general population subjects; complete denture patients 13 units, 23 units in general population subjects). OHIP-G49 medians were below population norms 6 to 12 months after treatment. In patients treated with removable/complete dentures, the expected posttreatment OHIP-G49 problem rate was 1.9 times the problem rate in patients treated with fixed prosthodontics, holding baseline OHIP-G49 and follow-up wave constant.

CONCLUSION

OHRQoL changed substantially comparing pretreatment scores with 1 and 6 to 12 months of follow-up in patients treated with fixed, removable, and complete dentures.

Recognition and management of somatoform disorders

Many clinicians have encountered patients with a somatoform disorder without recognizing the clinical presentation. Somatoform disorders can confound a diagnosis, consume inordinate amounts of treatment time, and may cause treatment failure. Recognition and management of somatoform disorders in prosthodontic patients is discussed in this clinical report to assist practitioners in avoiding initiation of prosthodontic treatment for patients with physical symptoms that are caused by a psychologic disorder rather than organic disease.

Emotional effects of tooth loss in community-dwelling elderly people in Hong Kong

PURPOSE

This study investigated the emotional effects of tooth loss among community-dwelling elderly people in Hong Kong and compared the effects among edentulous and partially dentate elderly.

MATERIALS AND METHODS

A questionnaire study involved 233 southern Chinese elderly who were recruited and interviewed at social centers for elderly people throughout Hong Kong. Data were analyzed using chi-square or chi-square exact tests.

RESULTS

Twenty-two percent of the participants reported difficulty accepting tooth loss, with no difference between the edentulous and partially dentate. However, 95% stated that their confidence was unaffected. For more than half of elderly people, tooth loss had a negative effect on food choice and enjoyment of food, with removable denture wearers having greater restrictions. Avoiding going out, eating in public, and forming close relationships were less-common problems. Twenty-two percent felt unprepared for the effects of tooth loss, and more than half said that better communication with the dentist would have helped.

CONCLUSION

The emotional effects of tooth loss were not marked among elderly people, and there were no differences between edentulous and partially dentate individuals. However, significant disability was experienced because of restrictions in daily living activities. Restrictions were more severe in people who had lost enough teeth to necessitate denture wearing.

A comparison of patient's satisfaction between complete and partial removable denture wearers

OBJECTIVES

The aim of this study was to compare satisfaction between complete denture (CD) and Kennedy Class I removable partial denture (RPD) wearers.

MATERIALS AND METHODS

A total of 156 CD and 112 RPD wearers took a part in this study. From the primary group of the examined patients, only those whose RPDs and CDs were assessed as excellent or very good by the dentist, took a part in this study. Patients graded satisfaction of their dentures by using an analogue scale from 1 to 5 (1=unsatisfactory; 5=excellent).

RESULTS

Both CD and RPD wearers were mostly satisfied with their dentures (the distribution of the scores of the patients' assessments was skewed towards the highest scores; more than half of the patients scored all the examined variables to the best score category). Complete Denture wearers were significantly more satisfied with chewing, speech and retention of maxillary denture than RPD wearers (P<0.05). Removable partial denture wearers were significantly more satisfied with the retention and the comfort of wearing mandibular denture (P<0.05). There was no significant difference between CD and RPD wearers for general satisfaction with their dentures, aesthetics and comfort of wearing maxillary denture (P>0.05; N.S.).

CONCLUSIONS

A majority of CD and RPD wearers were satisfied with the dentures. CD wearers were more satisfied with speech, chewing and retention of maxillary denture, while RPD wearers were more satisfied with the retention and the comfort of wearing mandibular denture. Different groups of denture wearers have to make significant, but different adjustments to wear their dentures successfully.

A survey of treatment outcomes with removable partial dentures

The patient's satisfaction with removable partial denture (RPD) therapy has become an increasingly important factor in prosthetic treatment. This study examined patients' satisfaction with RPDs in relation to some socio-economic variables, patients' habits of wearing and cleaning RPDs, comfort of wearing RPDs and different RPDs characteristics. A questionnaire was devised for the purpose. Two hundred and five patients were required to assess satisfaction with RPDs. They graded RPDs, depending on the level of satisfaction, on scale ranging from 1 to 5. A dentist determined Kennedy classification, material and denture support, denture base shape, number of missing teeth and evaluated denture construction. Majority of the patients were satisfied with the prosthesis. The patients of a higher education level gave lower grades (P < 0.05) to aesthetics of maxillary RPDs. Almost half of the patients were wearing RPDs during the day. Most of the patients cleaned RPDs three times a day. A significant difference was found between the patients' grades for comfort of wearing mandibular RPDs and number of missing teeth and between hygiene of mandibular RPDs and habits of cleaning them. Majority of the patients treated with RPDs were satisfied with the prosthesis. Dissatisfaction was related to mastication, esthetics, number of missing teeth and maintenance of oral hygiene.

Discuss before fabricating: communicating the realities of partial denture therapy. Part I: patient expectations

During planning for treatment involving cast removable partial dentures (RPDs), it is important to remember that the 2 major reasons why patients seek this treatment are to improve esthetics and to improve mastication. Treatment that is considered unsuccessful may not necessarily represent poor execution of procedures, but rather may not have fulfilled the patient's expectations with regard to these 2 goals. Searches of the Cochrane Collaboration and MEDLINE databases were conducted to identify issues pertaining to patient compliance in wearing cast RPDs. Compliance was better when the patient's chief concern was replacement of anterior teeth. The success of RPDs for replacement of teeth missing from other areas depended on the patient's perception of the value of such replacement. Maximum masticatory efficiency is equivalent for people functioning from second premolar to second premolar and those wearing partial dentures. Many clinicians believe that the prescription of partial dentures which replace teeth missing distally to the second premolars represents overtreatment.

Discuss before fabricating: communicating the realities of partial denture therapy. Part II: clinical outcomes

The premise of this review is that patients' satisfaction (and hence compliance) with partial denture therapy may be better if they are more fully informed about the limitations of the prosthesis they are to receive. Neither the dentist nor the patient should assume that all of their respective expectations will be mutually understood and inherently met. By discussing patient-centred issues and predictable clinical outcomes, both dentist and patient will be better prepared to determine whether a removable prosthesis is appropriate. Searches of the Cochrane Collaboration and MEDLINE databases were conducted to identify issues pertaining to patient compliance in wearing cast removable partial dentures. In addition to the 2 most frequent patient concerns, esthetics and mastication, discussed in the first article of this series, additional aspects of concern to the dentist and the patient when considering a removable partial denture include overeruption, post-insertion care, comfort, longevity of the prosthesis, effect on speech and biologic consequences are discussed here.

Validity and limitations of self-reported periodontal health

OBJECTIVES

To study the agreement between self-reported dental conditions and clinical findings in an adult population (20-84 years of age), and thus evaluate questionnaires as a tool in epidemiological studies of oral health, in general, and periodontal health, in particular.

MATERIAL AND METHODS

A questionnaire was sent to 900 randomly selected subjects in the age groups 20-29, 50-59 and 75-84 years. Of these, 723 subjects (81.0%) answered the questionnaire and 20% of them underwent a clinical examination.

RESULTS

As regards the remaining teeth, there was a mean difference of 1.4 teeth between the number indicated in the questionnaire and that found on the clinical examination. This difference was most marked in the older subjects. Eight of the nine subjects with removable dentures reported in their answers that they had removable dentures. Periodontal variables--we found significantly more subjects with pathological gingival pockets among those who stated that they had pockets than among those who answered that they did not (P = 0.01; chi-square independent test). Gingival bleeding was common in those who answered 'Yes' than in those who answered 'No' to the question concerning bleeding gums. This difference was significant (P = 0.05; chi-square independent test) in the three age groups. However, there was no correlation between the questionnaires and the clinical examination concerning tooth mobility.

CONCLUSION

Questionnaires concerning oral status are valid concerning the number of remaining teeth and use of removable dentures. They are less reliable about specific periodontal variables, but can still become a valuable tool for epidemiological studies of periodontal health.

Use of natural teeth in an interim partial denture

A clinical case is presented in which the patient's natural teeth were used in an interim partial denture. The patient accepted this treatment despite his reluctance to have the periodontally hopeless anterior teeth extracted. This technique may be used when the patient is emotionally unprepared for tooth loss, when the teeth to be replaced are highly characterized, or when no suitable denture tooth is available.

[Determining factors in the wearing of a removable prosthesis: the role of familial example. Prosthetic risk: the influence of parental behavior]

The aim of the present study was to provide a fuller clarification of the influence of sociocultural and socioeconomic data on the bucco-dental ageing. In Particular, was suspected, the influence of the parental behavior towards the wearing of their own prostheses in the wearing of removable prostheses among the descendants. The study was led in a dental service (CHU of Marseille) on 260 from 50 to 70 years old persons. Variables in the study were mainly basic sociocultural and socioeconomic variables (sex, age, educational level and social-professional groups...); the dental morbidity (DMF); the periodontal state (corrected CPITN, plaque index, gingival index), the prosthetic state of the subjects, the prosthetic state of the parents, the behavior of the parents towards the port of their prosthesis (CPP), the behavior of the subjects in front of dental care. The data were analyzed mainly by the method of logistic regression. They indicated that the most determining variables concerning the wearing of removable prostheses were: the plaque index (OR = 1.730), the behavior in front of dental care (OR = 1.306) and especially, the parental prosthetic behavior (OR = 4.420). In others words, the fact that the parents had removable prostheses and well tolerated it, constituted an important risk factor so that the children had removable prostheses. It was here, according to the authors, about sociological and psychological determinants on the bucco-dental aging.

Dental status and satisfaction with oral function in a sample of community-dwelling elderly people in Japan

The purpose of this study was to determine the influence of dental status on oral function and satisfaction among a group of independently living elderly persons in an urban area of Japan. The study sample consisted of participants of the Senior Citizens' College from 1995 to 1999. Their dental status and oral satisfaction were measured by a questionnaire. The number of usable questionnaires was 3967, or 80.8% of the total sample. The mean age of the subjects was 66.5+/-4.3 years, and 52.2% were male. Twenty-nine percent of them had a natural dentition, and 7.0% were edentulous in both jaws. The prevalence of edentulism in the study sample was significantly lower (p < 0.01) than that for the national survey. Overall, 66.4% of the subjects were satisfied with their ability to chew, 56.2% with the appearance of their teeth, 63.1% with their ability to speak clearly, and 76.5% with their ability to taste food. For complete-denture wearers, the greatest dissatisfaction was with speech (28.5%); however, for the RPD wearers, it was with chewing ability (21.7%). Sixty-one percent of complete-denture wearers reported that they were satisfied with their chewing ability, but only 11% of them could eat all three of the evaluated foods without difficulty. The multiple stepwise logistic regression analyses showed that both dental status and self-assessed general health had a significant association with dissatisfaction with all four oral functions and self-assessed impairment of chewing ability. There were significant associations between the elderly subjects' dental status and oral function.

Treatment outcomes with removable partial dentures: a comparison between patient and prosthodontist assessments

PURPOSE

This article presents the results from a survey of patients' degree of satisfaction with their removable partial dentures (RPD) and the comparison between patient and prosthodontist assessments.

MATERIALS AND METHODS

A total of 165 experienced RPD wearers filled in a questionnaire and graded their RPDs depending on their level of satisfaction. A scale ranging from 1 to 5 was used to assess general satisfaction with RPDs and to assess their esthetics, retention, and hygiene. A specialist in prosthodontics assessed the same prostheses using the same scale, not knowing the patient's opinion.

RESULTS

The patients' assessments were high, and more than half of them graded their dentures as excellent. On average, all variables were assessed higher by the patients than by the prosthodontist (P < .001). For the patients who gave the worst grades to their dentures, the grades were lower than the prosthodontist's (P < .001), while the satisfied patients graded their dentures much better than did the prosthodontist (P < .001).

CONCLUSION

On average, patient assessment of the treatment outcomes with RPDs was less critical than prosthodontist assessment. However, the few dissatisfied patients assessed their dentures worse than did the prosthodontist.

The removable partial denture equation

This article describes the benefits and risks of providing RPDs. It emphasises the importance of co-operation between the dental team and patient to ensure that the balance of this 'equation' is in the patient's favour.

Quality of life assessment of bone-anchored fixed partial denture patients with unilateral mandibular distal-extension edentulism

STATEMENT OF PROBLEM

Dental implants are expanding their use among partially edentulous patients. However, whether implants can promote the quality of life (QOL) of these patients has not been sufficiently examined.

PURPOSE

This study compared the QOL level among implant denture, removable partial denture, and no restoration patients with distal extension type unilateral mandibular edentulism.

MATERIAL AND METHODS

Three groups (n = 12 each) of subjects with unilateral mandibular distal-extension edentulism who were matched for age, sex, and missing teeth were studied. The groups were (1) implant denture, (2) removable partial denture, and (3) no restoration. QOL levels of these 3 groups were compared using a self-administered questionnaire with 3 major subscales: oral condition, general condition, and dental treatment.

RESULTS

The implant denture group showed higher oral condition related QOL score than the other groups. There was no significant difference in oral condition-related QOL scores between the removable partial denture and no restoration groups. There was no significant difference in the general condition related QOL score and dental treatment-related score among the 3 groups.

CONCLUSION

In unilateral mandibular distal extension edentulous patients, oral-condition-related QOL levels for dental implant patients were higher than those of removable partial denture or no restoration patients. The QOL levels of the removable partial denture patients were almost identical to those of no restoration patients.

The relationship between satisfaction with mouth and number and position of teeth

A number of studies have suggested that many people are satisfied with less than 28 natural teeth. This review assesses the evidence. The main conclusion was that less than a complete dentition can satisfy oral functional needs. Missing posterior teeth were not very important from a subjective aspect. The demand for replacement of missing teeth is related to the position of missing teeth. Most studies agree that individuals were more concerned about missing anterior teeth and having anterior rather than posterior teeth replaced. Aesthetics is more important than function for a great majority of individuals. However, certain socio-demographic factors, such as age, can change the subjective need for replacement of missing teeth. Some studies have assessed the social and psychological impacts on oral health status. The position of missing teeth was assessed, in terms of groups of missing teeth, anterior or posterior, that would affect an individuals' subjective need for replacement by partial prosthesis. Large numbers of people that have free end removable partial dentures made do not wear them because subjective needs are lower than normatively determined needs for replacement of missing teeth. Some studies have proposed alternatives to the replacement of missing teeth, such as the shortened dental arch concept.