The initial interview with complete-denture patients: its structure and strategy

Impact of sociodemographic factors, duration of edentulism, and medical comorbidities on the mental attitudes of individuals with complete edentulism

STATEMENT OF PROBLEM

Understanding the attitude of elderly patients is important for successful complete denture therapy. However, data regarding the impact of sociodemographic factors, impact of medical comorbidities, and duration of edentulism on the mental attitudes of such patients are lacking.

PURPOSE

The purpose of this clinical study was to explore the association of sociodemographic factors, duration of edentulism, and medical comorbidities on the attitudes of completely edentulous patients.

MATERIAL AND METHODS

The study was conducted among 125 completely edentulous patients visiting the Department of Prosthodontics, Nepal Medical College from August 2020 to October 2020. General information including age, sex, education level, medical history, and duration of edentulism were collected during a routine clinical evaluation. The mental attitudes of the participants were categorized according to M.M. House Classification into philosophical mind, exacting mind, hysterical mind, or indifferent mind. The participants were categorized into 3 age groups: 45 to 54 years, 55 to 64 years, and 65 years and above. Similarly, they were divided into 3 categories depending upon the duration of edentulism: 0 to 2 years, 2 to 5 years, and more than 5 years. Data were entered in a statistical software program for descriptive analysis using frequency distributions, and the chi-square statistical test and the Freeman-Halton extension of the Fisher exact test were used to determine the association between categorical variables.

RESULTS

The highest number of participants was in the philosophical category (34.4%) with the fewest in the hysterical group (12%). Men had more philosophical and indifferent attitudes, whereas women were more exacting (P<.001). Those with a recent history of extraction had an increased exacting attitude (P<.001). The respondents without any comorbid diseases were more philosophical, whereas a higher percentage of respondents with different comorbid conditions were assessed to be in the hysterical category (P<.001). Significant relationships were not found between mental attitude and educational status or age (P>.05).

CONCLUSIONS

Socioeconomic factors, duration of edentulism, and existing comorbidities had a significant impact on the attitudes of edentulous patients. The role of these factors should be assessed during the appraisal of the mental attitudes of edentulous patients.

Correlation of patient's mental attitude with age, sex, and educational level: A survey

Objective:

The aim of this study was to determine any relationship, if exists, between the patient's mental attitude with age, sex, or educational qualification.

Methods:

A total of 200 patients who attended the outpatient department during a span of 1 year, for the fabrication of new complete dentures, were chosen for the study. After completing a routine case history and examination, a questionnaire was filled by the clinician as answered by the patient. Participants were evaluated and categorized based on the questionnaire and clinical experience during treatment according to a predefined classification of determining mental attitudes. Outcomes from the survey were correlated with participant gender, age, and educational status.

Results:

The male to female ratio was 83:117, out of the 200 enrolled participants. The results from the questionnaire showed that females were found to be more exacting (P = 0.007) in nature, while males, on the other hand, revealed more indifferent attitude (P = 0.02); both differences being statistically significant. Of the three age group categories: Participants in the age group of 45–54 years revealed a significant inclination toward an exacting attitude when compared with other age groups (P < 0.001). In regards to educational status, an illiterate or minimally educated group significantly outnumbered the college graduates in the indifferent attitude group (P < 0.001).

Conclusions:

Within the limitations of this study, it could be said that the mental attitudes of patients could vary according to gender, age, and educational status, which could affect patient cooperation and satisfaction with oral rehabilitation, eventually manipulating the overall success of the treatment rendered.

Treatment planning for the edentulous patient

This article discusses psychologic characteristics of edentulous patients who seek restorative dental services. Restorative treatment options range from conventional dentures to implant-supported fixed partial dentures. Through an understanding of patient motives and expectations, the most appropriate treatment can be selected. Recognizing psychologic factors that contribute to dissatisfaction with dental treatment will permit the dentist to match patient needs with suggested treatment.

Esthetics and the edentulous patient

Most individuals undergo some degree of psychological shock, depression, and loss of self-esteem after the loss of their teeth. Optimum success in the treatment of the edentulous patient can no longer be limited to the proper fit, function, speech, selection, and arrangement of teeth. In addition, today's dentists must use treatment strategies that include proper psychological management, caring, and recognition of the importance of the patient's perception of what is personally esthetic. This article addresses the esthetic considerations of this restorative challenge.

Patient satisfaction with current dental condition related to self-concept and dental status

Structured interviews were administered to 168 male veterans from five locations to examine the relationship between attitudes toward dental esthetics, age, self-concept, and dental status. Results indicate the following. 1. Subjects who had a more positive self-concept rated their current dental condition higher. 2. Veterans who use dentures do not have a lower self-concept than those who have remaining natural teeth and feel more positively about their dental appearance. 3. Among the sample studied, dental appearance was considered less important than function or comfort. 4. Diminished self-concept is not associated with greater concern for dental esthetics.

The maxillary complete denture opposing natural teeth: problems and some solutions

The problems involved in providing comfort, function, proper esthetics, and retention for the maxillary complete denture patient with natural opposing dentition can be challenging. Careful preparation of the patient is important. It provides the new complete denture patient the opportunity to adapt to a complete denture and allows the dentist to evaluate his patient physically and emotionally before fabrication of the final complete denture. Methods for planning and fabrication of a denture that provide comfort, function, and stability have been described.

Evaluation of patients for preprosthetic surgery

The success of preprosthetic surgery and subsequent complete dentures depends not ony on the technical success of the procedures but also on the patient's satisfaction with the outcome. Studies of patients' satisfaction with their complete dentures confirm the experience of prosthodontists--that the problems described by patients do not always correlate with detectable anatomic deficiencies or technical faults in the prostheses. Since the responsibility for patient care is shared by both the surgeon and the prosthodontist, it is important that both specialists by involved in the screening process and evaluation of patients for preprosthetic surgery, prior to treatment. This article describes the basic criteria for patient evaluation, including signs that might indicate a poor prognosis for preprosthetic surgery. Everyone benefits if a realistic prognosis for the proposed combined treatment can be established before therapy is begun.

Quality of care: compared perceptions of patient and prosthodontist

The results suggest that, with the exception of retention, differences between patients' and prosthodontists' perceptions of treatment with complete dentures display greater variability with regard to function than to either esthetics or comfort. Although the literature has suggested that satisfying the esthetic concerns of the patient is likely to be a major hurdle in denture treatment success, this study suggests that occlusion, retention, and vertical dimension may be of more importance to effective communication. Misconceptions and unreal expectations should be dealt with early in the treatment program to avoid patient dissatisfaction. During the 1972 International Prosthodontic Workshop held in Ann Arbor, Michigan, the statement was made that patients were generally an unreliable guide as to the adequacy of their dentures, especially after wearing them for a period of time, and that further research to document the patient's reliability seemed unnecessary. This study has demonstrated that patients are quite reliable judges of many criteria related to dentures, provided channels for two-way communication are opened. With the ever greater economic stresses that force dentists to consider patients' concerns, perhaps it is increasingly the dentist's responsibility to better educate patients to evaluate all aspects of the quality of care they receive and encourage extensive two-way communication early in the treatment process. The adjusted quality assessment criteria used in the present study may be a useful instrument to use with patients prior to the initial interview in an effort to establish a better dentist-patient relationship.

A self-administered questionnaire--an aid in managing complete denture patients

A written self-administered questionnaire aids in treating edentulous patients and greatly reduces the possibility of patient dissatisfaction and medicolegal complications. Twenty-two questions have been presented which are to be answered in writing by the edentulous patient prior to the interview and examination. Such a questionnaire has several advantages31: (1) It saves time for the dentist and reduces the cost of treatment. (2) It quickly identifies problem areas. (3) It provides background information on the patient which is useful during the oral interview. (4) It identifies patients who write more intelligently and openly than they speak. (5) It evaluates neuromuscular coordination through handwriting review. (6) It serves as a reference for postinsertion problems. (7) It has legal merit when properly dated and signed and indicates that maximum diagnostic and therapeutic efforts are intended.

A review of psychogenic aspects and treatment of bruxism

The signs and symptoms of bruxism are detectable, but unfortunately, the hypothesized etiologies and mechanisms of their action have not been satisfactorily substantiated. 2. Researchers emphasize the significance of the oral cavity in expressing emotions and that occlusal adjustments and other mechanical types of treatment may be inadequate. 3. The treatment of bruxism involves the management of psychic tension, signs and symptoms, occlusal irritations, and neuromuscular habit patterns. 4. With the greater sophistication in the social sciences, therapy for bruxism in the future may become largely behavioral in nature, rather than mechanical.

Examination forms for edentulous patients--a survey

Examination and diagnosis forms for edentulous patients from 46 dental colleges in the United States were used in this study. Selected data were taken from each form and compiled under four general and 15 specific entries. Some college forms use entries requiring few and succinct responses,while other forms use entries requiring many and detailed responses. It appears that a correlation does exist between the thoroughness of the examination form and the proficiency of the dental student rendering complete denture therapy. Stated in a positive manner, this survey of college complete denture examination forms suggests that most dental students: use a separate complete denture form for the examination and diagnosis; ask for the chief complaint of the patient; ask one to four questions on past dental history; record 10 to 19 entries relating to oral anatomy; record one to four entries relating to oral physiology; record the mental attitude using two to four descriptive terms; and record one prognosis. Stated in a negative manner, this survey of college complete denture examination forms suggest that most dental students: do not examine the present complete dentures worn by the patient; do not use oral diagrams to show unfavorable or abnormal areas; do not ask for a prognosis in two or more areas; do not ask if the patient wears complete dentures at night; do not ascertain the attitude of the patient after receiving complete dentures; do not ask questions on complete denture expectations; do not use an interview form; and do not work with a staff dentist who has a psychology degree. The intent of this study is to create a spectrum of awareness concerning the presence or absence of specific information on the examination forms. Complete denture examination forms would be more beneficial to the dental student if they provided a high quality of pertinent clinical information. This information would aid the dental student in making an intelligent diagnosis, treatment plan, and prognosis.