The influence of personality on patients' satisfaction with existing and new complete dentures

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.

Incidence and risk factors for non-adaptation of new mandibular complete dentures: a clinical trial

OBJECTIVE

To investigate the incidence and risk factors for non-adaptation of the conventional mandibular complete denture (CMCD).

MATERIALS AND METHODS

A total of 108 edentulous patients were rehabilitated with complete dentures (CDs) and followed up at 3- and 6-month intervals. Adaptation was confirmed based on chewing, phonetics, and comfortable swallowing with the CDs. The risk factors among sociodemographic and patient-centered factors were analyzed. Statistical analyses included the chi-square test and then a multivariate analysis.

RESULTS

After 3 months, 38.0% of patients showed non-adaptation to CMCDs. Non-adaptation was significantly associated with the absence of previous mandibular denture experience (p = 0.042), ulcerations after 15 days of rehabilitation (p < 0.001), and a reduced posterior mandibular ridge (p = 0.035). After 6 months, this incidence decreased to 14.1%. The factors associated with non-adaptation were ulcerative lesions after 15 (p < 0.001) and 30 (p < 0.001) days of the delivery of CDs and the non-regular use of mandibular CDs (p < 0.001).

CONCLUSION

The incidence of non-adaptation was higher after 3 months, with reduction after 6 months. Sociodemographic variables did not influence the adaptation. After 3 months, the absence of previous experience, traumatic ulcers, and reduced mandibular ridges hindered the adaptation of patients to mandibular CDs. After 6 months, only the occurrence of ulcerative lesions and non-regular wear of dentures were risk factors for non-adaptation.

CLINICAL RELEVANCE

A considerable number of patients have difficulties in adapting to the mandibular dentures. Identifying the factors of non-adaptation of the dentures will contribute to increasing the predictability of this critical adaptation period.

Complicating factors in complete dentures: assessing case complexity

This article aims to describe common complicating factors that impact on the success of complete denture treatment and present an overview of the challenges these pose in practice. The authors present a range of medical, oral and social factors to consider when providing treatment to edentulous patients, allowing the practitioner to identify cases which may require referral. The information is applicable to all dental practitioners, and is a useful aid to highlight complicating factors in individual patients and to make well-informed clinical decisions.

The association between denture self-satisfaction rates and OHRQoL - a follow-up study

Backgroud

The objectives of this study were to try to identify the key dimension in satisfaction from the combination of satisfaction clusters, and its effect on the change of OHRQoL(Oral Health-related Quality of Life) of elderly denture users.

Methods

This follow-up study was conducted in subjects aged 65 years and over. All participants (n = 2128) completed questionnaires before and approximately 6 months after receiving complete denture. Information obtained by questionnaire included demographic characteristics, patients’ self-satisfaction rate and OHRQoL. The 6 satisfaction dimensions (including speaking, stability, esthetic, chewing, doctor and general dimensions) were classified as 5 cluster groups, which is the group of not at all satisfied in all dimensions (NAS); only satisfied with doctor and general dimensions(SDG); moderate satisfaction group(MS); quite satisfied group(QS); the highly satisfied group(HS) by an analysis of PCA (Principle component analysis) and CA (cluster analysis). Multiple linear regression was adapted to estimate the association between satisfaction and the responsiveness of OHIP-7T (Oral Health Impact Profile).

Results

When compared to the cluster “NAS”, the greatest improvement of OHRQoL after treatment was found in the group “HS” (β = 7.31(6.26–8.36), followed by group “QS” (β = 4.71(3.54–5.87)), group “MS” (β = 4.33(2.92–5.74)) and group “SDG” (β = 3.25(2.10–4.41)). An increasing trend was detected in patient-rating satisfaction and OHRQoL. The satisfaction cluster group is an important factor of OHRQoL after adjusting for other confounders.

Conclusion

Psychological-related aspects is the greatest impacting dimension on OHRQoL among denture wearers in Taiwan elderly. Better communication from the dental professional team with denture patients would improve their OHRQoL.

Press Ganey Outpatient Medical Practice Survey Scores Do Not Correlate With Patient-Reported Outcomes After Primary Joint Arthroplasty

BACKGROUND

Patient delivery of care satisfaction surveys have emerged as instruments to assess the quality of health care at both the hospital and provider levels. We evaluated the correlation between these care satisfaction surveys and patient-reported outcomes (PROs).

METHODS

We reviewed secondary data on 540 patients with 540 random visits who underwent primary total joint arthroplasty between January 2014 and February 2017. The Press Ganey Outpatient Medical Practice Survey was collected from outpatient clinical encounters to measure patient satisfaction with their experience and matched to PRO measures from the same encounter. The PROs evaluated included the Patient-Reported Outcomes Measurement Information System physical function computerized adaptive test, v1.2, and the Patient-Reported Outcomes Measurement Information System Global 10 health survey. In addition to the random selection, we reviewed separate cross-sections of the data including preoperative visits within 90 days of the index procedure, all postoperative visits at least 1 year from the index procedure, and the magnitude of change in PRO scores from preoperative to a minimum 1-year postoperative visit. Data were evaluated using the Spearman correlation coefficient (r_s).

RESULTS

There was little if any correlation between the Press Ganey scores and PROs at all time points evaluated (all, r_s: -0.13 to 0.14). When evaluating knee and hip arthroplasty cases separately, the data demonstrated similar results (all, r_s: -0.33 to 0.18).

CONCLUSION

We found little, if any, correlation between a patient's satisfaction with their care experience and their own perception of physical function and global health measures at all time points evaluated. These data question the utility of these scores as surrogate measures of health care quality, especially when reimbursements become tied to these metrics.

An intervention study to test Locker's conceptual framework of oral health in edentulous elders

OBJECTIVE

To test a previously described conceptual framework of oral health in edentulous elders using an intervention study that included complete denture replacement. Confirmatory factor analysis (CFA) was also conducted to substantiate construct validity.

BACKGROUND DATA

To date, the model proposed by Locker has been tested on edentulous elders using structural equation model (SEM) analysis. However, cross-sectional designs and the Short-Form Oral Health Impact Profile (OHIP-14) cannot adequately express cause-effect relationships and distribution in edentulous patients. Accordingly, the authors investigated Locker's model using an interventional design that included complete denture replacement using the OHIP for edentulous subjects (OHIP-EDENT).

METHODS

A total of 265 edentulous participants who visited the Dental Hospital of Tokyo Medical and Dental University (Tokyo, Japan) for new complete dentures were recruited. Locker's model was investigated, and CFA was performed using the change in subscale scores in the Japanese version of the OHIP-EDENT before and after complete denture replacement.

RESULTS

CFA demonstrated an excellent model fit after adding several covariates. The Locker model also met the criteria of fit in all indices after 1 nonsignificant path was omitted. All path coefficients were significant.

CONCLUSION

The findings of the present interventional study demonstrated an empirical fit to Locker's model in edentulous elders using SEM analysis, which included complete denture replacement. It is anticipated that clarification of causal mechanisms of oral health-related quality of life will lead to improvement of overall quality of life, thus maintaining or improving the activities of normal daily life for edentulous elders.

A structural equation model to test a conceptual framework of oral health in Japanese edentulous patients with an item weighting method using factor score weights: a cross-sectional study

Background

To investigate Locker’s multidimensional model of oral health in Japanese edentulous patients with an item weighting method using factor score weights, which is more accurate than the sum scoring method. A previous study tested Locker’s model in edentulous elders in the UK, using empirical evidence from the Short-Form Oral Health Impact Profile (OHIP-14). Investigating the model using the OHIP for edentulous subjects (OHIP-EDENT), which contains 19 items suitable for these patients, may complement that study. Testing Locker’s model in Japanese patients may support generalization of the model.

Methods

A total of 394 patients who were edentulous in both arches and visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures were recruited. This cross-sectional study had a non-probabilistic sampling design and included the following: data collection; application of the new item weighting method that involves hierarchical confirmatory factor analysis (CFA) to derive factor score weights for each item, using the bootstrap method, to check the significance of the factor score weights; and empirical testing of Locker’s conceptual model of oral health in Japanese edentulous patients, using structural equation modelling analysis with the bootstrap method for precise estimations and model generation.

Results

Factor score weights derived from CFA were significant. After item weighting, the initial model was analyzed and found to have an inconsistent direct path (functional limitation to disability). This path was eliminated from the model and the modified model was re-run. All effects were significant. The model showed acceptable fit on indices including the model chi-squared, standardized root-mean-square residual, root mean-square error of approximation, goodness-of-fit index, comparative fit index, and P-value.

Conclusions

Our findings showed an empirical fit to Locker’s model in Japanese edentulous patients when using the item weighting method, which was more accurate than the sum scoring method. These results could contribute to the generalization of Locker’s model.

Trial registration

The experimental procedures were published in the University hospital Medical Information Network (UMIN) Center (UMINCTR Clinical Trial, Unique trial Number: UMIN000028711).

Association of Clinician Denial of Patient Requests With Patient Satisfaction

IMPORTANCE

Prior studies suggesting clinician fulfillment or denial of requests affects patient satisfaction included limited adjustment for patient confounders. The studies also did not examine distinct request types, yet patient expectations and clinician fulfillment or denial might vary among request types.

OBJECTIVE

To examine how patient satisfaction with the clinician is associated with clinician denial of distinct types of patient requests, adjusting for patient characteristics.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional observational study of 1319 outpatient visits to family physicians (n = 56) by 1141 adults at one Northern California academic health center.

MAIN OUTCOMES AND MEASURES

We used 6 Consumer Assessment of Healthcare Providers and Systems Clinician and Group Adult Visit Survey items to measure patient satisfaction with the visit physician. Standardized items were averaged to form the satisfaction score (Cronbach α = 0.80), which was then percentile-transformed. Seven separate linear mixed-effects models examined the adjusted mean differences in patient satisfaction percentile associated with denial of each of the following requests (if present)-referral, pain medication, antibiotic, other new medication, laboratory test, radiology test, or other test-compared with fulfillment of the respective requests. The models adjusted for patient sociodemographics, weight, health status, personality, worry over health, prior visit with clinician, and the other 6 request categories and their dispositions.

RESULTS

The mean (SD) age of the 1141 patients was 45.6 (16.1) years, and 902 (68.4%) were female. Among 1319 visits, 897 (68.0%) included at least 1 request; 1441 (85.2%) were fulfilled. Requests by category were referral, 294 (21.1%); pain medication, 271 (20.5%); antibiotic, 107 (8.1%); other new medication, 271 (20.5%); laboratory test, 448 (34.0%); radiology test, 153 (11.6%); and other tests, 147 (11.1%). Compared with fulfillment of the respective request type, clinician denials of requests for referral, pain medication, other new medication, and laboratory test were associated with worse satisfaction (adjusted mean percentile differences, -19.75 [95% CI, -30.75 to -8.74], -10.72 [95% CI, -19.66 to -1.78], -20.36 [95% CI, -29.54 to -11.18], and -9.19 [95% CI, -17.50 to -0.87]), respectively.

CONCLUSIONS AND RELEVANCE

Clinician denial of some types of requests was associated with worse patient satisfaction with the clinician, but not for others, when compared with fulfillment of the requests. In an era of patient satisfaction-driven compensation, the findings suggest the need to train clinicians to deal effectively with requests, potentially enhancing patient and clinician experiences.

Does Neuroticism Influence Oral Health-Related QOL in Patients with Removable Partial Dentures?

This prospective cohort study investigated the relationship between patient neuroticism and oral health-related quality of life (OHRQoL) before and after prosthetic treatment as well as changes in OHRQoL-namely, treatment efficacy. Sixty-three patients (23 men and 40 women; mean age 67.2 ± 8.6 years), who were scheduled to receive new removable partial dentures (RPDs), were recruited. OHRQoL was assessed using the Japanese version of the Oral Health Impact Profile (OHIP-J). The Japanese version of the NEO Five-Factor Inventory (NEO-FFI) was used to assess neuroticism. Spearman's rank correlation coefficient was calculated to determine the association between neuroticism and OHIP-J scores before and after treatment. After stratifying patients according to neuroticism score, the Wilcoxon signed-rank test was used for intragroup comparison of OHIP-J scores before and after treatment. Moreover, logistic regression analysis was used to determine the impact of covariates on treatment efficacy such as age, sex, Eichner classification, neuroticism, changes in maximal occlusal force, and OHIP-J scores before treatment. Statistical analyses showed that higher neuroticism scores were associated with higher total OHIP-J scores before treatment ( r = 0.41, P = 0.001) but were not associated with OHIP-J scores after treatment ( r = 0.07, P = 0.566). When the effect of all independent variables was analyzed in multivariate analysis, neuroticism and OHIP-J scores before treatment affected treatment efficacy. These results suggest that OHRQoL of patients with higher levels of neuroticism was low before prosthetic treatment but significantly improved by oral rehabilitation with RPDs to the same level as patients with lower levels of neuroticism. Knowledge Transfer Statement: The results of this study may change the clinical perception of the effect of prosthetic rehabilitation with removable partial dentures in patients with higher levels of neuroticism. The study concluded that prosthetic rehabilitation could contribute toward satisfaction even in neurotic patients, who are presumed to show less satisfaction with their oral status.

Predictors of Patient Satisfaction with Removable Denture Renewal: A Pilot Study

PURPOSE

Conventional removable dentures still play an important role in the treatment of lost teeth. A thorough understanding of the parameters that influence patient satisfaction is useful for deciding whether denture replacement is meaningful. From a clinical perspective, factors that can be measured before starting treatment are relevant. This pilot study investigated whether patient satisfaction after denture renewal was affected by aspects related to the old prostheses, type of jaw, and patient motivation for denture renewal.

MATERIALS AND METHODS

Fifty subjects (mean age 68.2 ± 8.4) were provided with 74 removable dentures (partial n = 20, complete n = 54). Satisfaction was assessed before treatment and 3 months after new prosthesis insertion. Total satisfaction 3-month post-insertion (TSP3) merged 6 individual satisfaction items measured after treatment. Change of total satisfaction 3-month post-insertion (CTS3) represented the difference of total satisfaction when old and new prostheses were compared. The effect of the following independent variables was investigated: reason patients requested new dentures (fit, esthetics, broken denture, wear, advice of dentist, extractions), satisfaction with the old prosthesis (general, retention, stability, comfort, pronunciation, chewing, esthetics), and technical quality of the old prostheses as assessed by a dentist (stability, retention, fit, border, wear, esthetics). Gender, age, and a cognitive screening test were included as confounding variables. Mann-Whitney-U tests and linear mixed model analysis were performed.

RESULTS

All individual satisfaction items significantly improved with new prostheses for maxillary and mandibular jaws. TSP3 was higher for maxillary prostheses, if retention satisfaction with the old prosthesis was good, and if the dentist assessed the esthetics of the old prosthesis as deficient. CTS3 was associated with male gender, dissatisfaction with chewing before treatment, and dissatisfaction with esthetics before treatment.

CONCLUSIONS

This pilot study showed that satisfaction 3 months after new denture insertion was associated with aspects of satisfaction and quality related to the old prosthesis, type of jaw, and gender. These factors may help dentists predict therapeutic benefits when deciding on the need for denture replacement. Further research should be done with a greater number of subjects and should include balanced quantities of the different types of dentures.

Hypochondriacal attitudes and beliefs, attitudes towards complementary and alternative medicine and modern health worries predict patient satisfaction

Objective

To investigate how hypochondriacal attitudes and beliefs, attitudes towards complementary and alternative medicine (CAM) and modern health worries (MHWs) related to patient satisfaction with their general practitioner.

Design

Participants completed a five-part questionnaire anonymously which measured satisfaction with one’s doctor, hypochondriacal beliefs, attitudes to CAM, MHWs and personality.

Setting

England

Participants

Included 215 adults from a variety of cultural backgrounds.

Main outcome measure

The Illness Attitudes Scales measuring the attitudes, fears and beliefs associated with hypochondriasis; Worry about Illness; Concerns about Pain, Health Habits, Hypochondriacal beliefs; Thanatophobia, Disease phobia, Bodily preoccupations; Treatment experience and Effects of symptoms.

Results

Correlations (around r = .10 to .25) and Regressions (R square from .06 to .09) showed demographic and personality variables only modestly related to patient satisfaction. Hypochondriasis, CAM and MHWs were associated with greater patient dissatisfaction as predicted with the former as the most powerful correlate.

Conclusion

The study indicates the different needs of potential patients in a typical medical consultation. It is important to ascertain patients’ health beliefs and practices with regard to medical history, attitudes to CAM and MHWs to increase consultation satisfaction.

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.

The relationship between various parameters of complete denture quality and patients' satisfaction

BACKGROUND

Patients' appreciation of their conventional complete dentures might be affected by the quality of the dentures.

METHODS

A random sample of 33 edentulous patients who were rehabilitated by means of conventional complete dentures participated in the study. Three independent investigators who underwent technique calibration evaluated the dentures on the basis of seven clinical criteria by using a validated examination form. The patients filled out a validated denture satisfaction scale. The author used Pearson product-moment correlation and analysis of covariance to identify possible correlations.

RESULTS

The study results showed that most patients were between "reasonably satisfied" and "very satisfied" with their dentures. The author found nominally higher satisfaction among those receiving both mandibular and maxillary dentures and significant positive correlations between the overall denture satisfaction score and the stability of the mandibular denture (P = .039) and retention of the mandibular denture (P = .005). In contrast, esthetic lip support and lower lip line, occlusion, and maxillary stability and retention were not correlated with participants' overall satisfaction level (P > .064).

CONCLUSIONS

The results of this study show that a clinically stable mandibular denture was the most important determinant of patients' satisfaction.

PRACTICAL IMPLICATIONS

The study findings highlight the most important denture quality parameters that can aid clinicians in meeting their patients' expectations.

Effect of Patient's Personality on Satisfaction with Their Present Complete Denture and after Increasing the Occlusal Vertical Dimension: A Study of Edentulous Egyptian Patients

Complete denture wearers often find it difficult to accept a new denture. Personality traits are among the factors that possibly affect patient satisfaction with a complete denture. Our aim was to investigate the influence of patients' personality on satisfaction with their present denture and after an increase in the occlusal vertical dimension (OVD). Sixty edentulous patients with complete dentures (22 men and 38 women, mean age 66 years, and range 50–75 years) participated in the study. The age of their complete dentures ranged from 5 to 16 years. Patients' personalities were evaluated using the Arabic version of the Eysenck Personality Questionnaire. Their satisfaction with their dentures before and after restoration of the OVD and relining of the mandibular denture was evaluated using two questionnaires (I and II), Patients with a high score of neuroticism were less satisfied with their original dentures and after relining and an increase of OVD compared with patients with an average score in that trait. The personality trait of psychoticism was significant to patients' acceptance of an increase in OVD; that is, patients with a high score were less satisfied with their dentures after increase of OVD than patients with an average score. It is concluded that personality traits affect patients' acceptance of their complete dentures.

Evaluation of psychological guidance impact on complete denture wearer's satisfaction

The purpose of this study was to evaluate the impact of psychological intervention on edentulous patients' satisfaction with complete clinically satisfactory complete dentures. The survey was conducted in China Medical University involving 84 individuals receiving complete dentures at this institution from August 2013 to March 2014. Participants were randomly allocated to intervention and control groups consisting of 42 subjects, respectively. In the intervention group, individuals received oral health education and psychological intervention before and after the whole process. In the control group, 42 cases received doctor's regular advice after treatment. Satisfaction regarding aesthetic, speech, mastication, retention and comfort was rated in the first and third month after prosthesis treatment. Patients overall aesthetic, speech, mastication and retention were significantly improved in both intervention and control groups in 3 months later after prosthesis treatment when compared with the first month (P < 0·05). No significant difference existed for comfort in control group. Patient scores on aesthetic, speech, mastication and retention at both first and third month evaluations (P < 0·05) differed between the control and intervention groups. However, there was no difference for their scores related to comfort (P > 0·05) in first and third month. The study concludes that psychological intervention plays a significant role in improving patient satisfaction with complete dentures.

The usefulness of psychometric tests in dental treatment of patients aged above 65

OBJECTIVE

The aim of this study was to analyze the occurrence of some psychological disorders in elderly people in three different social settings and to evaluate the impact of those problems on the adaptation of denture wearers to removable prostheses.

MATERIALS AND METHODS

The study was conducted in three social settings: the geriatric clinic of a university hospital, nursing homes and a Third Age University school (TAU). Each group consisted of 70 randomly selected individuals. Of the total number of 210 subjects, 183 persons wore maxillary removable dentures while 150 had mandibular prostheses. Some symptoms of psychological disorders were diagnosed on the basis of results provided by two tests: GHQ and GDS. For identification of an inter-relationship between the use of removable dentures and the psychic status, the difficulties in adaptation to removable dentures were evaluated.

RESULTS

Statistical analysis showed that the number of individuals with depressive symptoms was significantly lower in the group of TAU students than among the nursing home residents. No statistically significant difference in the occurrence of depression was found between the group of hospital patients and the students of TAU. A comparison of the GDS test results with the incidence of denture use difficulties indicated a significant inter-relationship.

CONCLUSIONS

The GHQ and GDS tests may prove useful in the prosthetic treatment of those removable denture wearers who complain of oral discomfort without manifesting any visible causes. The proportion of elderly with signs of psychic disorders is significantly lower among TAU students than nursing home residents and hospital patients.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

Correlation of previous experience, patient expectation and the number of post-delivery adjustments of complete dentures with patient satisfaction in a Brazilian population

A number of variables may influence the outcome of complete denture therapy. The objective of this study was to verify possible correlations between previous experience with dentures, patient expectation and the number of post-delivery adjustments with patient satisfaction after treatment. One hundred patients (mean age 61·9 ± 10·3) rated their previous experiences with complete dentures and their expectations before and satisfaction after treatment on a visual analogue scale (VAS) using scores from 0 (worst results) to 10 (best results). The number of post-delivery adjustments and other patient-related clinical variables was also noted. Patient expectation scores were higher than previous experience scores and satisfaction after treatment scores. Positive and weak correlations were found between previous chewing experiences with complete dentures, with regard to chewing expectations and comfort of use. Phonetics and comfort of use in previous experiences presented a positive correlation with expectations for chewing, aesthetics, phonetics and comfort of use. Groups of patients with different levels of education presented significant differences in expectation scores regarding comfort of use as well. A negative and weak correlation was found between phonetics satisfaction and the number of post-delivery adjustments. Patients' expectations for the therapy were higher than their satisfaction after treatment. Previous experiences with complete dentures could slightly influence patients' expectations and satisfaction, whereas lower scores for previous experience with complete dentures caused lower scores for both expectation and satisfaction. Patients' educational levels and the number of post-delivery adjustments influenced negatively the expectations about comfort of use and patient satisfaction, respectively.

Association of cephalometric changes after 5 years of complete dentures wearing and oral health-related quality-of-life

OBJECTIVE

The aim was to investigate cephalometric changes after 5 years of wearing complete dentures (CDs) and to asses a possible relationship between changes in cephalometric parameters and patients' oral health-related quality-of-life (OHRQoL).

MATERIALS AND METHODS

New complete maxillary and mandibular dentures were fabricated for 30 participants. Two lateral radiographs were obtained from each participant with their CDs in the position of maximal intercuspidation (centric relation): the first radiograph was obtained at the CDs delivery and the second one after 5 years of CDs wearing. A questionnaire (OHIP 14) was given to all participants at the 5-year appointment.

RESULTS

Significant differences in most linear and angular cephalometric measurements were found after 5 years of CDs wearing, due to the reduction of the height of the lower third of the face and the forward shifting of the mandible. A significant correlation between the OHIP summary scores and five cephalometric variables was found (ANS-Xi/Xi-Pm angle, FH/N-Pog angle, SN/Go-Gn angle, Go-Gn/ANS-PNS angle and occlusal plane/FH), indicating that more severe cephalometric changes were related with the increase of OHIP scores.

CONCLUSION

Changes of cephalometric angles due to lowering of the face and forward shifting of the mandible were related to the decreased OHRQoL (increased OHIP scores).

Denture wearer's perception of ambient care. Part 2. Analyses of data

OBJECTIVE

The aim was to investigate to what extent denture wearers were satisfied with the ambient care (care) received.

MATERIALS AND METHODS

A study sample of 117 completely edentulous and 56 partially edentulous patients, who had received their dentures in the period 1997-2005 at Bergen School of Dentistry, completed a questionnaire containing eight specific items regarding different aspects of care, each with two positive (a and b) and two negative (c and d) categories, and four global items. The care items, including confidence in the dental team, information, waiting time and cost, constitute the Ambient Care Scale; the global items were concerned with overall care, satisfaction with dentures, self-reported oral and general health.

RESULTS

Between 91-100% of Ambient Care Scale responses were in the two positive categories. The completely edentulous group was significantly more satisfied than the partially edentulous group regarding several Ambient Care Scale items and oral health. Also, ratios between categories b and a showed systematic higher degrees of satisfaction for the completely edentulous group than the partially edentulous group. Fifty-six per cent in the completely edentulous group and 36% in the partially edentulous group were very satisfied, i.e. with ≥ 6 of 8 possible responses in category a. Analysis of the very satisfied showed that the highest degrees of satisfaction for both groups were found regarding students and staff, the lowest regarding cost and waiting times.

CONCLUSIONS

Patient satisfaction with care was very high. Completely edentulous patients were systematically more satisfied than partially edentulous ones.

Reducing the risk of failure in complete denture patients

This paper aims to review the factors associated with an increased risk of failure in complete denture patients, based on the strength of the available evidence base. These include accuracy of jaw relations, a poorly formed mandibular ridge, poor quality dentures and patient neuroticism. Clinical strategies for overcoming these issues are described with particular reference to impression-taking and jaw relations.

CLINICAL RELEVANCE

Identifying potential problems will help to improve outcomes for edentulous patients treated with conventional complete dentures.

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.

The future of complete dentures in oral rehabilitation. A critical review

Based on available investigations and current trends in oral rehabilitation published in the dental literature, an attempt is made to describe the possible future role of complete dentures. For edentulous patients, complete dentures have for long been the only prosthodontic treatment option. Whereas a large number of edentulous patients report satisfaction with denture usage, a smaller number are unable to adapt; for such patients, sophistication of clinical and technical processes or quality of denture-supporting tissues, appear to have little influence on patient-perceived outcomes. Since the 1980s, osseointegrated dental implants have dramatically improved the therapeutic possibilities, especially so for maladaptive patients. Those able to access such treatment can expect significant improvements in oral functional status and quality of life. While there is a downward trend in edentulism in several countries, it is region-specific, confirming the overriding influence of socio-economic factors on health status. In most societies, despite ageing populations, the need for complete dentures is not likely to reduce in the near future. Whereas a two- or even a one-implant overdenture for the edentulous mandible is increasingly regarded as a minimum standard of care in many developed countries, its routine prescription for the majority in the world who are disadvantaged is unrealistic; for them, even 'low-tech' therapies like conventional dentures are beyond their reach. Improving the conventional management of edentulous patients is a necessity and requires a keener focus by researchers, educators and clinicians in the developed world on the needs of populations with fewer resources.

The current and future treatment of edentulism

The purpose of this review and summary is to focus the clinician's attention on existing potential limitations regarding the management of edentulism. The current published data and opinions concerning the need for treating edentulism, the quality of dentures, related morbidity, and alternative or related therapeutics (e.g., dental implants) suggest there are opportunities for improvement in the treatment of the edentulous population. This may be achieved by adopting a broader therapeutic strategy focused not solely on technical aspects of an oral prosthesis. Instead, a wider array of clinical features of the edentulous patient should be addressed. A contemporary strategy may include concerns for prevention of tooth loss, evaluation of residual alveolar ridge resorption, and related issues of denture function, continual evaluation of oral mucosal health, compassionate management of maladaptive patients, a rationale for timely replacement of dentures, and continued development of dental implant therapies. The importance of therapeutic technical quality can be underscored, but should not overwhelm the broader concerns for assuring the overall health and well-being of the edentulous population.

Satisfaction of the complete denture wearers related to various factors

All dentists who have worked with complete denture wearers know that patient satisfaction is not based only on the technical quality of the dentures. The aim of this study was at assessing the effect of gender, the number of the dentures used before, the length of time of denture usage, education and age on the satisfaction of the complete denture wearers. The students of the Dental Faculty of Marmara University (Turkey) made new dentures for 342 patients who were asked to participate in the investigation. The subjects (137 men and 205 women) were 39-89 years of age with a mean of 61.62 years. The attitude toward dentures in general was measured by means of 11 items of a questionnaire. The 10 main questions of the questionnaire were answered by the participants, and quantified on a 7-point scale, while the 11th issue (general satisfaction) was evaluated on a scale of 1-10. All main factors were also estimated in subgroups. For example, the education was analyzed in 4 subgroups, the time of denture usage was divided into two subgroups (below and above 3 years) and the number of dentures used before was also taken as up to 3 or more than 3 dentures. The age of the subjects was taken in 3 subgroups: 40-55, 56-65 and >65 years. One-way ANOVA, Tukey and Student t-tests were used to evaluate the answers to the questionnaire. Our patients displayed statistically significant differences only in the topics of their ability of cleaning their dentures, due to education and number of previously used dentures.

An investigation of factors influencing patients' satisfaction with new complete dentures using structural equation modelling

OBJECTIVE

To investigate possible relationships between patient and clinical factors and patient satisfaction with new complete dentures.

METHODS

Patients attending King's College London Dental Institute, Guy's Hospital, London, for new complete dentures were recruited. Relevant history was recorded and the edentulous mouth and existing dentures, where present, were examined at the beginning of treatment. The edentulous mouth, the previous and new dentures were re-examined at the first post-insertion visit. Three months after this visit, patients were sent a postal questionnaire to assess patient satisfaction. Data were analysed using structural equation modelling techniques.

RESULTS

723 patients were recruited. Significant relationships were found between quality of complete dentures, quality of residual alveolar, adaptability factors and patients' satisfaction with complete dentures.

CONCLUSIONS

Quality of the mandibular residual alveolar ridges, retention and stability of the mandibular dentures, accuracy of reproduction of retruded jaw relationship and patient adaptability were powerful determinants of patients' satisfaction with new complete dentures.