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ASSOCIATION OF PATIENT RELATED FACTORS WITH NEW COMPLETE DENTURES SATISFACTION - A STUDY.

Byline: FAHIMULLAH, MUHAMMAD RAZA, MOHANMMAD SARTAJ KHAN, SADIA AKRAM and BADSHAH AFSAR

Abstract

Objective of this study was to evaluate the association of patient related factors with complete denture satisfaction. Present study was carried out in the Prosthodontics department of Dental College during the period 2011-13. After preliminary examination new complete dentures (CD) were provided to 57 patients. To evaluate patient satisfaction with their CDs, a self-completed patient denture rating questionnaire, covering six items relating to denture esthetics, speech, mastication, retention, comfort and overall satisfaction was used. Associations between the clinical characteristics and patient satisfaction with CDs were analyzed using SPSS.

Younger women and patients with low socioeconomic were less satisfied as compared to older males and patients having high socioeconomic status. Moreover patients with favorable anatomical structures were more satisfied with their dentures.

Suitable denture fabrication, and proper instructions to the patients lead to better satisfaction by the patients.

Key Words: Complete Denture, Anatomical structures, Satisfaction.

INTRODUCTION

A decline in edentulism rates was documented in the last decade of the twentieth century.1 However, due to ageing of the society, it is estimated that the number of edentulous patients will not decrease.1 It deserves to be noted that the complete dentures (CDs) are commonly supply accepted as they provide a pleasing appearance and maintain normal speech, as well as occlusal support and adequate means for mastication of food.1-4

Difficulties in the acceptance of dentures are multifactorial, therefore, the risk of the dissatisfaction should be considered. Satisfaction with CDs has been associated with several factors as confirmed by several studies.5-9 Among these factors, general health, age, gender, personality traits, experience with previous dentures and patient expectation regarding treatment were evaluated in previous studies. Furthermore, it has been shown that patient satisfaction is unrelated to denture quality and to sophisticated techniques for the treatment.5-10

According to literature patient's adaptation to CDs is strongly related to the anatomical conditions, which combines denture quality and the characteristics of denture supporting tissues (DSTs). Thus, the discrepancy between the dentist's evaluation of denture quality and the patient's subjective judgment may result from inappropriate assessment of the quality of the denture-bearing surfaces.11

Two other studies concluded that the shape of the residual edentulous ridge influences patients' satisfaction and the use of new dentures.11-12 The quality of the denture supporting tissues that is dependent upon the condition of anatomical structures seems to be more important for successful CD therapy. Large residual ridges provide better support and stability for the denture base than those which are relatively resorbed. According to a recent review of the literature, studies on this area are equivocal and lack standardized methodologies for direct comparison.13 Since prognostic indicators are likely to take on increasing importance as a diagnostic tool for selection of patients for CDs provision, the need for further research in this area has never been higher.11-13

Therefore, the purpose of this study was to evaluate the association between oral condition and satisfaction with CDs in local patients using a standardized and reproducible methodology. The research hypothesis was that the quality of the denture supporting tissues may influence treatment outcome with conventional CDs.

METHODOLOGY

All edentulous patients reporting for CD treatment at the prosthodontic department of Dental College between January 2011 and December 2013 were invited to participate in the study. After a preliminary examination, patients exhibiting gross congenital / surgical defects or severe manifestations of systemic diseases in their denture supporting tissues were excluded from the study. Very ill, handicapped and uncooperative subjects were also not included. Each edentulous patient was seated in a dental chair. After explaining the purpose of the study and obtaining informed consent, data from each subject were collected by a single examiner in a standardized manner using a specifically structured two part data collection Performa. In the first part, data related to each of the subject's personal information including their age, gender, and socioeconomic status were collected.

The second part of the data collection sheet was used to collect data pertaining to the various anatomical structures of the edentulous maxillary and mandibular. The anatomical structures of the maxilla that were considered as important in CD prognosis included; residual alveolar ridge height and width, hard palate depth, arch form, arch size, soft palate / throat morphology, median palatal fissure, border tissue attachment levels, alveolar mucosa, maxillary tuberosities and tori. In the mandible, residual alveolar ridge height and width, arch form, arch size, border tissue attachment levels, alveolar mucosa, lateral throat form and mandibular tori were noted. Descriptive features of each of the mentioned anatomic structures rendering them as unfavorable (score 1 features) and favorable (score 2 features) are detailed in (Table 1).

A set of CDs was fabricated for all completely edentulous patients by one Assistant Professor using a standardized technique. Primary impressions of edentulous maxilla and mandible were recorded in edentulous stock trays in irreversible hydrocolloid impression material (Algin major). After obtaining the preliminary casts in dental stone, custom trays were fabricated in self-cure acrylic resin. The borders of the trays were shortened by an amount of 2mm. After performing border molding with the green stick impression compound, secondary impressions were recorded in Zinc Oxide Eugenol impression material (Cavex Holland). Temporary denture bases in selfcure acrylic resin were fabricated on the master casts thus obtained. Wax occlusal rims were mounted on for the subsequent recording of vertical dimension of occlusion (VDO) and centric relation (CR).

These were then mounted on a Hanue semi-adjustable articulator and artificial teeth were arranged. The dentures were then trial checked and processed in heat cure acrylic resin by compression molding technique. The finished and polished dentures were inserted. Borders were adjusted and occlusion was balanced in CR.

To evaluate patient satisfaction with their CDs, a self-completed patient denture rating questionnaire, covering six items relating to denture esthetics, speech, mastication, retention, comfort and overall satisfaction was used. The answers for satisfaction could range from 1 (unsatisfied) to 10 (highest level of satisfaction). All the questions were explained to the patients, as to enable them to understand meanings of each question. All the patients were asked to choose the numbers according to their satisfaction. After completing the treatment, all the patients were asked after six months post-insertion follow up visit to choose the numbers according to their satisfaction.

The Mann Whitney test was used to test the association between the satisfaction score and gender while Spearman's correlation test was used to determine the correlation between age and above mentioned score The associations between the clinical characteristics of the maxillary and mandibular denture supporting tissues and patient satisfaction with CDs were analyzed. Confidence level was set at 95% (p 15 mm).###Maxillary tuberosity: Moderately curved in A-P di-

Soft palate / Throat Morphology (House 1958): Class III###rection with some vertical inclination in the hamular

Mid palatal fissure: Present###notch area.

Border tissue attachment level (Labial):###Hard palate depth: Shallow or Medium (<15 mm).

<7.5 mm apical to the ridge crest.###Soft palate / Throat Morphology (House 1958): Class

Border tissue attachment level (Buccal):###I or Class II.

<7.5 mm apical to the ridge crest.###Mid palatal fissure: Not present.

Tori: Present.###Border tissue attachment level (Labial):

Lateral throat form: Class I and II (House 1958)###More than 7.5 mm apical to the ridge crest.

###Border tissue attachment level (Buccal):

###More than 7.5 mm apical to the ridge crest.

###Tori: Not Present.

###Lateral throat form: Class III (House 1958)

TABLE 2: GENDER DISTRIBUTION OF PATIENTS AMONG DIFFERENT AGE GROUPS

Patient Age###Gender###Total

###Male###Female

40-50 years###2 (3.5%)###12(21.0%)###14(24.6%)

51-60 years###9(15.8%)###19(33.3%)###28(49.1%)

61-70 years###13(22.8%)###2(3.5%)###15(26.3%)

Total###24(42.1%)###33(57.9)###57(100%)

TABLE 3: CORRELATION AND ASSOCIATION RESULTS OF THE INVESTIGATED PARAMETERS

Para-###Esthetics###Speech###Mastication###Retention###Comfort###Overall sat-

meters###isfaction

###Be-###After###Be-###After###Be-###After###Be-###After###Be-###After###Be-###After

###fore###fore###fore###fore###fore###fore

Age###0.62###0.88###0.48###0.32###0.67###0.86###0.66###0.43###0.04###0.07###0.37###0.92

Gender###0.65###0.83###0.43###0.37###0.66###0.85###0.61###0.48###0.03###0.06###0.29###0.86

TABLE 4: SATISFACTION SCORE LEVEL AMONG DIFFERENT SOCIOECONOMIC GROUPS

Satisfaction Score###Very low###Low###High###Very High

1-5###6(10.5%)###3(5.3%)###1(1.7%)###0(0.0%)

6-10###22(38.6%)###15(26.3%)###6(10.5%)###4(7.0%)

Total###28(49.1%)###18(31.6%)###7(12.3%)###4(7.0%)

TABLE 5: SATISFACTION SCORE LEVEL FOR UNFAVORABLE/ FAVORABLE ANATOMICAL STRUCTURES.

Satisfaction###Unfavorable###Favorable

Score

1-5###8(14.0%)###2(3.5%)

6-10###1(1.7%)###46(80.7%)

Total###9(15.8%)###48(84.2%)

Patients having shorter duration of edentulism scored less satisfaction with their CDs. A significant association (p=0.002) was observed with regard to socioeconomic status and satisfaction level. Poor patients were less satisfied with their CDs (Table 4). The relationship of the patients oral condition satisfaction level was highly significant (p=0.000) indicating that patients with unfavorable anatomical edentulous jaw structure scored very low satisfaction scores (Table 5).

DISCUSSION

Patients' satisfaction with their dentures is fundamental to improving oral health-related quality of life among edentulous individuals. Performance of complete dentures is evaluated by measuring outcome like longevity, function and esthetics. Both the clinicians' as well patient's appraisals are important for assessing the efficiency of a prosthesis. A recent study confirms the prosthesis positively influenced the patient quality of life, ability to perform and degree of satisfaction.10

This study results regarding patient satisfaction are an important information that can guide clinicians to provide treatment that will fulfill patient's demands and expectations.11-13

Most dentists suggest that patient's age has an effect on their ability to adapt to new dentures.12 This assumption is based on the idea that older patients need time to adjust to dentures. A number of studies 10-15 found no correlation among complete dentures, patient age, and patient satisfaction. However in our study young group were less satisfied from the esthetic of their denture, speech and comfort of wearing denture than the older one.

Generally, women are more concerned about aesthetics and are usually not satisfied with their dentures. However, this concept is old fashioned. Modern articles 16 have concluded that significant differences exist between genders regarding their acceptance and satisfaction related to dentures aesthetics, chewing, general satisfaction, retention, and comfort of wearing. Like the old fashioned concept, in our study group females were unsatisfied. The reason may be mostly the participants' belonged to rural areas of Peshawar having low socio economic status. Moreover two previous studies17-18 had shown correlation between socioeconomic status and denture satisfaction. The lower the socioecnomic status, the lower the satisfaction level.

Dentures made in poor oral conditions are more difficult to wear, which reduces patient's satisfaction. The most influential factor in the influence of oral conditions on patient's satisfaction seems to be the mandibular ridge. Poor ridge leads to lower satisfaction. Similarly from present results it can be seen that patients having unfavorable ridges were dissatisfied from their dentures. Resorbed mandibular ridges have a consequence of poor satisfaction rate with mandibular dentures. Mandibular dentures with reduced satisfaction rate have been shown to be a good predictor of dissatisfaction with new dentures.19-22

The quality of denture has a debatable impact on patient approval. Some authors report that quality of denture does not meet the criteria of the patient.11-12

In a similar study, patient's accepted their dentures despite technical problems, even patients with unfavorable anatomical structures received complete dentures and were satisfied.13 However, there was an increase in patient satisfaction as the quality of denture, that is retention and stability were improved. Other studies strongly supported the relationship between denture quality and patient satisfaction.17-19 This study showed similar results, increase in retention will lead to more patient satisfaction.

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Publication:Pakistan Oral and Dental Journal
Article Type:Report
Geographic Code:9PAKI
Date:Sep 30, 2016
Words:2947
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