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Knowledge, awareness, and perception towards prosthodontic treatment and services among the natives of Durg, Chhattisgarh.

BACKGROUND

Today, a modern view of dentistry is one that recognises the emotions or psychological essence of the patient in relationship to the dental situation, dental health care, and, especially, aesthetics. [1]

Teeth play an important role in the maintenance of a positive self-image. [2] The loss of teeth results in significant disabilities, which can profoundly disrupt social activities. Tooth loss is very traumatic and upsetting and is regarded as a serious life event that requires significant social and psychological readjustment. [3,4] In its broadest sense, Prosthodontics is concerned with the replacement of partial or complete loss of teeth and oral function due to tooth or tissue damage (Carlsson GE and Omar R, 2006). With the rapid improvement in oral health and the reduction of edentulism in many countries, increasing numbers of people are retaining more teeth later in life (Carlsson GE and Omar R, 2006). Knowledge of subjects regarding prosthodontic treatment may play a role in their acceptance of the prostheses (Shigli et al., 2007). The aim of this paper is to evaluate the level of knowledge, perception, awareness, attitude, and behaviour of patients in the Department of Prosthodontics of Maitri College of Dentistry & Research Centre, Durg, Chhattisgarh aged between 21-91 years towards the options available for replacing missing teeth and the factors preventing them from taking treatment.

MATERIALS AND METHODS

The present study was a questionnaire survey conducted at Maitri College of Dentistry & Research Centre, Durg. The study samples of 250 subjects were randomly selected from patients, persons accompanying the patients, and from the residents of Durg. The sample population consists of 142 males and 108 females within age range of 21 to 91 years. A self-designed questionnaire containing nineteen questions was designed on knowledge and awareness for different Prosthodontic treatment modalities and reasons for choosing or refusing treatments were measured.

The dentist, dental technicians, and assistants were excluded from the study. Sociodemographic details including age, gender, etc. were noted. A total of 250 questionnaire forms were distributed & collected responses were tabulated.

Statistical Analysis

Data was statistically analysed using the SPSS 16.0 program. Frequencies were generated and mean calculated with standard deviation using descriptive statistical analysis. Chi-squared test was used to identify significance. The probability was assessed using P value by considering p < 0.05 as significant.

Questionnaire

Survey to analyse the Knowledge of Prosthodontic Rehabilitation.

Q. No. Question

1) Are you aware that missing teeth have to be replaced?

Yes / No

The various types of replacement that they are aware of

a. Complete Denture.

b. Removable Partial Denture.

c. Fixed Partial Denture.

d. Implants.

2) Do you have any missing teeth? Yes / No If Yes: Anterior / Posterior.

3) How long have the teeth been missing?

Year ... Month ... Days ...

4) Did you get them replaced? Yes / No If yes type of replacement:

a. Complete Denture.

b. Removable Partial Denture.

c. Fixed Partial Denture.

d. Implant supported.

If not replaced then why?

a. Financial constraints.

b. Inadequate knowledge.

c. Not motivated.

d. Rumours.

5) What would you choose between fixed & removable prostheses?

Fixed/Removable.

6) Where would you like to go for replacement of missing teeth?

a. Dental clinic.

b. General hospital.

c. Dental college.

d. Others (please mention). 7 8

7) Are you aware that there is a Dental college where replacement of missing teeth is done in your district? Yes/ No

8) Have you faced any problem during and/or after dental treatment? Yes/ No

9) Do you have any fear related to prosthetic treatment? Yes/ No.

If yes

a. Fear of swallowing.

b. Fear of prosthesis coming out.

c. Fear of discomfort.

d. Fear of gagging.

e. Fear of allergic reaction.

10) Have you experienced failure/repeat of any prosthetic treatment? Yes / No.

11) Will quality of your life improve after prosthetic treatment? Yes/ No.

12) Will your masticatory ability improve after prosthetic treatment? Yes/ No.

13) Why you underwent prosthetic treatment?

a. For aesthetics.

b. For mastication.

c. For speech/phonetics.

d. Others.

14) Are you content with your oral prosthesis? Yes/ No.

15) Do you let your dentist decide with regard to your prosthetic treatment? Yes/ No.

16) If you are not satisfied with the treatment options, do you choose another dentist? Yes/ No.

17) Do you talk to your family about prosthetic treatment options? Yes/ No.

18) Do you consider dental prosthetic treatment is too expensive? Yes/ No.

19) Do you think that prosthesis needs oral hygiene maintenance as natural teeth? Yes/ No.

RESULTS

The study sample consisted of 56.8% males (N=142) and 43.2% females (N=108) with a mean age of 39.048 [+ or -] 13.66 years. Analysis of sociodemographic details shows that there was no statistically significant difference between the gender distribution and age of the sample population P=0.94. Each question was analysed for the frequency, and the relation between the gender difference was tabulated. (Table 1).

Question 1

Awareness about missing teeth replacement: The results show that 10.0 % (N=25) of the study population, including both males and females, has the awareness that they have to replace the missing tooth. There was no statistically significant difference between the genders. (Table 2).

Knowledge about various treatment options: Out of the 250 individuals, 100% (N-250), 43.77% (N=109), 80.7% (N=201) and 10.84% (N=27) had the knowledge of Complete Denture, Removable Partial Denture, Fixed Partial denture and Implants respectively. There were no significant differences noted statistically, P>0.05.

Question 2

Have any missing teeth: 84% (N=210) individuals that participated in this study had missing teeth. The males showed a higher frequency of missing teeth than females. This result was statistically proven with chi square test, P=0.23 (Table 3). There was no statistical difference between the loss of anterior and posterior teeth.

Question 3

Duration of tooth loss: The duration of missing teeth among the participants of the survey was 15.12 + 10.10 months for males and 10.34 + 10.22 months for females. There was no statistical difference between the genders, P<0.001 HS. (Table 4).

Question 4

Attitude towards prosthetic rehabilitation: Considering the attitude towards the replacement of the missing teeth with prosthesis 33.3% (N=210) individuals were positive and were planning to replace the missing teeth. But there were no significant differences between the genders even though comparatively more men were willing for replacement. (Table 5).

Question 5

Type of Replacement perceived: Comparison of the individual's knowledge towards different prosthetic replacement options and their perceived option for replacing the missing tooth were as follows. Most of the people were willing to replace the missing teeth with complete denture i.e., 42.85% (N= 30/70), compared to 28.57% (N= 20/70) for fixed partial denture and 21.42% (N= 15/70) for removable partial denture. The individuals did not prefer to replace their missing teeth with implants, i.e., 7.1% (N=5/70). But these results were not significant within groups and between genders. (Table 6).

Question 6

Reasons for not replacing the missing teeth: The main reason for not undergoing the prosthodontic replacement was financial constraint & rumours in this study population (28.57, N=140), followed by lack of knowledge, regarding the prosthetic replacements (22.85%, N=140) and lack of motivation by the dentist towards the same (20.01%, N=140) and these observations were not statistically significant. (Table 7).

Question 7

Choice of place for replacing missing teeth: 55% chose to get treated in dental college followed by dental clinic (45%). (N=250). (Table 8).

Question 8

How many patients who underwent dental treatment faced problems? 42.85% patients faced problem during or after seeking dental treatment (30 out of 70 patients faced problems) while 40 patients out of 70 were satisfied with their dental treatment (57.14%). (Table 9).

Question 9

Do you have any fear related to prosthetic treatment? 200 out of 250 patients said yes (80%). (Table 10 & 11).

97 patients feared of discomfort followed by patients fearing of prosthesis coming out (68). 54 patients feared of discomfort during swallowing.

Question 10

Have you experienced failure/repeat of any prosthetic treatment? Out of 70 patients, 19 (8 male, 11 female) had experienced failure with earlier treatment (27.14%). (Table 12).

Question 11

Will quality of your life improve after prosthetic treatment? 78.57% (55 patients out of 70) patients had improvement in quality of life after treatment. (Table 13).

Question 12

Will your masticatory ability improve after prosthetic treatment? 56 (out of 70) had their mastication improved after prosthetic treatment (80%). (Table 14).

Question 13

Why you underwent prosthetic treatment? The main reason for undergoing the prosthodontic replacement was aesthetics- 33 out of 70 patients, 47.1%; for mastication- 31 patients, N=70, 44.28%; for speech- 6 patients, 8.5%. (Table 15).

Question 14

Are you content with your oral prosthesis? 56 patients were satisfied with their oral prosthesis i.e. 80% (N=70). (Table 16).

Question 15

Do you let your dentist decide with regard to your prosthetic treatment? 88% patients (220 out of 250) let their dentist decide the treatment plan. (Table 17).

Question 16

If you are not satisfied with the treatment option, do you choose another dentist? 220 out of 250 were willing to change their dentist if not satisfied with the treatment plan (88%). (Table 18).

Question 17

Do you talk to your family about prosthetic options? 207 out of 250 discuss about prosthetic treatment options with their family. (Table 19).

Question 18

Do you consider dental prosthetic treatment is too expensive? 60.8% (152) patients believed dental prosthetic treatment to be very expensive. (Table 20).

Question 19

Do you think that prosthesis needs oral hygiene maintenance as natural teeth? 66.4% (166 patients) believed that prosthesis needs oral hygiene maintenance. (Table 21).

DISCUSSION

In India, epidemiological data on patients' attitude towards tooth replacement are scarce. Therefore, an attempt was made to find out the attitude towards replacement of teeth among patients reporting to the Maitri College of Dentistry & Research Centre, Durg. Two hundred fifty patients reported for the study, male patients being more in number.

Most of the patients belonged to the forty to fifty-five years age. Older people make extensive use of medical facilities, but they seem to underuse dental facilities. Lack of information, and misconceptions about the value of dental visits have been mentioned as contributing to this apparent disinterest in dental care among geriatric patients. [5]

Individuals with greater financial resources have better access to dental care. Those who have attained higher levels of education are more apt to have greater financial opportunity and to place a higher priority on dental health. Lack of education about the importance of oral health, the need for preventive services, and the consequences of neglect appear to constitute a significant barrier to dental health care. [6]

Most patients reported that they had reserved money for health care, which may have been for general health rather than oral health because in India dental health insurance is not very common. In India, overall health insurance coverage is low; less than 10 percent of the population is estimated to have access to health insurance. For the most part, the health care demands of the rural poor and informal workers have been largely unmet. However, several initiatives and experiments have been tried. The Rashtrapati Swasthya Bima Yojna & The Mukhyamantri Swasthya Bima Yojna of Chhattisgarh Government provide medical & dental facilities by providing financial insurance to the poor. Since the patients in our study had reported on their own to the institute for replacement of teeth, it was not surprising to find that all the subjects expressed that missing teeth had to be replaced.

Most patients in our study gave financial constraints & rumours for not replacing teeth. Cost was the main barrier for obtaining dentures and is in agreement with the findings of Macek et al. [7]

Osterberg et al8 reported that aesthetics rather than functional factors determine a young individual's subjective need for the replacement of missing teeth while old age patients crave for functional need of the prosthesis (mastication). The demand for replacement of missing teeth is strongly related to the position of the missing teeth. Replacement of missing posterior teeth, and cosmetic dental treatment in general, depends on the perception of the patient. Even in countries with highly developed dental care systems, open spaces in the premolar and molar regions are well accepted by people of all ages. The prospect of a good aesthetic result frequently motivates the patient to wear a new denture, and aesthetics can be more important than function for many individuals. [9] In our study, patients who had lost teeth only in the anterior segment needed tooth replacement for aesthetics; those who had lost teeth only in the posterior segment needed tooth replacement for mastication; and patients with teeth missing in both the anterior and posterior segment needed tooth replacement for mastication. These findings could be explained by the fact that most people in India are aware of only the mastication function served by the teeth. They are less aware of the aesthetic and phonetic functions of teeth. According to Leake et al, [10] the subjective need for prosthetic replacement of teeth, particularly posterior teeth, is often low because such replacements seldom improve the individual's social status Moreover, as tooth loss usually occurs gradually over a period of time, it allows the individual to adapt to the situation with no apparent complaints. Therefore, many older individuals may not perceive a need for dentures in spite of losing significant numbers of teeth because they have adapted to their missing teeth over time. [11]

When a question regarding equivalence of artificial teeth to natural teeth was asked, it indirectly represented the expectation of the patient. Expectations represent attitudes that are complex and often difficult to change. In our study, a higher number of patients said that artificial teeth were equivalent to natural teeth. They might have perceived this because of the matching of the colour and anatomy of the artificial teeth to the natural teeth, the resiliency of the acrylic tooth material, or the care taken by the operator during tooth selection.

Most patients knew that artificial teeth create no problems. Patient education before, during, and after prosthodontic treatment may have prevented the expected problems with the artificial teeth or prosthesis. Patients' perceptions regarding replacement of teeth may have been better appreciated if differences in attitude among denture-wearers and non-denture-wearers had been analysed in our study.

The knowledge and attitude of patients towards the replacement of teeth would prepare a prosthodontist to provide a satisfying prosthesis. Knowledge of patient expectations can help in planning a prosthesis in harmony with the hard and soft oral tissues and in harmony with the patient's expectations as well. [12] Future studies should determine how the dental profession might help an increased demand for dental services among people who have limited financial resources & would provide important insights into the various types of assistance and insurance programs that might be designed and implemented to benefit older adults.

CONCLUSION

The present results may serve as a baseline for the future evaluation of attitudes towards replacement of teeth. The findings indicate that awareness needs to be created regarding the other functions of teeth like aesthetics and phonetics because many subjects in this study were only aware of the masticatory function performed by teeth, especially among individuals in the lower socioeconomic group. [13] Attitudes of patients towards replacement of teeth should be assessed to educate the patient accordingly and improve patient compliance with acceptance of prostheses.

The acceptance of dental implants and other advanced treatment modalities other than the conventional complete denture and removable partial denture options in the elderly population might be increased by providing further knowledge and awareness and promoting oral health in general.

REFERENCES

[1] Levinson NA. Psychologic facets of esthetic dental health care: a developmental perspective. J Prosthet Dent 1990; 64(4):486-91.

[2] Roessler DM. Complete denture success for patients and dentists. Int Dent J 2003; 53(5):340-5.

[3] Omar R, Tashkandi E, Abduljabbar T, et al. Sentiments expressed in relation to tooth loss: a qualitative study among edentulous Saudis. Int J Prosthodont 2003; 16(5):515-20.

[4] Fiske J, Davis DM, Frances C, et al. The emotional effects of tooth loss in edentulous people. Br Dent J 1998; 184(2):90-3.

[5] Maupome G, MacEntee MI. Prosthodontic profiles relating to economic status, social network, and social support in an elderly population living independently in Canada. J Prosthet Dent 1998; 80(5):598-604.

[6] Marcus PA, Joshi A, Jones JA, et al. Complete edentulism and denture use for elders in New England. J Prosthet Dent 1996; 76(3):260-6.

[7] Macek MD, Cohen LA, Reid BC, et al. Dental visits among older U.S. adults, 1999: the roles of dentition status and cost. J Am Dent Assoc 2004; 135(8):115-462.

[8] Osterberg T, Hedegard B, Sater G. Variation in dental health in 70-year-old men and women in Goteborg, Sweden: a cross-sectional epidemiological study including longitudinal and cohort effects. Swed Dent J 1984; 8(1):29-48.

[9] Mazurat NM, Mazurat RD. Discuss before fabricating: communicating the realities of partial denture therapy. Part I: patient expectations. J Can Dent Assoc 2003; 69(2):90-4.

[10] Leake JL, Hawkins R, Locker D. Social and functional: impact of reduced posterior dental units in older adults. J Oral Rehabil 1994; 21(1):1-10.

[11] Pallegedara C, Ekanayake L. Tooth loss, the wearing of dentures, and associated factors in Sri Lankan older individuals. Gerodontology 2005; 22(4):193-9.

[12] Conny DJ, Tedesco LA, Brewer JD, et al. Changes of attitude in fixed prosthodontic patients. J Prosthet Dent 1985; 53(4):451-4.

[13] Khan SA, Dawani N, Bilal S. Perceptions and myths regarding oral health care amongst strata of low socio economic community in Karachi, Pakistan. J Pakistan Med Ass 2012; 62(11):1198-203.

Vivek Lath (1), Priyabrata Jena (2), Nitin A. Vaidya (3), Vidya N. Vaidya (4), Saumya Sharma (5), Gulab Chand Baid (6), Sopan Singh (7), Neeraj Gupta (8)

(1) Senior Lecturer, Department of Prosthodontics, Maitri College of Dentistry and Research Centre, Anjora.

(2) Postgraduate Student, Department of Prosthodontics, Maitri College of Dentistry and Research Centre, Anjora.

(3) Professor and HOD, Department of Prosthodontics, Maitri College of Dentistry and Research Centre, Anjora.

(4) Professor, Department of Prosthodontics, Maitri College of Dentistry and Research Centre, Anjora.

(5) Professor, Department of Prosthodontics, Maitri College of Dentistry and Research Centre, Anjora.

(6) Reader, Department of Prosthodontics, Maitri College of Dentistry and Research Centre, Anjora.

(7) Senior Lecturer, Government Dental College, Raipur.

(8) Senior Lecturer, Department of Prosthodontics, Maitri College of Dentistry and Research Centre, Anjora.

Financial or Other, Competing Interest: None.

Submission 02-03-2017, Peer Review 27-03-2017, Acceptance 03-04-2017, Published 10-04-2017.

Corresponding Author:

Dr. Vivek Lath, F/301, Ashok Heights, Mowa, Vidhan Sabha Road, Raipur.

E-mail: drviveklath@gmail.com

DOI: 10.14260/jemds/2017/512
Table 1

          N     %

Male     142
Female   108
Total    250   100

Table 2

Are you Aware that Missing   Male   Female   P value
Teeth have to be Replaced?

Yes                          142     108
No                            0       0
Total                        142     108

Table 3

Do you have any   Male   Female   P value
Missing teeth?

Anterior           31      30      0.23
Posterior          89      60
Total             120      90

Table 4

How Long have the Teeth     Mean [+ or -] SD      P value
been Missing?

Male                      15.12 [+ or -] 10.10   <0.001 HS
Female                    10.34 [+ or -] 10.22
Total                      13.4 [+ or -] 10.27

Table 5

Did you get them Replaced?   Male   Female   P value

Yes                           40      30     1.00 NS
No                            80      60
Total                        120      90

Table 6

What would you Choose between   Male   Female   P value
fixed & Removable Prosthesis?

Complete Denture                 17      13     0.45 NS
Removable partial Denture        10      10
Fixed partial Denture            11      4
Implant supported                2       3
Total                            40      30

Table 7

Why did you not get    Male   Female   P value
the Teeth Replaced?

Financial constraint    25      15      0.08
Inadequate knowledge    20      12
Not motivated           10      18
Rumours                 25      15
Total                   25      15

Table 8

Where would you like to   Male   Female   P value
go for Replacement of
Missing Teeth?

Dental clinic              72      40      0.20
General Hospital           0       0
Dental college             70      68
Others                     0       0
Total                     142     108

Table 9

How many Patients who        Male   Female   P value
Underwent Dental Treatment
Faced Problems?

Yes                           14      16     0.12 NS
No                            26      14
Total                         40      30

Table 10

Do you have any fear    Male   Female   P value
Related to Prosthetic
Treatment?

Yes                     115      85     0.65 NS
No                       27      23
Total                   142     108

Table 11

Reason for Fear of Prosthetic   Male   Female     P
Treatment                                       value

Fear of swallowing               35      19
Fear of prosthesis coming out    34      34
Fear of discomfort               56      41     0.42
Fear of gagging                  17      14
Fear of allergic reaction        0       0
Total                           142     108

Table 12

Have you Experienced Failure/   Male   Female   P value
Repeat of any Prosthetic
Treatment?

Yes                              8       11      0.40
No                               22      19
Total                            40      30

Table 13

Will quality of your life   Male   Female   P value
Improve after Prosthetic
Treatment?

Yes                          31      24      0.80
No                           9       6
Total                        40      30

Table 14

Will your Masticatory Ability   Male   Female   P value
Improve after Prosthetic
Treatment?

Yes                              34      22      0.23
No                               6       8
Total                            40      30

Table 15

Why you Underwent       Male   Female   P value
Prosthetic Treatment?

For aesthetics           18      15      0.137
For mastication          21      10
For speech               01      5
Others                   0       0
Total                    40      30

Table 16

Are you Content with    Male   Female   P value
your Oral Prosthesis?

Yes                      33      23     0.54 NS
No                       07      07
Total                    40      30

Table 17

Do you let your Dentist decide   Male   Female   P value
with regard to your Prosthetic
Treatment?

Yes                              119     101     0.019 HS
No                                23      7
Total                            142     108

Table 18

If you are not Satisfied with   Male   Female     P value
the Treatment Option, do you
choose another Dentist?

Yes                             130      90     0.047 SIGNI
No                               12      18
Total                           142     108

Table 19

Do you talk to your Family   Male   Female   P value
about Prosthetic Options?

Yes                          101     106     <0.00001
No                            41      2
Total                        142     108

Table 20

Do you consider Dental Prosthetic   Male   Female   P value
Treatment is too Expensive?

Yes                                  80      72      0.097
No                                   62      36
Total                               142     108

Table 21

Do you think that Prosthesis     Male   Female   P value
needs oral Hygiene Maintenance
as Natural Teeth?

Yes                               90      76      0.24
No                                52      32
Total                            142     108
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Article Details
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Title Annotation:Original Research Article
Author:Lath, Vivek; Jena, Priyabrata; Vaidya, Nitin A.; Vaidya, Vidya N.; Sharma, Saumya; Baid, Gulab Chand
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Geographic Code:9INDI
Date:Apr 10, 2017
Words:3756
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