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Psychological Effects of Missing Maxillary Anterior Teeth on Daily Life
Abstract
The orofacial region's appearance and functionality are crucial parts of human life that can be impacted by tooth loss and lower quality of life. The purpose of this study was to determine how anterior tooth loss affected patients' quality of life and dental satisfaction. Methods: 100 control subjects without missing teeth and 100 partly edentulous patients with missing anterior teeth were enrolled in the study. By age, gender, and educational attainment, the control participants were comparable to the patients. The impact of dental issues on daily life and dental satisfaction was evaluated using a dental impact on daily living questionnaire. Patients' daily activities, contentment with their looks, pain thresholds, dental comfort, overall performance, and eating abilities are all significantly impacted by tooth loss (p=0.000). The patients' overall satisfaction with their dentition and daily living was unaffected by their age or education level. Females, however, were less satisfied than males with their eating, general performance, and looks (p=0.003, 0.005, and 0.007, respectively). Patients' overall satisfaction (p=0.028) and their contentment with their look, dental comfort, general performance, and eating dimensions (p=0.001, 0.048, 0.011, and 0.009, respectively) all showed significant associations with the number of missing anterior teeth. Conclusion: Regardless of individual characteristics like age, gender, and educational level, tooth loss has a definite impact on patients' happiness with their dentition. The degrees of satisfaction with dentition and daily living decline as tooth loss increases.
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With the aid of questionnaires symptoms of mandibular dysfunction and some general and oral conditions were studied in a group of previous patients and in a randomly selected population sample. From the two materials answers were obtained from 82 persons (81%) and 1.106 (91%) respectively. The results confirmed that women are heavily overrepresented in patient materials. This differs from the fairly equal sex distribution found in population studies of mandibular dysfunction. The most frequent symptoms of mandibular dysfunction were TMJ-sounds which appeared in 39 and 79% and pain on opening the mouth which appeared in 12 and 42% of the population and patient samples respectively. All symptoms of mandibular dysfunction, headache, clenching of the teeth and unilateral chewing appeared significantly more often in the previous patients, but the number of natural teeth did not differ in the two samples. The general state of health was poorer and general joint -- muscle symptoms were more common in the previous patients as well as in those of the population sample with symptoms of mandibular dysfunction. This finding suggests that functional disturbances of the masticatory system often may be related to impaired general health.
To determine the risk factors associated with tooth loss between the ages of 18 and 26.
Dental examinations at ages 18 and 26 were conducted on Study members in the Dunedin Multidisciplinary Health and Development Study, and sociodemographic and dental service use data were collected using a self-report questionnaire. At age 15, an estimate of socio-economic status (SES) for each Study member had been obtained by classifying the occupation of the male parent. A case of tooth loss was defined as an individual who had lost one or more teeth (excluding third molars) due to caries between ages 18 and 26. Logistic regression and Poisson analysis were used to model the occurrence of tooth loss.
Among the 821 study members who were examined at both ages, one or more teeth were lost because of caries by 85 (10.3%). After controlling for sex, SES and visiting pattern, baseline caries experience predicted subsequent tooth loss, with the odds increasing by 2.8 for every increase by 1 in the number of decayed surfaces present at age 18. Episodic dental visitors had 3.1 times the odds of their routine visiting counterparts of losing a tooth over the observation period. The number of teeth lost was, on average, 2.3 times higher among episodic dental visitors.
Socio-economic inequalities in tooth loss appear to begin early in the life course, and are modified by individuals' SES and dental visiting patterns.
Our purpose was to test the hypotheses that cigar and pipe smoking have significant associations with periodontal disease and cigar, pipe, and cigarette smoking is associated with tooth loss. We also investigated whether a history of smoking habits cessation may affect the risk of periodontal disease and tooth loss.
A group of 705 individuals (21 to 92 years-old) who were among volunteer participants in the ongoing Baltimore Longitudinal Study of Aging were examined clinically to assess their periodontal status and tooth loss. A structured interview was used to assess the participants' smoking behaviors with regard to cigarettes, cigar, and pipe smoking status. For a given tobacco product, current smokers were defined as individuals who at the time of examination continued to smoke daily. Former heavy smokers were defined as individuals who have smoked daily for 10 or more years and who had quit smoking. Non-smokers included individuals with a previous history of smoking for less than 10 years or no history of smoking.
Cigarette and cigar/pipe smokers had a higher prevalence of moderate and severe periodontitis and higher prevalence and extent of attachment loss and gingival recession than non-smokers, suggesting poorer periodontal health in smokers. In addition, smokers had less gingival bleeding and higher number of missing teeth than non-smokers. Current cigarette smokers had the highest prevalence of moderate and severe periodontitis (25.7%) compared to former cigarette smokers (20.2%), and non-smokers (13.1%). The estimated prevalence of moderate and severe periodontitis in current or former cigar/pipe smokers was 17.6%. A similar pattern was seen for other periodontal measurements including the percentages of teeth with > or = 5 mm attachment loss and probing depth, > or = 3 mm gingival recession, and dental calculus. Current, former, and non- cigarette smokers had 5.1, 3.9, and 2.8 missing teeth, respectively. Cigar/pipe smokers had on average 4 missing teeth. Multiple regression analysis also showed that current tobacco smokers may have increased risks of having moderate and severe periodontitis than former smokers. However, smoking behaviors explained only small percentages (<5%) of the variances in the multivariate models.
The results suggest that cigar and pipe smoking may have similar adverse effects on periodontal health and tooth loss as cigarette smoking. Smoking cessation efforts should be considered as a means of improving periodontal health and reducing tooth loss in heavy smokers of cigarettes, cigars, and pipes with periodontal disease.
The aim of the present study was to examine: (1) the prevalence of tooth loss in persons living in community dwellings and (2) the strength of the association identified between tooth loss experience and the psychosocial factors of lifestyle, stress, and anxiety.
A cross-sectional study was carried out in a convenience sample where data were collected by means of self-administered questionnaires of lifestyle and psychosocial factors (stress and anxiety) and a clinical examination. A total of 516 subjects aged 14-30 years of age were included in the study. Subjects had a visual dental examination. Prevalence and mean of tooth loss were calculated excluding third molars, and their related factors were adjusted in a binary logistic regression.
Mean age of participants was 17.4+/-3.0 years; 45.5% were men. The prevalence of tooth loss (when at least one tooth was lost) was 20.5%. Among the 516 persons, a total of 201 teeth were lost with a mean tooth loss 0.39+/-0.95 overall. Mean tooth loss in subjects with at least one missing tooth was 1.90+/-1.26 teeth. Results adjusted by anxiety in the multivariate logistic regression model showed tooth loss was associated with lifestyle (OR=1.95, 95% CI=1.17 - 3.24), age (OR=2.65, 95% CI=1.64 - 4.26), and Angle's malocclusion II and III (OR=2.86; 95% CI=1.67 - 4.90). A slight association toward tooth loss was observed (p<0.10) in the sex and stress variables.
Lifestyle and tooth loss have a substantial association. According to age group, these results suggest tooth loss is an oral health problem in the study population.
The literature has shown that patients' satisfaction with dental prostheses is associated with the existence of certain personality profiles. It is important to study such relationships in dental implant patients.
Fifty patients (28 men and 22 women), aged between 22 and 71 years (mean age 43.22 years, SD 12.24 years), who were partially edentulous and were seeking dental implant therapy were entered into this study. The patients were requested to answer two reliable and valid questionnaires--the Dental Impact on Daily Living (DIDL) and the Neuroticism Extraversion Openness Five-Factor Inventory (NEO-FFI)--before implant treatment and 2-3 months after prosthodontic rehabilitation therapy.
Certain personality traits were found to have a significant relationship with patients' satisfaction with dental implants both before and after implant therapy (P < 0.05). Neuroticism score had valuable features in predicting patients' total satisfaction ratings (P = 0), satisfaction with appearance dimension (P = 0), satisfaction with oral comfort dimension (P = 0.005) as well as satisfaction with general performance dimension (P = 0).
Personality traits have an impact on patients' satisfaction with dental implant therapy. In addition, personality traits provide valuable information for the prediction of patients' satisfaction with their implant-supported prostheses. Neuroticism, openness, agreeableness and consciousness are very helpful in this regard. Neuroticism was found the main predictor of the patients' oral health-related quality of life following implant treatment.
The objective of this study was to identify factors that may affect patients' satisfaction with their dentition after orthodontic treatment. Fifty patients (20 males and 30 females; mean age 20.7 +/- 4.2 years) who successfully had finished fixed orthodontic treatment were included in the study. All subjects were treated with upper and lower fixed orthodontic appliances for an average duration of 19 +/- 4 months and were in retention stage (6-12 months) with upper Hawley and lower fixed bonded retainers. Dental Impact on Daily Living questionnaire was used to assess the effect of orthodontic treatment on daily living and satisfaction with the dentition in the study sample. The NEO Five Factor inventory was used to assess personality profiles in the study sample. Comparisons between groups were made using chi-square test. Personality traits were found to be correlated with patients' satisfaction with their dentition after orthodontic treatment. Higher neuroticism scores had a significant negative relationship with total satisfaction with the dentition (P < .05). Age, sex, and pretreatment orthodontic treatment need had no relationship with the patient's satisfaction. Patients treated nonextraction showed more dissatisfaction with their dentition (P < .05). In orthodontically treated patients, higher neuroticism scores were associated with lower levels of satisfaction with the dentition.
There is an increasing awareness of the need for measures of the social and psychological consequences of oral disorders. There are data on the social and psychological impacts of oral disease, but they do not measure the seriousness of the impacts. Therefore further research is needed on socio-dental indicators to develop simple, comprehensive, valid and reliable measures of dental functioning that can be linked to clinical status measures. The main objective of this research is to develop a socio-dental method which includes measures of how oral health status affects the quality of daily living and links that to clinical status. The measure will include social and psychological dimensions as well as clinical measures. The hypothesis is that the degree of the impact of the mouth in terms of self-image, performance, comfort and symptoms affects people socially and psychologically. Based on categories developed by Cushing (1986), the Social Impact of Dental Disease, the questionnaire being proposed includes the following dimensions: appearance, pain, comfort, eating restriction and general performance. The dimensions have been validated and reliability has been tested. Furthermore, utility weighting for questions is discussed. A final score for each dimension and for all dimensions together was calculated by summing question scores. From this three different groups were formed: the satisfied, the relatively satisfied and the dissatisfied. Their clinical status was analyzed. The questionnaire has been tested in Brazil, on a sample of 662 people, aged 35 to 44 years, of two social classes and both genders. The clinical oral measure used is the DMFT, and three groups have been selected : low, median and high DMFT. This study presents a measure of how oral health is perceived and how it affects people's life, dealing equally with negative and positive contributions to quality of life. Combined with clinical status measures it should improve estimates of need.
The aim of the current study was to gather information about time and etiology of tooth loss, and to analyze the reasons for treatment needs with a questionnaire used among edentulous patients. 60 patients (age 44-98 years) who requested dental treatment were included. More than half of the patients were edentulous before the age of 60, in almost all cases the maxilla was affected first. This difference was more pronounced in women, who experienced tooth loss in the maxilla 17 years prior to the mandible. At the time of edentulism women were about ten years younger than men. According to patients'report, periodontal disease was the most common reason for tooth loss. In the mandible, prosthesis retention was influenced by alveolar ridge resorption, while in the maxilla there was no relation between the amount of resorption and perceived retention. This indicates that maxillary prostheses retention is influenced by other factors besides the alveolar ridge morphology. So, permanent intake of drugs potentially causing xerostomia was related to poorer assessment of prostheses retention in the upper jaw. The results of the questionnaire "Patient satisfaction related to prosthetic restoration" before treatment indicated that the general satisfaction with the existing complete denture in the mandible was influenced by functional problems and the impairment of patients'self-confidence (R-squared = 0.754). The main reason for requesting treatment was the poor retention of the lower denture. More than half of the participants stated that they refrained from eating certain foods due to a reduced chewing ability.
The aim of the present study was to elucidate the relationship between health practices and masticatory function. Masticatory function was evaluated by chewing ability based upon a questionnaire on food intake (mastication score), maximum occlusal force measured by the Prescale TM, and the number of present teeth. The items on general health practice, included smoking, physical activity, drinking alcoh ol, sleeping hours, body, weight, diet, and eating between meals, were used in a previous investigation carried out by Breslow et al. Additionally, we examined the frequency of drinking sweat beverages. The persons who were conscious about their diet had a higher mastication score (p<0.05), higher occlusal force (p<0.05) and larger number of present teeth than the persons who did not care about their diet. The persons who frequently eat between the meal had a lower mastication score (p<0.05). Furthermore, the volume of sweat beverages was significantly related to the mastication score. The other health practices were not related to the masticatory functions. These results suggest that the health practice with respect to diet is closely related to the masticatory function in particular.
A survey was carried out to determine the relation between eating ability and physical activities/nutritional condition in institutionalised elderly persons with a mean age of 80.9yr. Assessment of eating ability was made using the test jelly method. Physical activities assessed were grip strength, equilibrium, and activities of daily living (ADL).Those that kept their eating ability also retained physical activities, and vice versa. Therefore, eating ability is related to physical activities. However, nutritional condition was not affected by eating ability bacause of the good nutritional managemement in this nursing home.
The Florida Dental Care Study (FDCS) is a longitudinal study of changes in oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination. Two objectives of the FDCS were to: (i) describe satisfaction with chewing ability in a diverse sample of dentate adults; and (ii) quantify the associations between satisfaction with chewing ability and other measures of oral health. Approximately 16% of subjects reported that they were dissatisfied or very dissatisfied with their chewing ability. Bivariate and multivariate results provided consistent evidence of the construct validity of a proposed multi-dimensional model of satisfaction with chewing ability. Multiple regression analysis suggested that dissatisfaction with chewing ability was independently associated with 12 specific clinical and self-reported measures of oral disease/tissue damage, pain, functional limitation, and disadvantage. The self-reported measures of oral health and the proposed model of satisfaction with chewing ability improve our understanding of this important oral health outcome in diverse population groups.
summary The aim of this study was to investigate whether older people having missing posterior teeth had few impacts and considered their teeth and mouth acceptable. The main objective was to assess the relationship between satisfaction with teeth and mouth, and the number, position and condition of the natural teeth. The sample was an employed unrepresentative population most of whom were in daily contact with the public. There was a very poor association between reported satisfaction with teeth and the number of standing teeth. There was little difference in satisfaction with dental and mouth status and the number of functional posterior occluding pairs (POPs). Satisfaction with the number and position of the functional POPs was not statistically significantly different in those with more or less than four POPs. However, there was slightly more satisfaction with teeth in the group with more than four POPs. Overall, those with more molar and premolar pairs were most satisfied with their teeth.
Abstract A group of 483 men, all of whom were 68 or 69 yr old and had lived for a long time in the city of Malmö were examined with regard to number of teeth present, removable dentures, fixed bridges, and tooth spaces. 76.4% had one or more natural teeth remaining, 59.2% had removable dentures, and 0.2% were edentulous and without dentures. The mean number of teeth present in a fixed dentition calculated on dentate subjects was 16.21 ± 8.02, including teeth replaced by pontics and 15.0 ± 7.44 when natural teeth only were recorded. The number of bridges was high, 28.8% of natural dentate persons having bridgework. This cohort had fewer remaining teeth than in similar groups in other areas of Sweden, but more fixed bridges. 19.5% had open tooth spaces corresponding to one or more teeth in the visible parts of the dental arches. The availability of dentistry has been extremely good in Malmö and financial support for all types of dental care has been provided for all inhabitants since 1974. In spite of this, a low number of remaining teeth and many untreated tooth spaces in visible part of the dental arches were found, though on the other hand much fixed bridgework was found. It appears from the present study that the population tends to polarize into two groups, namely one group which takes advantage of the dental services and one which does not.
Abstract– Objectives: To describe: (1) the 24-month incidence of tooth loss in a diverse sample of dentate adults; and (2) the clinical, attitudinal, behavioral, and sociodemographic correlates of tooth loss incidence. Methods: The Florida Dental Care Study is a prospective longitudinal cohort study of persons who at baseline had at least one tooth, were 45 years or older, and who resided in north Florida. An in-person interview and clinical examination were conducted at baseline and 24-months after baseline, with 6-monthly telephone interviews between those times. A two-level hierarchical generalized linear regression (logit model) was used to quantify tooth-specific and person-level factors simultaneously. Results: Of the 739 persons who attended for a 24-month examination, 24% lost one or more teeth during follow-up. Tooth loss was more common in persons with dental disease at baseline, incident dental signs or symptoms, those with negative attitudes to-ward dental care and dental health, those with limited financial resources, older adults, blacks, females, and problem-oriented users of dental care (as distinct from regular attenders). Although disease presence at baseline was a major factor associated with incident tooth loss, most diseased teeth were in fact still present 24 months after baseline. Conclusions: Other than periodontal attachment loss, severe tooth mobility, and dental caries, no single factor was a dominant predictor of tooth loss; instead, numerous factors made statistically significant but small contributions to variation in tooth loss. Tooth loss apparently is the result of complex interactions among dental disease, incident dental signs and symptoms, tendency to use dental care in response to specific dental problems, dental attitudes, and ability to afford non-extraction treatment alternatives.
This paper describes the burden of oral disorders in a population of adults aged 50 years and over living independently in the community. In so doing it uses clinical, functional, experiential and psychosocial impact measures to document the oral health status of this section of the population. The data reveal that substantial proportions of subjects report that their quality of life was compromised in some way by oral problems. Although only 24.1 per cent were edentulous, 30.5 per cent were unable to chew one or more foods; 37.2 per cent reported oral or facial pain in the previous four weeks and 67.5 per cent experienced one or more other oral symptoms. One third reported problems with eating and communication--social interaction, 18.7 per cent worried a great deal about their oral health and 30.8 per cent were dissatisfied with some aspect of their oral health status. Income was consistently associated with all health status measures examined, demonstrating the scope of inequalities in oral health. In addition, regression analysis showed that low income groups had higher scores on a psychosocial impact scale after controlling for clinical, functional and experiential oral health indicators. The paper illustrates the utility of a model of disease and its consequences derived from the international classification of impairments, disabilities and handicaps in exploring oral health.
In this study, the oral comfort was compared between subjects with shortened dental arches (SDA, n= 74), subjects with SDA and free-end removable partial dentures (SDA + RPD, n= 25) and subjects with complete dental arches (CDA, n= 72).
Oral comfort was measured by (i) absence of pain or distress; (ii) chewing ability; (iii) appreciation of the appearance of the dentition. Additionally, the history of free-end RPD over a period of nearly 7 years was taken into consideration.
On the whole, the results did not reveal any significant differences between the three groups with respect to pain or distress. Only 8% of the subjects with SDA reported impairment of chewing ability, and 11% had aesthetic complaints, due to missing posterior teeth in the upper jaw. Of the subjects with SDA * RPD, 20% had complaints about the RPD. In addition, the repeated necessity for repair or replacement of free-end RPD and the fact that some subjects (20%) stopped wearing the RPD during the observation period, confirm the poor performance of this dental provision. It is concluded that the oral comfort of subjects with SDA in this study is compromised to a small extent but remains on an acceptable level. Free-end RPDs do not appear to help oral comfort in these cases.
Dental care should be aimed at the preservation of a natural functioning dentition for life, within the available resources. In general, preference should be given to dentitions comprising complete dental arches or 14 occluding pairs of teeth. However, in many subjects--such as the elderly--this goal might be neither attainable nor necessary. In these cases, dental care should be aimed at preserving the strategic parts of the dental arch, which are the front and premolar regions (the so-called ultimate occlusal preservation target). Clinical observation as well as research findings indicate that elderly people can function at an acceptable level with a reduced dentition consisting of 10 or even fewer occluding pairs. The minimum size of a functional dental arch differs between individuals and depends on local and systemic factors. Important indicators are the age, the (periodontal) quality of the remaining dentition, the spatial relationship between the lower and upper teeth, the occlusal activity and the adaptive capacity. Dental health care systems should implement guidelines to concentrate the available resources primarily on the strategic regions of the dental arch, especially in high-risk groups. These guidelines should be based on research results. The main objective of this paper is to contribute to defining an acceptable oral status for elderly subjects.
In a previous study concerning oral function with shortened dental arches, it was found that approximately 10 per cent of the patients investigated complained of impaired masticatory ability despite a substantial reduction in arch length and, as a consequence, food platform area. This finding differs from those of studies relating masticatory performance to food platform area. From a review of pertinent literature, it is concluded that impairment of masticatory ability is manifest when less than 10 occluding pairs of teeth are present. Shortened dental arches are not associated with shifts in food selection adversely affecting general health.
A random sample of 542 respondents answered questions concerning the value assigned to the teeth, dental attendance pattern, oral health status, and dental anxiety. Non-linear multivariate analysis showed the data regarding value attached to the teeth to contain two dimensions, of which the second one was deleted due to extreme answer patterns (skewed distributions) on the pertinent variables. Repetition of the analysis, including a plot of the respondents, made it possible to discern four subsamples, characterized by specific answer patterns. In the discussion attention was given firstly to the separate variables estimating the value attached to the teeth, and next to the four subsamples, taking into consideration the dental attendance pattern, oral health status, and dental anxiety. It was concluded that the multivariate approach reveals that the respondents are of a rather high heterogeneity.
A total of 537 dentate adults from nine randomly selected government dental centers in three states in Malaysia were interviewed to assess their preference for either exodontia or preservation of teeth when they experience toothache, or have carious anterior or posterior teeth. The assumptions tested were i) patients prefer exodontia rather than preservation when they have toothache, and ii) patients are more willing to have posterior teeth extracted than anterior teeth for caries. Both these assumptions were rejected. Even though the majority of the subjects preferred preservation (59%) when having toothache, exodontia was the treatment of choice in a large proportion of subjects (41%). Significant differences in preference were found among the various ethnic, educational, income, and age groups. However, when ethnicity was held constant, binary regression indicated that the variations observed were determined by education, income, and age groups and not by ethnicity.
The purpose of the present study is to explore relationship of chewing ability to physical health status in the elderly. Subjects were 722 community elderly adults aged 65 years and over (participation rate 88.6%). They were divided into 2 groups according to chewing ability as rated by a questionnaire: good and bad. Results obtained were as follows; 1. Those who had good ability of chewing accounted for 86% of the subjects. The chewing ability was determined by dental status. Those with more natural teeth were better able to chew. 2. Multiple regression analyses controlled by age and sex showed that good chewing ability had significantly positive effect on weight, body mass and length of time for standing on one leg with eyes open.
The prevalence of removable partial dentures in North America is not known. This study was designed to collect information about (1) the indications for, (2) the teeth to be replaced with, and (3) the type of major connectors used in removable partial dentures. Five commercial dental laboratories situated in different regions of North America were selected to give as wide as possible a view of the production of removable partial dentures. Each laboratory was asked to provide details of 300 consecutive removable partial dentures. Photographs (35 mm) of master casts and processed partial dentures were obtained for more than 1300 patients. The color slides were analyzed and the remaining teeth and types of dentures were recorded. The dentures were classified as follows: cast frame denture, acrylic resin denture with or without some wrought metal, and acrylic resin denture with some cast units. The major connectors were classified as one of seven alternatives in the maxillae, and as one of six alternatives in the mandible.
The data from a dental health survey of a sample of the Brisbane population have been analysed with respect to posterior edentulousness and the wearing and prescription of partial dentures. Results indicated posterior edentulousness to be far more common in the lower arch with only a small proportion of subjects wearing partial dentures. Prescription rates were low except in those cases of a partially edentulous lower arch opposing a complete maxillary denture. There were no discernible differences in the prescription pattern of dentists regardless of experience.
Prosthetic treatment needs were studied in a sample of 1600 adults distributed equally into cohorts aged 25, 35, 50 and 65 years. A total of 1275 subjects (80%) were clinically examined with respect to the condition and age of existing prosthetic constructions, subjective needs for replacing missing teeth and the frequency of oral mucosal lesions associated with the wearing of dentures. Approximately half of the removable dentures (56%) were objectively non-acceptable and one-third (36%) subjectively so. One in four of those subjects with missing anterior teeth and premolars, or with 0-2 remaining mandibular molars and one in five of those with 0-2 remaining maxillary molars expressed a need to have one or more of the missing teeth replaced. The replacement needs were slightly greater for missing anterior teeth and premolars than for molars. Subjective needs for replacing missing teeth were greatest at the age of 50 years. The condition of removable dentures according to objective assessment was poorest among those aged 65 years. A high frequency of mucosal lesions associated with old and non-acceptable removable dentures was observed.
A sample consisting of 50 adult subjects aged between 21–23 years was assessed for their masticatory ability, by the use of a masticatory efficiency test. The occlusal status was assessed from study models using five occlusal indices. The scores obtained from the masticatory efficiency tests were correlated to those obtained from the occlusal analyses, using a correlation coefficient test. Significant correlations were found between the two scores.
A multiple regression analysis was used to predict the masticatory efficiency from the occlusal scores. The findings revealed that only a small proportion of the masticatory efficiency could be predicted. This suggested that factors other than those used in these indices may have an effect on the masticatory efficiency.
Masticatory ability may be assessed by analysis of cineradiographic film displaying the pattern of food placement during chewing. Examination was made of subjects in three groups: with intact arches, with defective arches with few teeth missing, and with arches having only anterior teeth in occlusion. The value of partial dentures which restored the defective occlusions was assessed by comparing the positions of the food bolus in the arch before and after fitting dentures. Patterns for intact arches showed almost continuous use of the cheek teeth associated with bilateral mastication.
Within the framework of an epidemiological, initially cross-sectional and subsequently longitudinal, population study of 70-year-old people, a representative sample of 386 subjects were subjected to odontological investigation. Forty six per cent of the men and 55% of the women were edentulous in both jaws and 20% of the men and 19% of the women were edentulous in one jaw. In dentulous subjects the mean number of teeth was 13.6 (men) and 13.5 (women). The tooth mortality rate was higher in the upper than in the lower jaw and higher in the lateral segments of the jaws than in the frontal region. The mean number of carious teeth was 3.2 for men and 2.4 for women and the mean number of intact teeth was 4.8 in men and 3.4 in women (p less than or equal to 0.05). Fifty four per cent of remaining teeth had been restored in men and 73% in women (p less than or equal to 0.01). Significantly more upper teeth were restored than lower teeth. Half of the dentulous subjects had worn their dentures for more than 10 years and only 14% had satisfactorily functioning dentures and acceptable occlusion. Poor retention and poor stability were very common in unsatisfactory dentures, more so in the upper than in the lower jaw. The proportion of dentures with these faults increased with increasing age of the dentures. The degree of dental invalidity was classified according to Eichner's index. This index was strongly correlated to the number of teeth and tooth contacts (p less than or equal to 0.001). The Eichner index covaried with frequency of visits to the dentist and special background factors such as income, education, marital status and past and present smoking habits. Married men tended to have a better level of dental health than other men (p less than or equal to 0.01), while the reverse was true for women. About half of the dentulous subjects were in need of prosthetic treatment and slightly less than half of them needed conservative dental treatment. Sixty per cent of edentulous subjects needed new dentures. The longitudinal comparisons between the ages of 70 and 75 showed small changes in dental invalidity. In a new cohort of 70-year-olds examined 5 years later the proportion of edentulous was significantly lower than in the first 70-year-old cohort.
Methods for studying efficiency and the results of studies using self-assessment and laboratory tests in subjects with various patterns of tooth loss are reviewed. It is concluded that age-related impairment of the dentition explains most of the decline in masticatory efficiency, while age per se has little influence. Many edentulous individuals are oral invalids and even when provided with optimal complete dentures their chewing efficiency is much lower than in those with natural teeth, with fixed prostheses on natural teeth, or with osseointegrated oral implants. The maintenance of a reasonable number of healthy natural teeth is the best guarantee for good masticatory efficiency with increasing age.
Shifts in food selection patterns result from impairments in masticatory ability, and the extent to which any dietary alterations occur appears to be influenced by the degree of impairment. Moreover, these shifts can be modified by a variety of physiologic, social, economic, and psychologic factors. The preference for softer, easier-to-chew foods in persons with complete dentures requires that the foods selected meet daily nutritional requirements. In view of the large proportion of individuals in the United States with complete dentures, an understanding of how these multiple factors affect the nutritional status of edentulous elderly persons may lead to more rational dietary approaches to the maintenance of health.
The aim of this study was to investigate whether older people having missing posterior teeth had few impacts and considered their teeth and mouth acceptable. The main objective was to assess the relationship between satisfaction with teeth and mouth, and the number, position and condition of the natural teeth. The sample was an employed unrepresentative population most of whom were in daily contact with the public. There was a very poor association between reported satisfaction with teeth and the number of standing teeth. There was little difference in satisfaction with dental and mouth status and the number of functional posterior occluding pairs (POPs). Satisfaction with the number and position of the functional POPs was not statistically significantly different in those with more or less than four POPs. However, there was slightly more satisfaction with teeth in the group with more than four POPs. Overall, those with more molar and premolar pairs were most satisfied with their teeth.
The relationship between cigarette smoking and periodontal destruction was assessed in young adults. Eighty-two regular dental attenders (21 current cigarette smokers, 61 non-smokers) aged between 20 and 33 years were examined. The smokers consumed on average 15.4 (+/- 7.3) cigarettes per day and had smoked for an average of 11.8 (+/- 7) years. Cigarette smokers had almost the same levels of plaque as non-smokers but had more proximal surfaces with subgingival calculus (P < 0.01) and which bled on probing (P < 0.05). Smokers had significantly more pockets > or = 4 mm (14.6 +/- 19.9) than non-smokers (5.8 +/- 7.9), P < 0.01. Only 2 (10%) of the smokers and 1 (2%) of the non-smokers had deep pocketing (> or = 6 mm). Smokers had significantly more sites (21.8 +/- 24.9) with periodontal attachment loss of > or = 2 mm than non-smokers (9.3 +/- 12.2), P < 0.01. Severe loss of periodontal attachment (> or = 6 mm) was present in 4 (19%) of smokers compared with 2 (3%) of non smokers. In total 4 (19%) of the smokers had "established periodontitis" compared with 1 (2%) of the non-smokers. The odds ratio for the presence of "established periodontitis" and smoking was 14.1 (confidence interval 1.5 to 132.9). It is concluded that cigarette smoking was a major environmental factor associated with accelerated periodontal destruction in this selected group of young adult regular dental attenders.
Eight hundred forty-nine Japanese dentists were asked to record the reason for every tooth extraction of permanent teeth during 1 week in each of four seasons. The reasons were assigned to six groups: dental caries, periodontal disease, eruption problems, trauma, orthodontics and other reasons. Thirty-eight to 40% of the dentists returned the forms in each season, relating to a total of 11,175 extracted teeth. Overall, caries was the most frequent reason for tooth extraction (55.4%), followed by periodontal disease (38.0%). The females lost more teeth due to caries than did the males. In the > or = 16 age groups, caries was the main reason for tooth extraction. However, periodontal disease became principal only in the males aged 46-65 yr. Anterior teeth, especially in the mandible, represented the highest percentage of periodontal extractions. A considerable difference in the major reason for maxillary tooth loss was observed between both sexes. Maxillary premolars and molars in the males were extracted for periodontal disease as much as for caries, whereas caries was the predominant reason for loss of all maxillary teeth in the females.
A number of studies are beginning to show that oral disorders can have a significant impact on the functional, social and psychological well-being of older adults. The Oral Health Impact Profile (OHIP) was developed to collect information on the nature and extent of this impact, and to facilitate the use of such data in oral health surveys, the evaluation of dental procedures and the clinical evaluation of patients. This paper describes OHIP and the results of two studies undertaken in Ontario to assess its measurement properties and to provide preliminary data on the way in which oral conditions compromise the quality of life of older adults. The measure proved to be reliable and valid, while data collected using this measure indicated that oral conditions have a negative impact on the daily lives of substantial proportions of older people. This impact was particularly marked among both edentulous and dentulous individuals who did not make regular visits for dental care.
Understanding the value of teeth to older adults is important in marketing dental services and motivating patients to care for their teeth. The authors surveyed more than 1,000 older adults in North Carolina to determine how teeth affect the quality of their lives.
Masticatory function can be assessed by chewing tests and questionnaires or personal interviews. Whereas the chewing tests allow the assessment of masticatory efficiency with some objectivity, questionnaires help evaluate a person's subjective responses about chewing ability. Epidemiologic studies indicate a subjective decrease in chewing ability with increasing degree of tooth loss, a trend that was confirmed in the literature. Of interest was that the subjective measures of masticatory ability are often overrated when compared with the functional tests. Masticatory function is a patient factor rather than a parameter that prosthetic treatment can qualify. It depends on a variety of personal and subjective factors that can hardly be influenced by the practitioner. This article describes and discusses scientific sociophysiologic and biomedical approaches to evaluating masticatory function.
This study examined the reasons for tooth loss in an adult population with dental insurance.
Computerized records were used to identify Kaiser Permanente Dental Care patients aged 40-69 years who had an extraction during 1992 (n = 1,877). A random sample of 839 dental charts were reviewed.
Slightly more than 51 percent of the teeth were extracted for periodontal disease, 35.4 percent for caries, 9.5 percent for a combination of the two, and 3.5 percent for other reasons. When considering patients as the unit of analysis, 58.4 percent of the patients had an extraction for caries, 39.9 percent for periodontal disease, 5.0 percent for both, and 2.6 percent for other reasons.
In this population both caries and periodontal disease play a role in tooth loss. For this reason, prevention programs focusing on the prevention of both disease processes should be developed for adults.
This study analysed data on periodontal reasons for tooth extractions, obtained from 52 dentists practising general dentistry in Singapore. The results revealed that, out of 2172 teeth extracted from 1276 patients, 35.8% were lost due to periodontal disease and 35.4% due to caries. Extraction due to periodontal problems increased with age, were more conspicuous in the Indian ethnic group and were frequently associated with pocketing and tooth mobility.
The retention of natural teeth among the elderly is increasing and, in recent studies, dental caries has been identified as the main reason for teeth being extracted. The 5-year incidence of tooth loss and dental caries and the most crucial dental factors for tooth extraction were studied in a random sample of 60-, 70- and 80-year-old inhabitants of Gothenburg. Of the 208 persons examined at baseline, 148 (71%) participated in the follow-up examination: 69, 51 and 28 respectively in the different age groups. In all, 110 teeth had been extracted during the period in 40% of the participants. Only 9 persons had lost three or more teeth. The mean numbers of remaining teeth were 22. 18 and 15 respectively in the 60-, 70- and 80-year age groups and the mean numbers of teeth lost during the 5-year period increased with age from 0.4 in the 60-year-olds to 0.8 and 1.4 in the 70- and 80-year-olds (P < 0.05). The major reason for tooth extraction was dental caries and it was found in 60% of all cases and at a higher rate of 77% in the oldest age group. Fifty-one per cent had developed new coronal carious lesions and 61% had new root carious lesions, while 27% had not developed caries during the period. The mean 5-year increment in decayed and filled coronal surfaces increased with age from 2.3 in the 60-year-olds to 3.7 and 5.3 in the 70- and 80-year-olds (N.S.I. The increment in decayed and filled root surfaces was higher in women than men, 3.4 compared with 1.8 (N.S.), which also increased with age from 1.4 in the 60-year-olds to 2.4 and 5.5 in the 70- and 80-year-olds (P < 0.0001). It was concluded from this study that few teeth had been lost during the 5-year period but that dental caries still appeared to be a serious problem among some very elderly people.
A number of studies have suggested that many people are satisfied with less than 28 natural teeth. This review assesses the evidence. The main conclusion was that less than a complete dentition can satisfy oral functional needs. Missing posterior teeth were not very important from a subjective aspect. The demand for replacement of missing teeth is related to the position of missing teeth. Most studies agree that individuals were more concerned about missing anterior teeth and having anterior rather than posterior teeth replaced. Aesthetics is more important than function for a great majority of individuals. However, certain socio-demographic factors, such as age, can change the subjective need for replacement of missing teeth. Some studies have assessed the social and psychological impacts on oral health status. The position of missing teeth was assessed, in terms of groups of missing teeth, anterior or posterior, that would affect an individuals' subjective need for replacement by partial prosthesis. Large numbers of people that have free end removable partial dentures made do not wear them because subjective needs are lower than normatively determined needs for replacement of missing teeth. Some studies have proposed alternatives to the replacement of missing teeth, such as the shortened dental arch concept.
A 1984 study investigated the reasons underlying the extraction of teeth in Scotland. The survey described in this paper, used a similar methodology and aimed to determine the reasons for the extraction of permanent teeth by general dental practitioners and investigate changes in the influences on tooth extraction over a 10 year period.
During a 1 week period in November 1994, 139 general dental practitioners working throughout Scotland, recorded the reasons for all permanent tooth extractions.
A total of 917 permanent teeth were extracted from 613 patients, the reason for extraction being stated as dental caries (51%), periodontal disease (21%), orthodontics (11%) and failed endodontics (4%). Trauma, pericoronitis and other reasons accounted for 5.5% of extractions whilst, in 7.5% of cases, patients requested extraction in preference to other treatments. The proportion of extractions attributed to periodontal disease increased from age 31-60 years, but declined thereafter.
Comparing the results with those obtained in the 1984 study, whilst the mean number of teeth extracted by each practitioner had reduced, the overall relative contribution of different reasons for extraction was similar.
In part 1 of this epidemiological study, a survey was conducted for all senior citizens aged 70 and over who resided in a mountainous village in the mid-section of Hyogo Prefecture. It focused on the relationship among the number of existing teeth, life environment, health status, and activities of daily living; and the correlation between oral status and QOL was analyzed. The daily activities of individuals were compared between those having one or more teeth and others who were totally edentulous. Subsequently, it was found that for both males and females, the odds ratio was significantly high for the dentulous individuals, in comparison with edentulous individuals, to exhibit a behavior indicative of a better QOL (such as "opportunity for conversation with family members or others)", "regular physical activities", and "attend meetings or group outings"). The result of this survey indicates that the presence of teeth is very closely related to one's daily activities. It was concluded that preventing tooth loss is vital for maintaining the masticatory function; so to prevent tooth loss, periodontal disease must be averted.
The purpose of this study was to compare the emotional effects of tooth loss in three edentulous populations.
A questionnaire study involved 142 edentulous subjects undergoing routine prosthodontic care at Guy's, King's and St Thomas's Dental Institute, London; the Dental School, Dundee, Scotland; and the Faculty of Dentistry, University of Hong Kong. Data were analyzed using the chi-squared test.
Difficulty in accepting tooth loss was a relatively common experience (44%) in all groups, with almost half feeling that their confidence had been affected. The majority (66%) felt that their choice of food was restricted and that the overall eating experience was less enjoyable, particularly the Hong Kong group. A significant proportion of the participants were concerned about their appearance without dentures, although the trend was less marked in Hong Kong. Forty-three percent felt that they were not adequately prepared for tooth loss, although the Hong Kong group was least concerned.
In general, the emotional effect of tooth loss was significant in all groups. The restrictions on daily activities were generally greater in the Hong Kong group. However, this group was much less inhibited by denture wearing. The differences observed in the Hong Kong Chinese are most likely due to different cultural values and expectations associated with these aspects of daily living.
Objectives:
To quantify racial and socioeconomic status (SES) disparities in oral health, as measured by tooth loss, and to determine the role of dental care use and other factors in explaining disparities.
Data sources/study setting:
The Florida Dental Care Study, comprising African Americans (AAs) and non-Hispanic whites 45 years old or older who had at least one tooth.
Study design:
We used a prospective cohort design. Relevant population characteristics were grouped by predisposing, enabling, and need variables. The key outcome was tooth loss, a leading measure of a population's oral health, looked at before and after entering the dental care system. Tooth-specific data were used to increase inferential power by relating the loss of individual teeth to the disease level on those teeth.
Data collection methods:
In-person interviews and clinical examinations were done at baseline, 24, and 48 months, with telephone interviews every 6 months.
Principal findings:
African Americans and persons of lower SES reported more new dental symptoms, but were less likely to obtain dental care. When they did receive care, they were more likely to experience tooth loss and less likely to report that dentists had discussed alternative treatments with them. At the first stage of analysis, differences in disease severity and new symptoms explained tooth loss disparities. Racial and SES differences in attitudes toward tooth loss and dental care were not contributory. Because almost all tooth loss occurs by means of dental extraction, the total effects of race and SES on tooth loss were artificially minimized unless disparities in dental care use were taken into account.
Conclusions:
Race and SES are strong determinants of tooth loss. African Americans and lower SES persons had fewer teeth at baseline and still lost more teeth after baseline. Tooth-specific case-mix adjustment appears, statistically, to explain social disparity variation in tooth loss. However, when social disparities in dental care use are taken into account, social disparities in tooth loss that are not directly due to clinical circumstance become evident. This is because AAs and lower SES persons are more likely to receive a dental extraction once they enter the dental care system, given the same disease extent and severity. This phenomenon underscores the importance of understanding how disparities in health care use, dental insurance coverage, and service receipt contribute to disparities in health. Absent such understanding, the total effects of race and SES on health can be underestimated.
The proportion of older people continues to grow worldwide, especially in developing countries. Non-communicable diseases are fast becoming the leading causes of disability and mortality, and in coming decades health and social policy-makers will face tremendous challenges posed by the rapidly changing burden of chronic diseases in old age. Chronic disease and most oral diseases share common risk factors. Globally, poor oral health amongst older people has been particularly evident in high levels of tooth loss, dental caries experience, and the prevalence rates of periodontal disease, xerostomia and oral precancer/cancer. The negative impact of poor oral conditions on the quality of life of older adults is an important public health issue, which must be addressed by policy-makers. The means for strengthening oral health programme implementation are available; the major challenge is therefore to translate knowledge into action programmes for the oral health of older people. The World Health Organization recommends that countries adopt certain strategies for improving the oral health of the elderly. National health authorities should develop policies and measurable goals and targets for oral health. National public health programmes should incorporate oral health promotion and disease prevention based on the common risk factors approach. Control of oral disease and illness in older adults should be strengthened through organization of affordable oral health services, which meet their needs. The needs for care are highest among disadvantaged, vulnerable groups in both developed and developing countries. In developing countries the challenges to provision of primary oral health care are particularly high because of a shortage of dental manpower. In developed countries reorientation of oral health services towards prevention should consider oral care needs of older people. Education and continuous training must ensure that oral health care providers have skills in and a profound understanding of the biomedical and psychosocial aspects of care for older people. Research for better oral health should not just focus on the biomedical and clinical aspects of oral health care; public health research needs to be strengthened particularly in developing countries. Operational research and efforts to translate science into practice are to be encouraged. WHO supports national capacity building in the oral health of older people through intercountry and interregional exchange of experiences.
Recent years have witnessed a consistent trend toward the introduction of patient assessment of different treatment outcomes in dental practice. Patient satisfaction with dental implants was considered among these treatment modalities. Few literature reviews have been published on this topic. This article critically analyzes the concerned topics related to patient satisfaction with dental implant. A MEDLINE search was completed from 1983 to 2004, along with a manual search, to locate related articles on the topic. Dental implants provided promising and predictable results regarding patient satisfaction and various aspects of life assessment.
Epidemiological study on improving the QOL and oral conditions of the aged-Part I: The relationship between the status of tooth preservation and QOL
- Y Yoshida
- Y Hatanaka
- M Imaki
Yoshida Y, Hatanaka Y, Imaki M et al. Epidemiological study on improving the QOL
and oral conditions of the aged-Part I: The relationship between the status of tooth
preservation and QOL. J Physiol Anthropol Appl Human Sci 2001 20: 363-368.