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 Table of Contents  
Year : 2022  |  Volume : 22  |  Issue : 3  |  Page : 262-267

Effect of physical and psychological status on oral health quality of life of geriatric patients undergoing complete denture treatment

1 Department of Prosthodontics, AME Dental College and Hospital, Raichur, Karnataka, India
2 Department of Prosthodontics, Crown and Bridge, Jaipur Dental College, Maharaj Vinayak Global University, Jaipur, Rajasthan, India
3 Department of Prosthodontics, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India
4 Private Practitioner, Bengaluru, Karnataka, India
5 Department of Oral Surgery, Century Dental College, Kasargod, Kerala, India

Date of Submission01-Apr-2022
Date of Decision16-May-2022
Date of Acceptance29-May-2022
Date of Web Publication18-Jul-2022

Correspondence Address:
Sunil Dhaded
Department of Prosthodontics, AME Dental College and Hospital, Raichur, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jips.jips_162_22

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Aim: The present study was conducted to evaluate differences in Oral Health-Related Quality of Life (OHRQoL) in denture wearers based on psychological classification and patient satisfaction.
Settings and Design: A prospective study.
Materials and Methods: 284 patients, aged 30 years and above who fulfilled the eligibility criteria were recruited. Participants answered the OHIP – EDENT questionnaire at the time of denture insertion and 6 months later. Psychological categorization was based on MM House classification. Patient satisfaction was graded from totally satisfied to not very satisfied.
Statistical Analysis Used: SPSS 23 version was used for analyzing descriptive and inferential statistics. ANOVA was used to find significant differences for OHRQoL based on psychological classification and patient satisfaction. Before and after intervention analysis was assessed using student 't' test.
Results: Philosophical and exacting patients had better adaptation to dentures than the hysterical and indifferent class of denture wearers. Totally satisfied and very satisfied patients with dentures had lesser mean scores as against the other categories which was significant in all domains suggesting better. Overall, OHIP – EDENT score decreased from 20.253 ± 12.466 to 17.168 ± 14.143, which were significant at P =0.043, thus showing an improvement after a 6 month follow up.
Conclusions: Psychological attitude of denture wearers must be considered by the prosthetic specialist for effective adaptation and acceptance by the edentulous patient.

Keywords: dentures, edentulousness, patient satisfaction, quality of life

How to cite this article:
Dhaded S, Kumar SM, Kaur M, Subashani, Hegde P. Effect of physical and psychological status on oral health quality of life of geriatric patients undergoing complete denture treatment. J Indian Prosthodont Soc 2022;22:262-7

How to cite this URL:
Dhaded S, Kumar SM, Kaur M, Subashani, Hegde P. Effect of physical and psychological status on oral health quality of life of geriatric patients undergoing complete denture treatment. J Indian Prosthodont Soc [serial online] 2022 [cited 2022 Aug 12];22:262-7. Available from: https://www.j-ips.org/text.asp?2022/22/3/262/351275

  Introduction Top

Oral health as defined by Dolan is “a comfortable and functional dentition that allows individuals to continue their desired social role.[1] Edentulism impacts an individual's work capacity and concentration in their daily routine. Literature studies documenting demographic trends depict an increase in the number of elderly patients with a subsequent increase in the frequency of edentulousness.[2],[3] This extent of growth calls for meticulous oral care to be taken among the elderly to maintain optimal health and acceptable standard of life. The current era offers a multitude of treatment choices for the replacement of missing teeth. Despite this, complete denture therapy has remained the mainstay treatment for edentulism and is the preferred choice in many countries owing to its cost-effectiveness, esthetic appeal, and easy maintenance.” Often the success of a complete denture was based solely on the dentist's clinical judgment and evaluation of characteristics such as retention, stability, esthetics, and occlusion. However, these quantifications do not consider about patient's satisfaction or their perception about oral health-related quality of life (QoL).[4],[5],[6]

The ultimate goal of prosthetic treatment is to reinforce the patient's well-being. However, the criteria adopted in clinical practice do not consider the patient's requirement or attitude, which is the deciding drive for patient satisfaction or QoL.[7]

In recent years, QoL has evolved to be a conceptual patient outcome measure for health-care intervention. It includes multidimensional factors such as physical health, psychological state and well-being, social functioning, economic situation, relationships, and environment. It is a dynamic interaction of the individual with his/her social settings which shapes the individual. The concept is the interaction of different oral conditions, social and contextual factors, as well as the rest of the body.[8],[9]

Sociodemographic factors, psychological framework, and oral health-related QoL (OHRQoL) are significant factors linked with patients' satisfaction in determining denture adaptation and acceptance, consequently materializing into “success” or “failure of dentures. It hence becomes important for a dentist to understand the interplay of these factors. Literature correlating OHRQoL in denture wearers to psychological status or sociodemographic variables are limited in this part of the country.

A thorough understanding of these factors helps to evaluate patient satisfaction which is significant for denture acceptance. The existing data does not evaluate OHIP– EDENT, but mostly OHIP 14. Based on the knowledge obtained, oral health promotion and care programs can be planned to enhance general and oral health status.

Hence, the present study was conducted to test the hypothesis –“There is no effect of psychological factors or patient satisfaction on OHRQoL in edentulous patients undergoing denture treatment.” The objective of the study was to find the effect of psychological framework and patient satisfaction on OHRQoL as measured by the OHIP– EDENT questionnaire.

  Materials and Methods Top

A prospective cohort study was designed to evaluate OHRQoL among patients seeking complete dentures intervention based on physical and psychological status in a representative population of Belgaum, North Karnataka. Every subject was assessed two times; first at baseline which is immediately after consenting to be a part of the study and 6 months forming the second evaluation time.

Permission to conduct the study was obtained from the Institutional Ethical Committee of Jaipur Dental College. Informed consent of all participants was obtained. Patients requiring complete dentures aged 30 and above with good mental and physical health were included. Patients presenting with any systemic illness or any disease affecting their QoL and undergoing therapy for psychological conditions or having problems with communication were excluded. A single examiner conducted the study and assessed the psychological attitude of all patients, thus overcoming the element of variability.

Considering a 43% impact of complete dentures on OHRQoL as per the article of Nareudee Limpuangthip et al.,[10] the sample size was calculated to be as 284 based on the below formula, wherein n is the sample size, Z is the statistic corresponding to the level of confidence, P is expected prevalence, and d is precision.

A convenient consecutive sampling technique was employed till 284 samples were collected. This technique minimized volunteerism and other related selection biases by consecutively recruiting each accessible patient who met the eligibility criteria.

Sociodemographic information of age and gender were collected in a carefully designed pro forma. The psychological status of the patients was categorized employing the MM House classification into four kinds: philosophical, exacting, hysterical, and indifferent. OHRQOL was measured using the OHIP-EDENT[11] at the time of denture insertion and 6 months later. OHIP–EDENT utilizes a 19 variable questionnaire divided into seven domains, namely functional disability, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. It is specifically developed for edentulous subjects, addressing questions of masticatory capability, eating pleasure, comfort level, assurance while wearing prosthesis, and problems in relationships because of denture wearing. Questions regarding denture satisfaction (posttreatment) following the placement of the new complete dentures were recorded.

Data were analyzed using the Statistical Package for the Social Sciences version 23.0 (IBM; Chicago, Illinois, USA). One-way analysis of variance (test) was run to find the significant difference of OHRQoL with patient satisfaction and psychological classification. Paired t-test assessed differences between baseline and 6 months OHRQoL scores. P < 0.05 was considered to be statistically significant.

  Results Top

The present study was done on 284 denture wearers who were completely edentulous patients. [Table 1] shows the demographic data of the study population. A clear female predilection was noted with 70.6% of denture wearers being females. Of the 284 individuals examined, 58.8% were of the philosophical type, followed by exacting, hysterical, and indifferent.
Table 1: Demographic data of the study population

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[Table 2] demonstrates OHIP–EDENT scores against the psychological status of patients. In the physical pain domain, painful aching was found to be higher in the hysterical patients with a mean of 2.053 ± 0.000 and lowest in the philosophical patients with a mean of 0.160 ± 0.370 which was highly significant. The hysterical category of patients worried more with a mean of 4.046 ± 0.024 while philosophical patients worried lesser with a mean of 0.820 ± 0.690 which was statistically significant at P < 0.001. Exacting patients exhibited had a higher mean score of 2.5 29 ± 0.514, followed by hysterical, indifferent, and philosophical which was statistically significant at P < 0.001. Philosophical type of denture wearers had better scores for the functional domain variables of food catching and dentures not fixing as well at P < 0.0001. In the physical disability domain, the hysterical group of patients had higher scores for avoiding eating and unable to eat, while the indifferent class of denture wearers was interrupted during meal time. Social disability domain scores and handicap scores were lesser in the philosophical and exacting patients compared to the other two divisions. Overall, when OHRQoL was compared with the psychological status of patients, philosophical and exacting patients had better adaptation to dentures than the hysterical and indifferent class of denture wearers.
Table 2: Oral health-related quality of life with psychological status[23]

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[Table 3] shows OHIP–EDENT scored against patient satisfaction. Totally satisfied and very satisfied patients with dentures had lesser mean scores as against the other categories which was significant in all domains.
Table 3: Oral health-related quality of life with patient satisfaction

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When domain scores were compared between two evaluation periods, i.e., baseline and after 6 months, a significant difference was noted in functional limitation with mean scores decreasing from 3.084 ± 1.383 to 2.870 ± 2.613 at P < 0.001. Although the scores of physical pain did decrease, it was not significant. Psychological discomfort significantly improved at P = 0.038. Psychological disability and handicap did not demonstrate any remarkable change between 6 months. The social disability domain significantly improved with mean values reduced to 2.164 ± 2.219 at the end of 6 months from 3.613 ± 2.002 at the baseline as seen in [Table 4].
Table 4: Comparative analysis of baseline versus 6 months evaluation for each domain

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Overall, the adaptability of the study population to dentures was significantly better in domains of functional limitation, psychological discomfort, and social disability. Correlation analysis was assessed for the various variables against which OHRQoL was evaluated, as shown in [Table 5]. Psychological status and state of denture satisfaction were found to be significantly correlated with OHRQoL, suggesting a definite influence of these factors on oral health and its QoL.
Table 5: Correlation of oral health impact profile-EDENT with factors

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  Discussion Top

Various elements work together to ensure a patient's contentment while adopting a complete denture prosthesis. The ultimate concern for an operating dentist has been effective mastication, good aesthetics, comfortable speech, and patient wearing comfort. A psychological evaluation as related to satisfaction could be used to better comprehend patient–dentist relationships and treatment outcomes.[12] Self-reported assessments may be more significant than clinical measures, and they have been the most important determinants of happiness in this situation.[13]

The OHIP-EDENT employed in the current study is a validated questionnaire and is specific for edentulous patients. This version is used in several studies to verify the impact of oral rehabilitation on QoL parameters in patients requiring new complete dentures and to facilitate the comparison of data.[14]

A finding worth mentioning is that the dissatisfaction for lower dentures was higher when a new denture was delivered, probably due to problems of stability. However with time, this improved suggesting better adaptation of dentures overcoming functional restrictions. This is supported by the study of Forgie et al.[15]

OHRQOL was influenced by denture satisfaction. All domains of OHRQOL were found to have significant associations with denture satisfaction. These findings matched those of Yoshida et al.,[16] who found that patients who were happy with their prosthesis were indeed happy with their life quality. Although no effort was made in this study to quantify separately for maxillary and mandibular denture satisfaction, Berg[17] discovered that 1 year after implantation, patients still had increased pain from the mandibular denture.

OHRQoL was assessed as per patient satisfaction and psychological mindset. The present study showed a comparative evaluation of OHIP–EDENT before and after intervention, as shown in [Table 4]. A higher mean suggests a poorer QoL. The functional limitation score at baseline was 3.784 ± 1.383 which decreased to 2.870 ± 2.613, which was statistically significant at P < 0.001. Similarly, psychological discomfort also reduced from 3.934 ± 2.291 to 3.000 ± 1.371 in 6 months duration, statistically significant at P = 0.038. An improvement was also noted for the social disability score from 3.613 ± 2.002 to 2.164 ± 2.219 which was highly statistically significant. The domains of physical pain, psychological disability, and handicap on the other hand did not exhibit any significant changes. Overall, OHIP–EDENT score decreased from 20.253 ± 12.466 to 17.168 ± 14.143, which were statistically significant at P = 0.043. These findings are consistent with the study of Srdjan Dusan Postic et al.[18] wherein OHRQoL improved significantly from 35.367 to 32.709, significant at 0.027.

An evaluation of the mental attitude of the patients in the study of Julia et al.[20] revealed that the majority of the patients were of philosophical in attitude, with only a few exhibiting an aggressive attitude. No patient displayed a hysterical or indifferent attitude toward treatment. Our study also reported a greater segment of the patient in the philosophical category, consequently determining patient satisfaction. Literature shows a definite relationship of psychological factors affecting denture satisfaction. Al Quran et al.[21] observed a significant association of neuroticism with denture satisfaction in their study. Similar findings were noted in the study of Winkler.[20]

The current research is well designed to showcase the performance report of the best methodology, as per the principles of evidence-based practice. Yet certain considerations like behavioral and personality traits of patients cannot be standardized which in turn can destine denture acceptance. The subjective dilemma of the individual in reporting a disability or discomfort in eliciting OHRQoL also can be a possible limitation. The study design does not determine the causal relation of OHRQoL with either patient satisfaction or psychological categorization. Further studies employing larger multicentric options are needed to understand this relationship.

As rightly stated by Jamieson “Fitting the personality of the elderly patient is often more challenging than fitting the denture to the mouth.” It is critical for the dentist to recognise the patient's personality and mental attitude to facilitate treatment. The attitude of the dentist and effective communication are essential factors in the patient's attitude during treatment and acceptance of dentures.

  Conclusion Top

The present study reports a significant improvement in OHRQoL in complete dentures, 6 months after delivery when measured by OHIP–EDENT in all its domains. This finding is consistent with the findings of several other studies that examined the OHRQoL of completely edentulous patients before and after treatment. The patients' QoL was also found to be higher at 6 months than at baseline. This disparity in mean scores could be explained by the patients' continued adaptation to their new prostheses. It also upholds that patient satisfaction and the psychological status of the individual can influence OHRQoL.[23]

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Conflicts of interest

There are no conflicts of interest.

  References Top

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Hugoson A, Koch G, Gothberg C, Helkimo AN, Lundin SA, Norderyd O, et al. Oral health of individuals aged 3-80 years in Jonkoping, Sweden during 30 years (1973- 2003). II. Review of clinical and radiographic findings. Swed Dent J 2005;29:139-55.  Back to cited text no. 2
Marcus SE, Drury TF, Brown LJ, Zion GR. Tooth retention and tooth loss in the permanent dentition of adults: United States, 1988-1991. J Dent Res 1996;75 Spec No: 684-95.  Back to cited text no. 3
de Bruyn H, Collaert B, Lindén U, Björn AL. Patient's opinion and treatment outcome of fixed rehabilitation on Brånemark implants. A 3-year follow-up study in private dental practices. Clin Oral Implants Res 1997;8:265-71.  Back to cited text no. 4
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Limpuangthip N, Somkotra T, Arksornnukit M. Impacts of denture retention and stability on oral health-related quality of life, general health, and happiness in elderly Thais. Curr Gerontol Geriatr Res 2019;2019:3830267.  Back to cited text no. 10
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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