DENTURES AND QUALITY OF LIFE

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DENTURES AND QUALITY OF LIFE A LONGITUDINAL
ANALYSIS

• S.A. GRAY, M.R. INGLEHART D.
  SARMENTUniversity of Michigan, USA
• This study was supported by funds from the
• University of Michigan School of Dentistry
• Student Research Program.

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BACKGROUND

• Edentulism - Background Statistics
• 1983- 17 of US population is edentulous in at
  least one arch- 41 of the population 65 years
  or older are edentulousNHANES III 1988 to
  1994- 10.9 of white non Hispanic adults 35
  years and over

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Consequences of Edentulism

• masticatory problems - poorer diets -
  nutritional deficiencies - systemic disturbances
  speech difficulties psychological / social
  issues

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OBJECTIVE

• Does wearing dentures lead to low oral health
  related quality of life (ohrqol)?How?For whom?
  When? Consequences?

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HYPOTHESES

• HYPOTHESIS 1
• Patients with different levels of discomfort due
  to dentures differ in - functional
  considerations (chewing, speaking,
  swallowing), - psychological factors
  (appearance, self esteem), - social factors
  (smiling, interaction with peers), and
  - experienced pain.

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HYPOTHESES (contd)

• HYPOTHESIS 2
• A decline of ohrqol occurs in denture patients
  over time.HYPOTHESIS 3
• Ohrqol will correlate significantly with the
  patients - age, and - general health status.

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METHODS

• Respondents 120 former patients of
  undergraduate graduate clinics (response rate
  28)Gender 50 male 70 female patients
  Age 34 to 93 years (mean 66 years)Length of
  having dentures 5 months to nine years
  (mean 44 months).

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MATERIALS

• How do we measure discomfort?People use the
  following five words to describe pain /
  discomfort of increasing intensity. Which word
  describes the level of discomfort that you have
  during an average week due to your dentures?
• ?0 ?1 ?2 ?3 ?4 ?5no mild discomforting dis
  tressing horrible excruciatingdiscomfort

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How do we measure ohrqol?

• When you think about your dentures- On a scale
  from 1 no discomfort to 10 worst discomfort
  possible, how severe is this discomfort?- How
  effective are your dentures? 1 not at all to 5
  very - How much do you think having dentures
  interferes with your life? 1 not at all to 5
  very
• How much do you agree / disagree? 1 strongly
  disagree to 5strongly agre My
  dentures limit the kinds or amounts of food I
  eat. My dentures cause discomfort.
  My dentures cause a lot of worry and
  concern. My dentures keep me from socializing
  / going out. My dentures make me
  uncomfortable when eating in front of others.
  My dentures make me
  uncomfortable when speaking in front of others.
  My dentures make me nervous.
  My dentures make me concerned about
  the way I look. My dentures
  keep me from enjoying life. My
  dentures interfere with my daily activities.
  My dentures interfere with my
  intimate relationship. My dentures have a
  bad effect on taste and food.
  My dentures reduce my general happiness with
  life. My dentures affect my life in all of
  its aspects. If you would spend
  the rest of your life with your dentures as they
  are right now, how would you feel about it?1
  terrible to 5delighted

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RESULTS
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Figure 1 Different levels of discomfort
50
25
34
25
20
20
0

• No
• Discomfort

Mild Discomfort
Discomfort
Strong Discomfort
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HYPOTHESIS 1

• Patients with different discomfort levels due to
  dentures differ in ohrqol.

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• Table 1 Average answers to the ohrqol items in
  the four patient groups

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HYPOTHESIS 2

• A decline of ohrqol will occur
• in denture patients over time.
• NO!

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HYPOTHESIS 3

• Ohrqol will correlate significantly with the
  patients
• Age
• NO!

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Table 2 Correlations between ohrqol and general
health indicators
Sick in last 6 months
Satisfied with health
Health
Items
.32
-.42
-.36
Interfere with life
n.s.
-.27
-.17
Limit foods
.25
-.29
-.19
Cause discomfort
.23
-.24
-.17
Worry
.23
-.31
-.23
Keep from socializing
.27
-.38
-.22
Eating in front of others
n.s.
.27
-.38
Speak in front of others
.20
-.23
-.17
Nervous
.24
-.29
n.s.
Concerned about looks
n.s.
-.28
-.20
Not enjoying life
n.s.
-.31
n.s.
Interfere with daily life
n.s.
-.22
n.s.
Interfere with intimate relationship
.23
-.30
-.187
Bad effect on taste
n.s.
-.23
n.s.
Reduce happiness
n.s.
-.24
n.s.
Interfere with life
-.32
.42
.32
Rest of your life with
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DISCUSSION

• Ohrqol relatively new conceptIt focuses
  providers on ultimate outcome
• of care!With dentures - 2/3 of patients
  report discomfort - discomfort correlated with
  health!WHY?

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CONCLUSION

• Providing the best possible care for edentulous
  patients will have an extraordinary impact on
  these patients' quality of life.OHRQOL
  crucial outcome!
• Understand - how we can assess ohrqol,- how we
  can predict ohrqol,
• (example orthognathic surgery)- which other
  factors affect ohrqol (depression?)- and how we
  can use ohrqol in treatment.