Structural equation modeling of the impact of mandibular ridge form and denture quality on oral health-related quality of life in complete denture wearers

PurposeTo examine the effect of mandibular ridge form and denture quality on oral health-related quality of life (OHRQoL) in complete denture wearers by using structural equation modeling (SEM) analysis of data before and after new complete denture insertion.MethodsFour hundred thirty-two edentulous patients who visited the Dental Hospital of Tokyo Medical and Dental University for new complete dentures were recruited. An intervention study design was conducted, including complete denture fabrication with SEM analysis. Mandibular ridge form, mandibular denture stability, accuracy of jaw relation record, and the Oral Health Impact Profile for edentulous subjects (OHIP-EDENT-J) total score before and after new complete denture insertion were used in the hypothesized model.ResultsTwo hundred and thirty-seven participants completed the research. SEM analysis demonstrated adequate model fit. Path coefficients of mandibular ridge form to OHIP-EDENT-J before and after insertion, and mandibular denture stability to OHIP-EDENT-J before insertion, were significant.ConclusionsThis study demonstrated that mandibular denture stability and mandibular ridge form are important to ensure successful complete denture therapy.     

Masticatory ability, denture quality, and oral conditions in edentulous subjects.

This study investigated the relationships between the ability of 38 patients with complete dentures to comminute a tough artificial test food and their answers to questions about the chewing experience. Also, clinical assessments were made of denture quality and oral conditions. Significant but weak relationships were found between the ability to comminute the test food and the subjective chewing experience as well as the degree of resorption of the mandibular residual ridge. Masticatory ability is conceivably determined by many other factors as well. Results indicate that dentists cannot rely on asking denture wearers about chewing problems and clinical responses with respect to oral conditions and denture quality for predicting those patients' masticatory abilities. The ability of wearers of complete dentures to comminute tough foods should be determined individually by a series of chewing tests.     

Correlation between patient satisfaction with complete dentures and denture quality,oral condition,and flow rate of submandibular/sublingual salivary glands

PURPOSE: The purpose of this study was to examine the correlation between patient satisfaction with complete dentures and parameters of denture quality, oral condition, and flow rate of the submandibular and sublingual salivary glands. MATERIALS AND METHODS: The parameters were evaluated on 50 denture wearers using semiquantitative scales and a recently described submandibular/sublingual saliva collector. RESULTS: Most patients had a medication-induced reduced salivary flow rate (mean 0.024 mL/min/gland; SD 0.040). Submandibular/sublingual salivary flow rate correlated statistically with six denture satisfaction parameters: maxillary denture retention and comfort, mandibular denture retention and comfort, abilities of chewing, and speech. Residual alveolar ridge resilience, maxillary ridge shape, and denture quality did not significantly correlate with denture satisfaction. Characteristics of musculature correlated significantly only with subjective maxillary denture retention, and mandibular ridge shape correlated with comfort. CONCLUSION: Submandibular/sublingual salivary flow rate is an important factor in denture satisfaction. The retention of the maxillary denture was correlated to the oral musculature characteristics, and the mandibular denture comfort was correlated to the mandibular ridge shape. Denture satisfaction was not affected by other anatomic or denture quality-related parameters.     

The impact of dietary advice on edentulous adults' denture satisfaction and oral health‐related quality of life 6 months after intervention

Objective: The aim of this study was to compare the impact of customised dietary advice on patients' satisfaction with their dentures and oral health‐related quality of life (OHRQoL) in patients wearing implant‐supported mandibular overdentures (IOD) or conventional dentures (CD). Materials and methods: In this prospective cohort study, 28 IOD (two implant‐retained mandibular overdenture) and 26 CD patients completed a denture satisfaction scale and the 20‐item oral health impact profile (OHIP‐20) before and 6 months following provision of customised dietary advice. Results: At 6 months following provision of individualised dietary advice, the IOD group showed significantly greater satisfaction than the conventional group for denture comfort (80.6, ± 15.6, vs. 68.7 ± 15.6 P=0.001), stability (75.8 ± 15.9 vs. 59.5 ± 30.4, P=0.002), and perceived chewing ability (79 ± 30.4 vs. 59.5 ± 30.4, P=0.027) ± when adjusted for baseline scores. Before delivery of the dietary advice there were no significant differences between groups for Satisfaction or OHIP scores. No difference in OHRQoL was seen between groups. Conclusions: The delivery of customised dietary advice to edentulous patients impacts differently on their satisfaction with denture comfort, stability and chewing ability depending on the nature of their prosthesis. This re‐evaluation of satisfaction occurs when edentulous patients challenge themselves to consume more fruits, vegetables and fibre‐rich foods. The IOD group reported an increased level of satisfaction and perceived chewing ability whereas it appeared that CD wearers may have had their awareness of the shortcomings of this sort of prosthesis reawakened. To cite this article:
Ellis JS, Elfeky AF, Moynihan PJ, Seal C, Hyland RM, Thomason M. The impact of dietary advice on edentulous adults' denture satisfaction and oral health‐related quality of life 6 months after intervention.
Clin. Oral Impl. Res. 21 , 2010; 386–391.
doi: 10.1111/j.1600‐0501.2009.01859.x     

Association between self‐assessment of complete dentures and oral health‐related quality of life

The purpose of this study was to determine which factors related to patient self‐assessment of dentures are associated with changes in oral health‐related quality of life (OHRQoL) among edentulous patients after replacement of complete dentures, and to determine whether masticatory performance as determined using an objective method affects the changes in OHRQoL among edentulous patients. As a preliminary study, the existing questionnaire regarding self‐assessment of dentures consisting of 39 question items, measured with a 100‐mm visual analogue scale, was analysed by factor analysis. Then a questionnaire, composed of 22 question items, was developed containing six subscales of ‘function’, ‘lower denture’, ‘upper denture’, ‘expectation’, ‘aesthetic and speech’ and ‘importance’. Final participants in the present study comprised 93 edentulous patients requiring new conventional complete dentures (44 men, 49 women; mean age, 75·0 years). These patients were asked to complete the Japanese version of the Oral Health Impact Profile (OHIP)‐EDENT, comprising 19 question items for assessment of OHRQoL in edentulous patients, along with the developed questionnaire regarding self‐assessment of dentures. Moreover, masticatory performance was measured using a colour‐changeable chewing gum. The questionnaire and measurement were completed twice; before and after replacement of complete dentures. Stepwise multiple regression analysis identified ‘lower denture’ and ‘aesthetic and speech’ as significant independent variables besides OHIP‐EDENT scores before replacement. These results suggest that sufficient retention of lower dentures and appropriate appearance may lead to improved OHRQoL in edentulous patients.     

Effect of denture adhesives on oral moisture: A multicenter randomized controlled trial

PurposeThe purpose of this study was to investigate the effect of denture adhesives on oral moisture in a 10-center parallel randomized clinical trial.MethodsTwo hundred edentulous subjects wearing complete dentures were allocated into three groups: cream-type adhesive, powder-type adhesive and control groups. The adhesives (and saline solution in the control group) were applied to the mucosal surface of the dentures for 4 days, and baseline data and data after the intervention for eight meals over 4 days were obtained. For the main outcome, oral moisture was measured with a moisture checking device. Secondary outcomes were denture satisfaction, masticatory performance, denture retention, and occlusal force. In addition to between-group and within-group comparisons of oral moisture, investigations for secondary outcomes were undertaken in subgroups classified according to the degree of oral moisture at baseline (normal subgroup and dry mouth subgroup). Intention-to-treat analysis was also performed.ResultsBetween-group and within-group comparisons of oral moisture showed no significant differences. The cream-type and powder-type denture adhesives were significantly effective in the dry mouth group for denture satisfaction ratings of ability to masticate, stability, retention, and comfort of mandibular dentures (p < 0.05). The masticatory performance and retentive force of the dry mouth denture adhesive using groups were significantly improved after intervention (p < 0.05).ConclusionsThe oral moisture of complete denture wearers was not influenced by the use of denture adhesives. Our findings showed that denture adhesives improved subjective denture satisfaction, masticatory performance, and retention for complete denture patients with oral dryness.     

The relationship between various parameters of complete denture quality and patients’ satisfaction

BackgroundPatients’ appreciation of their conventional complete dentures might be affected by the quality of the dentures.MethodsA random sample of 33 edentulous patients who were rehabilitated by means of conventional complete dentures participated in the study. Three independent investigators who underwent technique calibration evaluated the dentures on the basis of seven clinical criteria by using a validated examination form. The patients filled out a validated denture satisfaction scale. The author used Pearson product-moment correlation and analysis of covariance to identify possible correlations.ResultsThe study results showed that most patients were between “reasonably satisfied” and “very satisfied” with their dentures. The author found nominally higher satisfaction among those receiving both mandibular and maxillary dentures and significant positive correlations between the overall denture satisfaction score and the stability of the mandibular denture (P = .039) and retention of the mandibular denture (P = .005). In contrast, esthetic lip support and lower lip line, occlusion, and maxillary stability and retention were not correlated with participants’ overall satisfaction level (P > .064).ConclusionsThe results of this study show that a clinically stable mandibular denture was the most important determinant of patients’ satisfaction.Practical ImplicationsThe study findings highlight the most important denture quality parameters that can aid clinicians in meeting their patients’ expectations.     

A comparison of patient's satisfaction between complete and partial removable denture wearers

OBJECTIVES: The aim of this study was to compare satisfaction between complete denture (CD) and Kennedy Class I removable partial denture (RPD) wearers. MATERIALS AND METHODS: A total of 156 CD and 112 RPD wearers took a part in this study. From the primary group of the examined patients, only those whose RPDs and CDs were assessed as excellent or very good by the dentist, took a part in this study. Patients graded satisfaction of their dentures by using an analogue scale from 1 to 5 (1=unsatisfactory; 5=excellent). RESULTS: Both CD and RPD wearers were mostly satisfied with their dentures (the distribution of the scores of the patients' assessments was skewed towards the highest scores; more than half of the patients scored all the examined variables to the best score category). Complete Denture wearers were significantly more satisfied with chewing, speech and retention of maxillary denture than RPD wearers (P<0.05). Removable partial denture wearers were significantly more satisfied with the retention and the comfort of wearing mandibular denture (P<0.05). There was no significant difference between CD and RPD wearers for general satisfaction with their dentures, aesthetics and comfort of wearing maxillary denture (P>0.05; N.S.). CONCLUSIONS: A majority of CD and RPD wearers were satisfied with the dentures. CD wearers were more satisfied with speech, chewing and retention of maxillary denture, while RPD wearers were more satisfied with the retention and the comfort of wearing mandibular denture. Different groups of denture wearers have to make significant, but different adjustments to wear their dentures successfully.     

Effect of a denture adhesive on mandibular denture dislodgment

The cineradiographic technique was used to assess the retention of complete mandibular dentures during chewing. The study comprised ten complete-denture wearers with severe alveolar ridge resorption in the mandible. Two cineradiographic recordings were performed, with and without a denture adhesive spread onto the base of the mandibular denture. The analysis of the cineradiographic films disclosed a significant decrease in denture dislodgment, expressed as maximal value, when a denture adhesive was used. The mean dislodgment also decreased, but not significantly.     

Demographic factors, denture status and oral health-related quality of life

OBJECTIVES: This study investigated the association between denture status, demographic factors, and oral health-related quality of life (OHRQoL). METHODS: OHRQoL was measured using the German version of the Oral Health Impact Profile (OHIP-G, 53 items), which was administered in a personal interview to 2050 subjects (60% of eligible subjects responded) 16-79 years of age in a national survey. Median regression was used to analyze the influence of denture status (no, removable, complete dentures), age, gender, education (less than 10 years of schooling, 10-12 years, more than 12 years), and residential area (rural, urban) on the OHIP-G summary score. RESULTS: In bivariable analyses, compared to the base category, the OHIP-G median increased 8.0 U for subjects with removable dentures, 20.0 U for subjects with complete dentures, 1.7 U for each 10-year age period, 2.0 U for men, 3.0 U for less than 10 years of schooling (compared to > or =10 years.), and 1.0 U for urban areas (P < 0.05 for all effects except for residential area). In the multivariable analysis, compared to subjects without dentures, subjects with removable dentures had a 7.5 (95% CI: 5.2-9.8) higher OHIP-G median and subjects with complete dentures had a 18.5 (95% CI: 14.7-22.4) higher median when demographic variables were controlled. No demographic variables were statistically significant except for residential area (P = 0.04). CONCLUSIONS: Denture status was a stronger predictor for impaired OHRQoL than demographic variables and rendered age and education almost negligible in their influence on OHRQoL.     

A randomised trial of a simplified method for complete denture fabrication: patient perception and quality

Complete denture fabrication involves a series of complex technical procedures. Nevertheless, simplified methods may be as effective as conventional ones albeit the lesser use of time and resources, without disadvantage for the patient. This study compared a simplified method for complete denture fabrication to a conventional protocol in terms of oral health‐related quality of life (OHRQoL), patient satisfaction and denture quality. Forty‐two edentulous patients requesting treatment with complete dentures were randomly allocated into two study groups. Group S received dentures fabricated by a simplified method and Group C received conventionally fabricated dentures. Before interventions and after three and 6 months following insertion, OHRQoL and patient satisfaction were analysed by specific instruments. A prosthodontist assessed denture quality 3 months after delivery. Groups presented no difference for OHRQoL, denture quality and general satisfaction. Differences regarding patient satisfaction with some aspects of the dentures were found after 3 months (S > C), but were insignificant at 6 months. It was concluded that the simplified method is able to produce dentures of a quality comparable to those produced by the conventional method, influencing OHRQoL and patient satisfaction similarly.     

Residual ridge resorption, lower denture stability and subjective complaints among edentulous individuals

Residual ridge resorption in the mandible after tooth loss may lead to worsening of complete denture stability and to various subjective complaints. The aim was to evaluate the association between radiologically assessed residual ridge resorption in the mandible, clinically assessed stability of lower complete denture and subjective complaints among elderly denture wearers. The study population consisted of 326 (115 men and 211 women) edentulous subjects aged 60-78years, all of whom were wearing complete dentures in the mandible. Data on subjective complaints were obtained from questionnaires and interviews. Denture stability was assessed clinically. Residual ridge resorption was analysed from panoramic radiographs. The results showed that women were significantly more often satisfied with their lower dentures and reported fewer problems with eating than men. They also had significantly more often residual ridge resorption than men. Among women, residual ridge resorption was significantly associated with poor chewing ability, low satisfaction with dentures and poor denture stability. Among men, residual ridge resorption did not associate with subjective complaints or denture stability. Poor satisfaction with dentures associated significantly with poor denture stability in both genders. In conclusion, these results highlight the importance of denture maintenance treatment. As the extent of residual ridge resorption in the mandible was the most important factor that increased dissatisfaction with lower complete dentures, it is also important to inhibit the progression of resorption by preventing tooth loss or by using implant-retained dentures.     

种植覆盖义齿修复牙列缺失的生活质量研究

目的研究下颌牙列缺失患者采用全口义齿（CD）和种植覆盖义齿（IOD）修复后的患者满意度以及口腔健康相关生活质量（OHRQoL）,探讨种植覆盖全口义齿修复对老年下颌牙缺失患者的心理及社会行为是否存在积极的影响。 方法收集2016至2018年在中山大学附属口腔医院门诊就诊,50 ~ 80岁下颌牙列缺失,曾采用传统全口义齿修复且因义齿稳定性差而自愿行种植覆盖全口义齿修复的受试者19例,其中男8例,平均69.25岁;女11例,平均72.45岁。通过自身对照研究,每位受试者均先后佩戴在相同标准下制作的新传统全口义齿（CD）以及种植覆盖义齿（IOD）,并于戴用义齿3个月后完成口腔健康影响程度量表（OHIP-20）、老年口腔健康评价指数量表（GOHAI）和日常生活牙科影响量表（DIDL）调查,分析传统全口义齿和种植覆盖全口义齿修复对患者心理状态和生活质量的影响。数据采用Wilcoxon符号秩检验进行统计分析,P<0.05为差异有统计学意义,并计算CD组和IOD组OHRQoL得分的效应量（ES值）以评价其影响程度。 结果OHIP-20、GOHAI、DIDL量表均显示,IOD组在量表的功能限制、疼痛、心理不适、生理能力受限、心理能力受限、社交能力丧失、身心缺陷、美观、口腔舒适的各领域得分及总体得分上均明显优于CD组,差异具有统计学意义（P<0.05）。此外,根据DIDL量表评价标准得知,IOD修复可有效提提升患者满意度,并减少不满意人数的比例。3个量表在各领域及总得分的ES值均大于0.8,代表每个领域均受到高度影响,并以咀嚼能力（ES = 3.74）、生理能力受限（ES = 3.12）和功能限制（ES = 2.94）等生理功能改善最为显著。说明,IOD组比CD组对患者的生活质量改善较好,且对各方面的改善程度较高。 结论OHIP-20、GOHAI、DIDL量表调查结果反映种植覆盖全口义齿修复对老年下颌牙缺失患者的心理及社会行为有积极的影响。     

A structural equation model relating objective and subjective masticatory function and oral health‐related quality of life in patients with removable partial dentures

Summary The aim of this study was to investigate the relationships between objective masticatory function with respect to masticatory performance and food mixing ability, patients’ perception of chewing ability and oral health‐related quality of life (OHRQoL). Partially dentate patients with removable partial dentures (n = 131, mean age 67·1 year) participated in the study. Four tests were performed to evaluate objective and subjective masticatory function and OHRQoL. Masticatory performance and food mixing ability were assessed using peanuts or a two‐coloured wax cube as test items. Patients’ perception of chewing ability was rated using a food intake questionnaire. OHRQoL was measured using the Japanese version of the oral health impact profile. A structural equation model was constructed based on hypothesis in which objective masticatory function would be related to OHRQoL via perceived chewing ability as a mediator. Structural equation modelling analysis found a statistically significant medium effect of perceived chewing ability on OHRQoL and statistically significant medium or small effects of masticatory performance on perceived chewing ability and OHRQoL (P < 0·05); however, the effect of food mixing ability on perceived chewing ability or OHRQoL was not statistically significant (P > 0·05). A fit index indicated that the model fitted well to the data (Goodness‐of‐fit index = 0·99). These results suggest that perceived chewing ability is a critical factor for OHRQoL and that masticatory performance rather than food mixing ability is important for perceived chewing ability and OHRQoL in patients with removable partial dentures.     

义齿黏附剂和口腔湿润剂联合使用提高口干症患者全口义齿满意度的临床评价

目的：探讨义齿黏附剂和口腔湿润剂联合使用对牙槽嵴低平的口干症患者配戴全口义齿效果的影响。方法：选择10例牙槽嵴低平的无牙颌口干症患者,于义齿黏附剂使用前和使用后1个月及义齿黏附剂和口腔湿润剂联合使用后1个月、3个月及6个月对患者进行义齿满意度问卷调查, 采用SPSS17.0软件包对数据进行统计学分析。结果：义齿黏附剂与口腔湿润剂联合应用于全口义齿后6个月和使用口腔湿润剂前比较, 临床使用效果满意, 在总体满意度、咀嚼功能、舒适度以及下颌全口义齿固位效果等4个方面均显著提高)P<0.05) ; 而单独使用义齿黏附剂1个月后,患者配戴全口义齿的舒适度显著下降(P<0.05)。结论：对伴有口干症的牙槽嵴低平的无牙颌患者,联合应用义齿黏附剂和口腔湿润剂,可提高配戴全口义齿的满意度。     

Measuring patient-based outcomes: Is treatment satisfaction associated with oral health-related quality of life?

Objectives

To evaluate the level of association between patients’ denture satisfaction and oral health-related quality of life (OHRQoL) in edentate patients, and to identify the determinants of satisfaction that best predict OHRQoL. The effects of time and treatment type were also assessed.

Methods

Data from 255 edentate elders who participated in a randomised clinical trial were used. OHRQoL ratings were gathered using the Oral Health Impact Profile (OHIP-20) questionnaire. The McGill Denture Satisfaction Instrument was used to assess satisfaction with treatment (mandibular conventional denture or implant overdenture). Outcomes were measured prior to treatment, then 6 and 12 months after delivery of the new prostheses. Simple linear and multiple linear regression analyses were performed to statistically analyse the relationship.

Results

When the combined effect of all factors was assessed, only two variables of denture satisfaction ratings were significantly associated with OHRQoL: chewing ability (P = .005) and oral condition (P = .002). These two variables explained 46.4% of the variance in the OHIP change scores. This association varied with time, but the variables of importance remained the same. Type of treatment, gender, age and other socio-demographic variables were not significantly associated with improvement in OHRQoL once their effects were combined with denture satisfaction ratings.

Conclusions

Within the limitations of this study, a highly positive association exists between oral health-related quality of life and denture satisfaction. Chewing ability and oral condition are the determinants of denture satisfaction best associated with OHRQoL, predicting 46.4% of its improvement following a treatment.     

Correlations between self-ratings of denture function and oral health-related quality of life in different age groups

This study aimed to assess the correlation between self-rated denture function and oral health-related quality of life (OHRQoL) in different age groups. Subjects' OHRQoL was measured using the Oral Health Impact Profile, and self-ratings of denture function were assessed on a Likert-type scale for patients with fixed and removable partial dentures in 3 age groups (N = 253). For subjects with fixed partial dentures, all correlations were significant for the younger patients but not for higher age groups, whereas the opposite was true for subjects with removable partial dentures. The importance of self-perception of denture function in OHRQoL is different in various groups of patients, depending on age and dental status.     

Implant anchored complete mandibular denture: evaluation of masticatory efficiency, oral function and degree of satisfaction

Masticatory efficiency, oral function and degree of satisfaction with the treatment received were analysed in a group of fully edentulous patients with severe atrophy of the mandibular bone, rehabilitated with complete removable dentures, before and after anchoring the dentures to osseointegrated implants. Masticatory efficiency increased significantly and chewing cycles increased in amplitude after anchoring the denture. The component of the chewing cycle that most influenced the increase in functional area was the lateral one. A correlation was found between the increase in the lateral component of the chewing cycle and the increased masticatory efficiency achieved with implant‐anchored dentures. The degree of satisfaction with their rehabilitation reported by the subjects was correlated neither to increased masticatory efficiency nor to improved oral function.