Oral health impacts among adults in Finland: competing effects of age, number of teeth, and removable dentures

The aims of the present study were to evaluate the prevalence and severity of oral health impacts among adults and to analyse the effects of age, gender, level of education, number of teeth, and removable denture wearing on these impacts. Nationally representative data ( n  = 5,987) on Finnish adults aged 30+ yr were gathered in an interview, in a clinical examination, and by a questionnaire including the 14-item Oral Health Impact Profile. Subject age and the number of teeth were significantly associated with oral impacts (occurring fairly or very often) when the effects of gender, educational level, and removable dentures were considered. When subjects ≥ 75 yr of age were used as the reference group, the odds ratios (95% confidence interval) were 0.5 (0.3–0.8) and 0.7 (0.5–0.9) for 30–34-yr-old and 34–74-yr-old subjects, respectively. The odds ratios for those with 1–9 teeth and for those who were edentate were 3.4 (2.4–4.9) and 4.0 (2.6–6.3), respectively (20+ teeth as reference). Number of teeth modified the effect of denture wearing, and age modified the effect of educational level on oral impacts. Impaired subjective oral health related to many missing teeth might be improved by wearing removable dentures. Population groups needing special attention are young people with low education and those for whom only a few missing teeth are replaced with removable dentures.     

Treating Class II Patients with Removable Plates and Functional Orthopedic Appliances

OBJECTIVE: To determine the influence of physiological growth pattern and anterior tooth inclination on the outcome in Class II patients treated with removable orthodontic plates and functional orthodontic appliances. PATIENTS AND METHODS: After recruiting 50 patients with an upper anterior proclination of 1-SN >or= 107 degrees for this retrospective study, another 50 patients with a retroclination of 1-SN 相似文献   

A randomized controlled trial of self-perceived pain,discomfort, and impairment of jaw function in children undergoing orthodontic treatment with fixed or removable appliances

Objective:To compare patients’ perceptions of fixed and removable appliance therapy for correction of anterior crossbite in the mixed dentition, with special reference to perceived pain, discomfort, and impairment of jaw function.Material and Methods:Sixty-two patients with anterior crossbite and functional shift were recruited consecutively and randomized for treatment with fixed appliances (brackets and archwires) or removable appliances (acrylic plates and protruding springs). A questionnaire, previously found to be valid and reliable, was used for evaluation at the following time points: before appliance insertion, on the evening of the day of insertion, every day/evening for 7 days after insertion, and at the first and second scheduled appointments (after 4 and 8 weeks, respectively).Results:Pain and discomfort intensity were higher for the first 3 days for the fixed appliance. Pain and discomfort scores overall peaked on day 2. Adverse effects on school and leisure activities were reported more frequently in the removable than in the fixed appliance group. The fixed appliance group reported more difficulty eating different kinds of hard and soft food, while the removable appliance group experienced more speech difficulties. No significant intergroup difference was found for self-estimated disturbance of appearance between the appliances.Conclusions:The general levels of pain and discomfort were low to moderate in both groups. There were some statistically significant differences between the groups, but these were only minor and with minor clinical relevance. As both appliances were generally well accepted by the patients, either fixed or removable appliance therapy can be recommended.     

老年人可摘局部义齿修复对基牙的影响

目的:分析研究老年人可摘局部义齿修复后对基牙的影响,探讨其原因及预防措施。方法:对95例牙列缺失后的老年人行冷弯卡环固位式可摘局部义齿修复,记录和比较戴可摘局部义齿后基牙和非基牙的龋坏率和缺失率,用χ2检验分析其结果有无差异,并对影响基牙的原因进行分析。结果:戴用可摘局部义齿5a后,基牙的患龋率(17.38%)显著高于非基牙(7.10%);因牙折、牙周病松动及龋坏无法保留而拔除的基牙缺失率(27.01%)也显著高于非基牙(7.79%)(P<0.01)。结论:冷弯卡环固位可摘局部义齿修复后在一定程度上可增加老年人基牙的患龋率和缺失率。     

Partial edentulism, prosthetic treatment and oral function in a Dutch population

The aim of this study was to gain a better insight into the location and frequency of prosthetic replacements and the consequences of tooth loss on oral function. The sample, stratified according to socio-economic class and age, consisted of 750 subjects. The investigation was done by questionnaire and clinical examination. In the lower social levels the percentage of removable prostheses was lower than in the higher levels. An average of 60% of all open tooth spaces were not prosthetically restored. In the lower jaw 1 to 3 free-end spaces were completed with removable partial dentures (RPD). The present study did not support a relationship between missing teeth or number of contacting pairs and the functioning of the dentition. The distribution of antagonistic contacts in the dental arch seems to be of more importance.     

Maxillary and mandibular overlay removable partial dentures for the treatment of posterior open-occlusal relationship: a clinical report

This clinical report describes the use of maxillary and mandibular overlay removable partial dentures to treat a patient with class III skeletal malocclusion and a posterior open-occlusal relationship. Overlay removable partial denture therapy was used as an alternative to other options such as orthodontics and combined orthodontic/oral surgery procedures; it satisfied the esthetic and functional requirements of the patient and provided a stable occlusion. Overlay removable partial dentures are a reversible and relatively inexpensive treatment for patients with congenital or acquired anomalies, but the potential disadvantages of these prostheses include compromised esthetics when the dentures are removed; caries and periodontal disease as a result of poor oral hygiene; and veneer material fracture, debonding, discoloration, and wear.     

Veterans Administration Cooperative Dental Implant Study--comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures. Part IV: Comparisons of patient satisfaction between two treatment modalities.

This study compares treatment assessments made by two groups of patients with Kennedy class I or class II mandibular edentulous conditions, who received either a removable partial denture (RPD) (N = 115) or one or two fixed partial dentures (FPDs), each supported distally by a blade implant (N = 113). Two questionnaires were administered, one at 16 weeks after the implant or RPD insertion and at the 6-month interval and the other at 18, 36, and 60 months. Marked functional improvements were perceived by a large majority of patients in both groups after the insertion of prosthesis. At 6 months, a higher percent of patients with RPDs than those with FPDs found it easy to clean their RPDs and experienced chewing discomfort, restriction of food choices, feeling of insecurity with their RPDs, and difficulty with their pronunciation. The exclusion of assessments by 25 RPD patients, whose treatment was judged to be a failure functionally, made the mean differences between the two treatments statistically significant (p less than 0.05) only for ease of cleaning in favor of the RPD and fewer restrictions of food choices in favor of the FPD group. At 60 months, significant differences between the percents of patients with the most favorable responses occurred for perceptions of eating enjoyment, food particles seldom getting under the removable partial denture, and improvement in social life in favor of the FPD treatment and for the ease of cleaning the removable partial denture in favor of the RPD treatment. The results seem to support superiority of the FPD in terms of patient satisfaction, but not enough to favor this type of prosthesis over the RPD without consideration of other pertinent factors.     

Functional and social discomfort during orthodontic treatment--effects on compliance and prediction of patients' adaptation by personality variables

During the course of treatment orthodontic patients frequently endure a number of functional complaints and are anxious about their appearance. The aims of this longitudinal study were to follow the progress of patients' adaptation to discomfort, to elucidate the putative relationship between the type of appliance worn and functional and social discomfort experienced, to study potential predictability by their attitude to treatment and to evaluate the effects of discomfort as predictors of patients' compliance. Eighty-four patients undergoing either removable, functional, or fixed appliance treatment monitored their complaints during the first 7 days of treatment and rated them retrospectively 14 days, and 3 and 6 months after appliance insertion. The most frequent complaints were impaired speech, impaired swallowing, feeling of oral constraint and lack of confidence in public. A significant reduction in the number of complaints was observed between 2 and 7 days after insertion of the appliance. No further differences were revealed after longer periods of appliance wear. The type of appliance had an effect on impaired speech and swallowing. Patients' expectations of favourable treatment performance and appreciation of dental aesthetics were predictive of reported feeling of oral constraint and lack of confidence in public. There was a relationship between the complaints and acceptance of the appliance, as well as between lack of confidence in public and compliance with treatment. The results of this study highlight the importance of patients' attitudes to treatment and of functional and social discomfort associated with appliance wear for the theory and practice of the management of orthodontic patients, and the necessity for early intervention by clinicians.     

Prosthetic rehabilitation of a bone defect with a teeth-implant supported, removable partial denture

The use of teeth-implant, mucosa-supported removable dentures for rehabilitation of partially edentulous patients involves highly complex biomechanical aspects. This type of prosthesis associates 3 kinds of support that react differently to the functional and parafunctional forces developed in the oral cavity. Although the construction of removable partial dentures may seem paradoxical when osseointegrated implants are placed, in some cases, this option is an excellent alternative to solve difficulties related to the anatomic, biologic, psychomotor, and financial conditions of the patient. This article reports on a case in which a teeth-implant, mucosa-supported removable partial denture was the option of choice for a patient with financial and anatomic limitations, having a large structural loss of the residual alveolar ridge caused by trauma by a gunshot injury at the mandible. The 5-year follow-up did not reveal any type of biomechanical or functional problem.     

Retention and Stability – Taking Various Treatment Parameters into Account

PATIENTS AND METHOD: In order to assess stability after orthodontic treatment, 132 patients who had been treated by one orthodontist in private practice were examined 6 years on average after completion of their treatment. Therapeutically induced movements and post-therapeutic changes were measured using dental casts, and the number of cases which had relapsed was calculated as a percentage of the individual measurements. The extent of post-therapeutic changes in patients with and without long-term retention was analyzed together with possible correlations with retention time and retainer type. Furthermore, the influence of gender, Angle classification, treatment-induced changes, initiation, type and duration of therapy, and extraction of premolars on the development of relapse was also investigated. RESULTS AND CONCLUSIONS: Some degree of relapse was recorded in 13% of the measurements on average, even in patients with some form of long-term retention. However, it may be possible to reduce the relapse rate by taking account of the following criteria: Retention time should be increased in cases of short-term therapy, since relapse was found to occur more often on average (19%) when the treatment time was less than 3 years than when it was longer than 4 years (13%). As the highest relapse rate registered was 24% when therapy was started between the ages of 9 and 12 years, but was up to 42% in younger and older patients, there should be more extensive retention in these latter cases. Where there is a risk of relapse in the anterior arch, fixed lingual retainers should be given preference over removable ones. This is especially applicable to male patients and to non-extraction patients, as relapses in the anterior segment occurred more often or were more marked in these cases. The use of removable retainers is necessary when the transverse stability of the buccal segment is at risk. When only fixed retainers were used in the anterior area, relapses were recorded 6-31% more frequently in the interpremolar distance in the maxilla (21%) and the mandible (35%), and in the lower intermolar distance (27%). In particular, the use of a removable mandibular retainer should not be dispensed with after bicuspid extractions, transverse expansion and, in female patients, in the lower jaw, as relapse in the buccal segment was more marked or more common in such cases. On the basis of our clinical findings and of earlier studies, the retention time should be at least 2 years. The retainer type used has been found to be just as important as the retention time. If optimum relapse prevention is aimed at, fixed maxillary and mandibular retainers in the anterior region should be combined with a removable retainer and worn until the patients reach their late twenties.     

Dental implants: a survey of patients' attitudes

This study measured the psychologic attitudes of patients to implant prostheses and compared their status before and after therapy. Questionnaires were mailed to 95 patients with implants placed and restored at a university dental school. The implants had been in position for an average of 2.2 years. The patients had previously worn removable complete or partial dentures. Different questions addressed eating, speaking, relationships, employment, social life, esthetics, maintenance, and overall dental health. Sixty-one questionnaires were returned (64%). Satisfaction with the implant prosthesis was significantly greater than for the denture (p less than 0.0001). Responses to individual questions indicated that confidence was improved (88%), implants were worth the trouble (97%), the procedure would be worth repeating (89%), and overall dental health was improved (98%). This survey suggests that patients' attitudes toward their dental health improve significantly after treatment with implant prostheses.     

Oral lichen planus among 4277 patients from Gizan, Saudi Arabia

This paper reports on the prevalence of oral lichen planus among 4277 Saudi patients, aged 18-73 yr, seen in the dental department of King Fahd Central Hospital, Gizan, Saudi Arabia, between 1982 and 1987, 63% of the patients were males. Oral mucosal lesions consistent with lichen planus were identified both clinically and histologically in 72 patients (40 males and 32 females). The average age of the affected group was 49 yr. No correlation was evident between lichen planus and tobacco habits in this study, nor was there any association with diabetes or hypertension. The average period of follow-up was 3.2 yr, during which four cases developed malignant transformation of the oral lesions. The prevalence of oral lichen planus in this study was 1.7%, which is higher than the prevalence figures reported earlier for the population of Saudi Arabia.     

ASSESSMENT OF THE PREVALENCE INDEX ON SIGNS OF COMBINATION SYNDROME IN PATIENTS TREATED AT BAURU SCHOOL OF DENTISTRY,UNIVERSITY OF SAO PAULO

A group of destructive changes occurring in jaws in patients with maxillary complete dentures and mandibular removable partial dentures (bilaterally) has been described in the literature as the combination syndrome. However, this condition is not clinically observed in all patients. The aim of this study was to establish the prevalence index on signs of combination syndrome and to verify whether these changes also occurred in patients rehabilitated with a mandibular removable partial denture (unilaterally). Sample was composed of 44 patients, completely edentulous in the maxilla. Thirty-two patients had a Kennedy Class I removable partial denture and 12 a Kennedy Class II. Three major alterations were observed in 20.5% of the studied population. Nevertheless, these changes were present only in 25% of patients with Kennedy Class I removable partial denture. Based on the findings of this study, it can be concluded that patients with Kennedy Class II removable partial denture do not have similar signs that lead to the combination syndrome’s condition.     

Social equality and dental conditions--a study of an adult population in Southern Sweden

This study aimed to: describe dental conditions--focusing on prosthodontic variables--in relation to social conditions in the late 1990s in an adult population of Southern Sweden, evaluate if a change could be traced in the pattern of socioeconomic influences on dental conditions, and study if various attitudes toward dental care were associated with social as well as dental conditions. The study was based on questionnaire responses. Significant differences in dental conditions and denture prevalence were found for age and education. To a majority of the sample it was very important to have own teeth and/or fixed restorations and the opportunity to attend regular dental care. The cost for dental care was very important for 52% of the sample especially for men, those with low education, and those wearing removable denture. Need for dental care that could not be provided for because of the costs was experienced by 9%. Eighteen percent stated that they once or more had refrained from dental care because of the cost. Those with removable dentures and low education dominated. Besides socioeconomic differences in dental conditions, there were sociodental differences in attitudes concerning the importance of costs, self-estimated needs, and cost-barriers for dental care.     

Social and functional impact of reduced posterior dental units in older adults

The number of teeth needed to maintain adequate dental function in older adults is unknown. The purpose of this study was to examine the relationship between oral function and the number of opposing pairs of posterior teeth. We identified 338 subjects with complete anterior dentitions from an interview and examination survey of Ontario adults aged 50 and over; 261 had no partial denture and 77 had removable partial dentures (RPD). Oral function was measured using questions assessing chewing ability, mandibular function and socio-psychological impact.
Subjects with no partial dentures were further allocated to five groups, based on their dental status: complete dental arch ( n = 69); 5–7 functional units-pairs of opposing posterior teeth ( n = 109); 3 or 4 functional units ( n = 48) and 0–2 functional units ( n = 35). Oral function problems increased with decreasing functional units being markedly more prevalent among the groups with 0–2 functional units. 34% of subjects in the 0–2 group reported one or more problems with chewing ability compared to 6–17% in the other groups (χ² P = 0.001 d.f. = 3).
The 77 subjects who wore removable partial dentures, reported social and dental function at levels comparable to those with no dentures.
From these results, there appears to be little socio-functional need to replace lost posterior teeth with a partial denture until the person has fewer than, 3 posterior functional units. The low number of partial denture wearers limited our ability to detect a lasting benefit from RPD treatment.     

Oral health impact in patients wearing removable prostheses: relations to somatization, pain sensitivity, and body consciousness

PURPOSE: Previous studies investigating associations between patient personality traits and complaints related to wearing dental prostheses have been inconclusive. From the perspective of cognitive behavioral theory, the current study investigated whether pain sensitivity, body consciousness, and somatization affected the oral health of patients wearing removable dentures. MATERIALS AND METHODS: Eighty-eight patients were supplied with removable partial and complete dentures. The Oral Health Impact Profile (OHIP), with six subscales measuring oral health impairment and disability during daily living, the Pain Sensitivity Index, the Private Body Consciousness scale, and the Somatization Scale of the SCL-90-R, were used. RESULTS: The variables pain sensitivity, body consciousness, and somatization correlated significantly with all six OHIP subscales in removable denture wearers. In multiple hierarchic regression analyses, patient personality accounted for 38.0% of functional limitation and 41.5% of physical pain. CONCLUSION: Pain sensitivity and bodily preoccupation might be important factors in explaining the subjective oral health effects of removable denture wearing.     

Dynamic Functional Force Measurements on an Anterior Bite Plane during the Night

BACKGROUND: Anterior bite planes are used in removable and fixed appliance treatment. In removable appliance treatment the question arising is whether the delivered forces can achieve active intrusion in terms of their amplitude and duration. In fixed appliance treatment, the force effect on the incisors and associated pathologic side effects, in particular under the application of intrusion mechanics, have to be considered. SUBJECTS AND METHOD: The aim of the present study was to investigate the effects of an anterior bite plane during the night. For this purpose ten subjects underwent nocturnal sleep investigations by means of a telemetric system. A silicon force sensor was integrated into an anterior bite plane for continuous measurement of bite forces and of the frequency of occlusal contact with the plate. RESULTS: The occlusal forces exerted on the anterior bite planes ranged between 3 and 80 N. The average forces were 5.5-24 N. The number of occlusal contacts varied between 39 and 558, with forces of between 7 and 9 N being registered in most cases. Major interindividual differences were detected in the magnitude of the force as well as in bite frequency. The intraindividual pattern of arising occlusal forces showed an intermittent force effect. No significant differences were found with regard to gender or growth pattern. CONCLUSIONS: In subjects with removable appliances, no active intrusion of teeth is possible during the night owing to the small number of occlusal contacts. Due to the partially very high forces in fixed appliance therapy, the integration of an anterior bite plane has to be assessed as critical in patients with unfavorable root geometry or bruxism.     

Bite force and oral function in patients with osseointegrated oral implants

abstract – The function of the masticatory system was analyzed in 19 patients (13 women and 6 men), aged 39 to 68, randomly selected from a group of 165 patients who had been treated with osseointegrated oral implants within the last 7 years (average 3.5 years). The patients were well satisfied with the functional capacity of their implant reconstructions, especially compared with the poor function before treatment. According to the clinical examination, all but one patient had no or only mild symptoms of dysfunction of the masticatory system. Three bite-force levels were recorded. The mean value for gentle biting was 15.7 N, for biting as when chewing 50.1 N, and for maximal biting 144.4 N. The patients could thus well discriminate between the different bite-force levels, and the maximal values are much higher than those in persons with removable dentures.     

Patients’ experience of partial tooth loss and expectations to treatment: a qualitative study in Danish and Swedish patients

Knowledge of impairments, wishes and expectations is essential to make correct decisions regarding oral rehabilitation. The purpose of this study was to investigate discomforts, wishes and expectations in patients’ with partial edentulism before entering oral rehabilitation. In Copenhagen, Denmark, and Malmö, Sweden, respectively, 20 patients with partial edentulism seeking rehabilitation were interviewed in a semistructured qualitative manner. The interviews were transcribed and analysed yielding overall domains. Six themes appeared as overall domains: (i) experienced impairments, (ii) experienced social awareness, (iii) expectation to treatment, (iv) expectation to durability/survival, (v) coping strategies dealing with the tooth loss including explanations of the tooth loss and (vi) modifications to experienced impairment. The impairments were mostly experienced as problems in social settings. Most participants expressed a simple wish to function normally; a fixed solution was preferred. Many Danish participants accepted a removable solution whereas only few Swedish participants did so. The domains ‘coping strategies’ and ‘modifications’ were not part of the chosen topics of interest, indicating a high wish of the participants to explain their tooth loss and how they coped with it. In conclusion, a large degree of social impairment was found in the patient group along with several coping strategies. The impairments were modified by a number of factors indicating that highly individualised care and treatment is needed. A state of normality was described as the primary treatment wish with a higher acceptance of removable solutions in Denmark than in Sweden. For final decision‐making, surrounding factors seemed to influence the patients’ choices.