Effects of denture maintenance on satisfaction ... - Wiley Online Library

Original article

Effects of denture maintenance on satisfaction levels of Taiwanese elderly using removable partial dentures: a pilot study Ju-Hui Wu1, Yi-Hsin Yang2,3, Chau-Hsiang Wang1,4, Huey-Er Lee1,4 and Je-Kang Du1 1

Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 2Faculty of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Division of Statistical Analysis, Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 4School of Dentistry, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

doi: 10.1111/j.1741-2358.2011.00500.x Effects of denture maintenance on satisfaction levels of Taiwanese elderly using removable partial dentures: a pilot study Objective: The aim of this study was to evaluate the correlation between patient satisfaction with removable partial dentures and denture maintenance by patients, including regular application of denture adhesives and cleansers. Background: The success of removable partial dentures depends on patient satisfaction with dentures and their regular denture maintenance. Materials and methods: Demographic information, the Oral Impacts on Daily Performance (OIDP) indicator and details of denture maintenance (including the use of denture cleansers and adhesives) were collected from 193 (41.5% men and 58.5% women) participants by using questionnaires. A dentist performed oral examinations to evaluate denture function according to the OIDP items photographically and recorded the number of remaining teeth and Kennedy’s classification. Results: Most participants were satisfied with their removable partial dentures and tended to have higher satisfaction levels than the dentist’s estimation. Further, those using denture adhesives and cleansers had higher satisfaction levels than those not using such denture maintenance. Conclusions: Appropriate education regarding denture use is important because regular denture maintenance by patients affects their degree of satisfaction with dentures, as well as the dentist’s skill and the patient’s oral condition. Dentists could use this information to predict the potential success of dentures. Keywords: elderly, denture wearers, denture cleanser, satisfaction. Accepted 13 February 2011

Introduction Edentulism, even partial edentulism, is a handicap that affects the quality of life and nutrition. A welldesigned denture can maintain oral health-related quality of life and patient satisfaction1,2. Therefore, it is important for dentists to fabricate a welldesigned denture and improve denture retention and stability. However, patients may have different priorities in terms of the function of their dentures. Dentists and patients show poor agreement when evaluating prostheses according to satisfaction3,4. The real success of removable partial dentures (RPDs) definitely depends on patient satisfaction with dentures and their regular dene458

ture maintenance. Therefore, it is crucial for the dentist to understand satisfaction with dentures from the patient’s viewpoint to improve communication with the patient and success of the prostheses. The aim of this study was to evaluate the correlation between patient satisfaction with their dentures and denture maintenance by patients, including regular application of denture adhesives and cleansers.

Materials and Methods In this pilot study, 193 participants were enrolled from a community elderly activity group in

2011 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2012; 29: e458–e463

Satisfaction and denture maintenance

Kaohsiung City. Each participant underwent an oral examination and completed a questionnaire. The Institutional Review Board (IRB) of Kaohsiung Medical University Chung-Ho Memorial Hospital (KMUH-IRB-970209) approved the study. Each participant received written information and provided written informed consent. The questionnaire included demographic information, the Oral Impacts on Daily Performance (OIDP) indicator and details of denture maintenance (including the use of denture cleansers and adhesives). The 11-item OIDP questionnaire5,6 focused on the impact of oral health on the performance of daily activities, such as eating, speaking, cleaning dentures, sleeping, showing teeth, emotional state, going out, enjoying social contact, feeling comfortable, relaxing and overall satisfaction. The satisfaction levels were scored on a scale from 0 to 4 (where 4 = great satisfaction, 3 = satisfaction, 2 = acceptance, 1 = dissatisfaction and 0 = strong dissatisfaction). A dentist performed the oral examinations to record the number of remaining teeth and Kennedy’s classification as well as to evaluate denture function in terms of the OIDP items photographically. SAS 9 software (SAS Institute Inc., Cary, NC, USA) was used for statistical analysis. p < 0.05 indicated a statistically significant difference.

Results There were 41.5% men and 58.5% women participants in this study (Table 1). Their mean (SD) age was 70.38 (10.04) years, and 64.7% of the participants had an educational level below junior high school. Financially, 24.7% of the participants received their denture rehabilitation support from the government of Kaohsiung City. In terms of denture maintenance, 63% of the participants used a toothbrush to clean their dentures and the others used both a toothbrush and denture cleansers. In addition, 11% of the participants used denture adhesives to improve denture stability. In this study, 30.8, 15.5, 9.5 and 3.1% of the participants had Kennedy’s class I, II, III and IV RPDs, respectively. The proportions of 0, 1–9, 10–19 and 20 or more remaining teeth were 27.5, 27.5, 28.0 and 17.1%, respectively. Figure 1 shows the differences between the participants’ satisfaction level and the dentist’s evaluation of the OIDP items. The participants showed greater satisfaction with their dentures than the dentist’s estimation. In addition, the participants using denture adhesives had higher satisfaction levels than those not using denture

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Table 1 Demographic data in this study (N = 193). Parameter

Subgroup

n

%

Gender

Male Female 40–64 65–74 ‡75 Illiterate Elementary school Junior high school Government supported Self-supported Supported by offspring I II III IV 0 1–9 10–19 ‡20

80 113 47 59 67 64 57 66 42 55 73 107 54 33 11 53 53 54 33

41.45 58.55 27.17 34.10 38.73 34.22 30.48 35.29 24.71 32.35 42.94 30.75 15.51 9.48 3.16 27.46 27.46 27.98 17.10

Age (years)

Educational level Economic status

Kennedy’s class

Number of remaining teeth

adhesives (Fig. 2). Similarly, the participants using denture cleansers and a toothbrush experienced greater satisfaction than those not doing so (Fig. 3). Figure 4 illustrates the relationship between the satisfaction level and the number of remaining teeth. The participants using complete dentures and those with 20 or more remaining teeth were more likely to be satisfied with their dentures than their counterparts with 1–19 remaining teeth. The dentist also noted dissatisfaction in terms of the oral impact of 1–19 remaining teeth. The completedenture wearers and those with 20 or more remaining teeth who used denture adhesives had higher satisfaction levels compared with those having multiple remaining teeth (Fig. 5), although there was no significant difference between those who did or did not use denture adhesives in terms of the number of remaining teeth (Table 2). Furthermore, complete-denture wearers and those with 20 or more remaining teeth who cleaned their dentures with a toothbrush and denture cleansers had greater satisfaction (Fig. 6), without significant differences between those who did or did not use denture cleansers according to the number of remaining teeth (Table 2).

Discussion In Taiwan in 2004, 12.6% of the population was older than 65 years and 11.9% were edentulous7. The present study shows that the prevalence of edentulism in Kaohsiung City is 27.5% higher than


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Figure 1 Comparison of the participants’ responses and dentist’s evaluation according to the Oral Impacts on Daily Performance items. The line marked ‘acceptable’ indicates an acceptable level of satisfaction with dentures.

Figure 2 Comparison of the satisfaction levels of the participants using or not using denture adhesives according to their Oral Impacts on Daily Performance responses. *p < 0.05 was significant by the t test.

that in the whole country, and the participants with high prevalence of edentulism belonged to a lower social class or income level and had little or no education. A possible reason is that the government of Kaohsiung City covered the expenses of complete-denture rehabilitation in 2000. Considering the reported prevalence of edentulism among the elderly8 in the United States (26%), Canada

(58%) and the United Kingdom (46%), Taiwan has a lower prevalence. Kennedy’s class I RPDs were the most common dentures in this study, which is a finding similar to that reported in a previous study9. In Taiwan, the elderly prefer to preserve their teeth for chewing food and maintaining the residual ridges, even if the teeth are mobile or need to



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Figure 3 Comparison of the satisfaction levels of the participants using or not using denture cleansers and a toothbrush according to their Oral Impacts on Daily Performance responses. *p < 0.05 was significant by the t test.

Figure 4 Satisfaction levels of the participants according to the number of remaining teeth.

be extracted. Patients receive dental treatment only when toothache or discomfort occurs. According to the Kaohsiung City Government report of 2009, 1643.84 individuals are serviced by one dentist; therefore, dental treatment should be convenient for most of the elderly residents. The National Health Insurance programme, initiated in 1995 by the Taiwanese Government, supports oral health services, thus reducing the cost of dental treatments such as restorations, root canal therapy, periodontal therapy and extraction. Consequently, people choose restorative treatment or asked the dentist to preserve their teeth.

Figure 5 Satisfaction levels of the participants using denture adhesives according to the number of remaining teeth. Table 2 Participant distribution according to the number of remaining teeth. Maintenance type 0 teeth 1–9 teeth 10–19 teeth ‡20 teeth p Denture adhesive Yes 11.76 No 88.24 Denture cleanser Yes 40.82 No 59.18

15.09 84.91

11.76 88.24

3.33 96.67

0.445

33.96 66.04

38.46 61.54

33.33 66.67

0.8645

The values indicate the percentage of participants. p < 0.05 was significant by the chi-square test.


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Figure 6 Satisfaction levels of the participants using denture cleansers and a toothbrush according to the number of remaining teeth.

The number of remaining teeth is significantly related to the satisfaction level of older Taiwanese individuals with removable partial dentures. Consistent with this finding, there is a significant association between naturally occluding pairs of teeth and oral health-related quality of life10–13. In addition, there is a significant association between oral impact and denture quality in edentate older people in the UK14. In the present study, those with fewer remaining teeth expressed the greatest dissatisfaction with their dentures, possibly because of tooth mobility, periodontal disease or the use of clasp-retained RPDs. This finding may indicate a significant relationship between denture retention and denture design in edentate individuals. The participants with complete dentures experienced the greatest satisfaction. Clinically, the use of an overdenture design for a few remaining teeth may improve the satisfaction level of patients. Denture adhesives are widely used by patients wearing removable prostheses and have long been recognised by denture wearers as a useful adjunct to denture retention and stability15,16. Several publications17,18 have reported the use of disposable gnathometers to assess quantitatively the masticatory force needed to dislodge a denture; they also demonstrated the significant benefit of using denture adhesives for improving denture retention and stability. However, few studies evaluated the impact of denture adhesives on patient-based outcomes. In the present study, the complete-denture wearers using denture adhesives had a higher level of satisfaction than those with RPDs. Therefore, it is wise to provide patients with the appropriate information on the use of denture adhesives.

This use showed a statistically significant relationship with the satisfaction level, especially for cleaning dentures, sleeping, going out, enjoying social contact, feeling comfortable, relaxing and overall satisfaction. Surprisingly, there was not a statistically significant relationship for eating. This could be explained by the fact that the masticatory force decreases with age and elderly denture wearers have to consider eating softer food. Denture cleansers are essential to prevent malodour, poor aesthetics and accumulation of plaque or calculus and a biofilm19,20. They are widely used by patients wearing removable prostheses and are a useful adjunct to effective disinfection21,22. In the present study, the use of denture cleansers and a toothbrush showed a statistically significant relationship with the satisfaction level, especially for eating, cleaning dentures, sleeping and feeling comfortable. However, there were no significant differences between use and nonuse of denture adhesives and between use and nonuse of denture cleansers according to the number of remaining teeth. The clinical implications of these results will need to be studied further as the sample size of the present study is too small. The use of patient-based outcomes to measure the effectiveness of treatment is increasing as clinical scientists attempt to evaluate the impact of therapy on the recipient23. Numerous publications have described24–27 the OIDP indicator as a well-known oral health-related quality of life instrument. In the present survey, the participants tended to have greater satisfaction with their dentures in terms of the OIDP items than the dentist, although they shared the same opinion that denture quality has a great impact on the performance of daily activities such as eating. This difference may be explained by the participants’ education level and their understanding. The objectives of prosthodontic treatment of partially edentulous individuals with removable restorations are the elimination of oral diseases, preservation of oral health and restoration of oral function. However, a prosthesis is a replacement of a missing part of the human body by some artificial appliance, such as a denture. Therefore, it is important to consider the patient’s wishes to improve denture-related satisfaction.

Conclusions Most participants were satisfied with their dentures. The satisfaction levels of the Kaohsiung elderly participants significantly improved with the



appropriate application of denture adhesives and cleansers.

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Correspondence to: Je-Kang Du, Department of Dentistry, Kaohsiung Medical University Hospital, No.100, Tz-you 1st Rd., Kaohsiung 807, Taiwan. Tel.: (07)2015151 Fax: (07)2015153 E-mail: [email protected]
