Quality of Life … and Complete Dentures … Really?

Is anyone thinking of complete dentures when evaluating quality of life?

For those in the 50-64 age group, about 15 percent are missing all of their teeth in either the maxilla or the mandible. Typically it's the upper jaw that is missing all of the teeth by a 2.5 to 1 ratio over those patients missing all teeth in only the lower jaw. It's easy to understand a quality of life component applicable to our complete denture patients particularly for prosthetic "replacement" of the upper teeth. What about a completely edentulous patient?

An interesting idea relates to a patient's perception of a generalized feeling of oral health in terms of quality of life. Not only are the functional considerations a key point that deserve our attention, but also psychological components that related to confidence in a social setting that play a huge role in a patient's perception of oral health. A study by Baba, et al., evaluated the relationship where missing "occlusal units" decreased a patient's perceived quality of life.

What happens to our patients when dentures are lost?

Remember the earthquake that shook Japan in March of 2011? A study by Sato, et al. evaluates the oral health impact of the loss of dentures for 123 of the victims of the event in terms of the importance in the response to a natural disaster from a larger public health related focus. The point of emphasis was that dental care, which includes replacement of complete dentures, should be included in major-disaster relief efforts.

It is interesting to note that the relative risk of denture loss compared to those that did not lose their dentures as a result of the natural disaster were all psycho-social in nature. Specifically, the three highest age-adjusted and sex-adjusted risks in terms of perceived quality of life were:

1. Problems with smiling, laughing and showing teeth without embarrassment (Relative Risk = 7.49)
2. Problems enjoying the company of other people such as family, friends or neighbors (RR =5.78)
3. Difficulty speaking clearly (RR = 5.38). Compare this to the findings related to the difficulty in eating food (RR = 2.99) as a more functional consideration.

Those who had lost their dentures showed a significant difference or negative impact in their oral health related quality of life.

Emotional Impact of Losing Teeth

Davis et al. evaluated the emotional impact of losing teeth through a questionnaire sent to edentulous patients. The group of people categorized as having "experienced difficulties accepting tooth loss" (45 percent of the respondents) reported a noticeable decrease in self-confidence compared to the denture patients without reported difficulties in accepting tooth loss (69 percent and 2 percent, respectively).

This study found statistically significant differences in terms of quality of life experiences such as enjoying their food, eating in public, laughing in public and avoiding close relationships. All based on the patient's ability to accept the tooth loss and move forward or dwell on the tooth loss in an overall feeling of regret.

The Quality of Life Component to Restoring Missing Teeth

Those who lost their dentures as a result of a major natural disaster experienced a noticeable impact on social interactions. It's interesting to see that there is a measurable population of people that are experiencing similar challenges in social interactions due to the difficulties of accepting tooth loss.

Certainly, there are studies that show an increase in quality of life following the placement and restoration using dental implants. Pavel et al. demonstrated in their study a significant improvement in quality of life pertaining to oral health in patients where at least one dental implant is placed. The variables were much different because there was not a natural disaster associated here. Specifically, the variables measured were age, gender, marital and educational status, although it might have been interesting to see how speech sounds might affect or influence the quality of life with dental implant supported restorations.

It is my understanding that the treating dentists relationship with the patient is more important than the technical quality of a complete denture. Talk to the patient about what is going to happen, what to expect in the process and how to handle some of the issues that arise. Show them that you care. Demonstrate that we can hear and understand what the patient is sharing with us about a very personal challenge. This skill is as important in treatment related to complete denture as it is to patients with high esthetic demands for a crown & bridge or veneer case.

Douglas G. Benting, D.D.S., M.S., F.A.C.P. is a member of Spear Resident Faculty.

Resources

1. Baba K, et al. The relationship between missing occlusal units and oral health-related quality of life in patients with shortened dental arches. International Journal of Prosthodontics. 2008;21:72–4.
2. Sato Y, et al. Impact of Loss of Removable Dentures on Oral Health after the Great East Japan Earthquake: A Retrospective Cohort Study. Journal of Prosthodontics. 2015;24(1):32-36.
3. Davis DM, et al. The emotional effects to tooth loss: a preliminary quantitative study. British Dental Journal 2000;188:503-506.
4. Pavel K, et al. Dental implants and improvement of oral health-related quality of life. Community Dental Oral Epidemiology. 2012;40 Supplement 1:65-70.