DENTURES AND QUALITY OF LIFE – A LONGITUDINAL ANALYSIS

1. 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.

2. 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

3. Consequences of Edentulism: • • masticatory problems - poorer diets - nutritional deficiencies - systemic disturbances • speech difficulties• psychological / social issues

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

5. 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.

6. HYPOTHESES (cont’d) • 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.

7. 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).

8. 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 distressing horrible excruciatingdiscomfort

9. 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 5=strongly 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 5=delighted

10. RESULTS

11. Figure 1: Different levels of discomfort 50% • No • Discomfort 25% 34 25 20 20 0% Mild Discomfort Discomfort Strong Discomfort

12. HYPOTHESIS 1: • Patients with different discomfort levels due to dentures differ in ohrqol.

13. Items: No Discomfort Mild Discomfort Discomfort Severe Discomfort A1. Limit foods 2.00 2.23 3.00 3.84 A2. Bad taste 1.30 1.46 1.90 2.16 A3. Dentures are effective 1.52 1.96 2.37 3.26 B1. Interfere with life 1.39 1.86 2.47 2.84 B2. Cause worry 1.42 1.64 2.21 3.47 B3. Nervous 1.36 1.41 1.79 2.90 B4. Concerned about how I look 1.36 2.09 2.26 2.79 B5. Enjoying life 1.21 1.41 1.79 2.58 B6. Interfere with daily activities 1.15 1.41 1.90 2.53 B7. Reduce happiness 1.21 1.46 1.79 2.42 B8. All aspects of life 1.21 1.32 2.16 2.32 B9. Rest of life 1.88 2.27 3.21 3.74 C1. Keep from socializing 1.12 1.41 1.90 2.47 C2. Eating in front of others 1.46 1.64 2.42 3.32 C3. Speaking in front of others 1.40 1.68 2.05 3.37 C4. Intimate relationship 1.21 1.50 2.11 2.42 D1. Cause discomfort 1.46 2.23 3.16 3.63 D2. Discomfort 1.15 3.55 5.51 7.37 • Table 1: Average answers to the ohrqol items in the four patient groups

14. HYPOTHESIS 2: • A decline of ohrqol will occur • in denture patients over time. • NO!

15. HYPOTHESIS 3: • Ohrqol will correlate significantly with the patient’s: • Age • NO!

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

17. 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?

18. 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.