DENTURES AND QUALITY OF LIFE – A LONGITUDINAL ANALYSIS S.A. GRAY, M.R. INGLEHART & D. SARMENT University of Michigan, USA This study was supported by funds.

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DENTURES AND QUALITY OF LIFE – A LONGITUDINAL ANALYSIS S.A. GRAY, M.R. INGLEHART & D. SARMENT University of Michigan, USA This study was supported by funds from the University of Michigan School of Dentistry Student Research Program.

BACKGROUNDBACKGROUND Edentulism - Background Statistics 1983: -17% of US population is edentulous in at least one arch - 41% of the population 65 years or older are edentulous NHANES III – 1988 to 1994: -10.9% of white non Hispanic adults 35 years and over

Consequences of Edentulism: masticatory problems - poorer diets - nutritional deficiencies - systemic disturbancesspeech difficulties psychological / social issuesmasticatory problems - poorer diets - nutritional deficiencies - systemic disturbancesspeech difficulties psychological / social issues

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

HYPOTHESESHYPOTHESES 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.

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.

METHODSMETHODS 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).

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  5 nomilddiscomfortingdistressinghorribleexcruciating discomfort

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

RESULTSRESULTS

Figure 1:Different levels of discomfort NoDiscomfortMildDiscomfortDiscomfortStrongDiscomfort 50% 25% 0%

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

Table 1: Average answers to the ohrqol items in the four patient groups

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

HYPOTHESIS 3: Ohrqol will correlate significantly with the patient’s: AgeNO!

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

DISCUSSIONDISCUSSION Ohrqol = relatively new concept It focuses providers on ultimate outcome of care! With dentures: - 2/3 of patients report discomfort - discomfort = correlated with health! WHY?

CONCLUSIONCONCLUSION 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.