Edentulism is an inevitable oral health consequence resulting from the accumulated pathology such as dental caries, periodontal disease, or a deficient rehabilitation technique. Literature shows a 4% raise of this condition every decade among young adults and a further 10% by the individual reaches the age of 70. Edentulism has a direct connection to masticatory and nutritional issues, and some authors consider it to be a reliable predictor of mortality. Edentulousness is a serious condition that affects both overall health and quality of life (owing to the lesser consumption of fruits and vegetables and a diet with lesser nutritional value). Evidence is overwhelming that edentulism has a detrimental impact on oral health-related quality of life (OHRQoL) in the form of functional, psychological, and social impairment, which has an impact on daily living. Elderly people who have lost their teeth experience low self-esteem, a deterioration in psychological well-being, limited social engagement, and social isolation.
Complete loss of all erupted teeth, has been observed to have a detrimental effect on the OHRQoL. The most popular form of treatment for treating edentulism is a conventional complete denture for rehabilitation of such patients. Even though there have been some reported disadvantages, it would still be the opted choice because of its affordability and in cases where implant placement is contraindicated because of existing illnesses.
The Oral Health Impact Profile (OHIP) is one of the most often used evaluation methods for quantifying OHRQoL. In patients with receiving complete dentures, Stober et al. found a substantial correlation between overall satisfaction and OHRQoL. OHIP comprises 49 items for assessing OHRQoL. The OHIP-Edentulousness (OHIP-EDENT) is a condensed version of the OHIP, which includes 19 items tailored to measure OHRQoL of edentulous patients. Research exploring various demographic variables and their relationship to OHRQoL among the denture wearers in this region is scantly reported with noteworthy conclusions, which prompted this study.
The study population consisted of 284 first time, complete denture wearers aged 30 years and above recruited within a time period of six months. Based on the study of Limpuangthip et al. which showed a 43% impact of complete dentures on OHRQoL, the sample size was determined to be 284, using the below formula, wherein n is the sample size, Z is the statistic corresponding to level of confidence, P is expected prevalence, and d is precision:
Patients with any type of cognitive disability, systemic disorders, and a history of previous dentures were excluded. The study was carried out in accordance with the ethical standards for medical research involving human subjects set forth in the Helsinki Declaration of the World Medical Association. Informed consent of all participants was taken after explaining them the details of the study and ensuring confidentiality.
The participants were asked to fill out a questionnaire eliciting demographic details such as age and gender. Smoking status was binomially categorized into smokers and nonsmokers. Those who had a history of smoking and have quit were also considered nonsmokers. OHRQoL was assessed using OHIP-EDENT, which was translated into native language. To ensure linguistic validity, the questionnaire was forward translated, reconciled, back translated, and reviewed for the corrected version in the same order. OHIP-EDENT includes seven domains for assessing the quality of life, namely functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. The obtained data were analyzed using the Statistical Package for the Social Sciences version 23.0 (IBM; Chicago, Illinois, USA). One-way analysis of variance was applied to find differences between age groups, gender, smoking, and socioeconomic status on OHRQoL among complete denture wearers. The level of significance was set at 5%.
70.7% of the study participants were males while 29.3% of females participated in the study. 60.9% of the denture wearers fell above 65 years of age, as shown in Table 1.
Table 2 presents OHRQoL and its different domains as related to age. Functional limitation domain in OHRQoL demonstrated a significant difference with age for all its variables. A highly significant difference was noted for difficulty in chewing with >65 years of age having greater impact (1.576 ± 1.160) as compared to <65 years (0.666 ± 1.020). Similarly, a higher mean score was noted in >65 years for food catching and dentures not fitting variables with 0.596 ± 0.495 and 1.384 ± 1.122 values, respectively, which was significant at P = 0.038 and 0.005. Painful aching, uncomfortable to eat, sore spots, and uncomfortable dentures had slightly higher scores in the age group of above 65 years, but their p-value was not significant. The variables of worried and self-conscious in the psychological domain were almost equally distributed in both ages with no significant difference noted. Higher age group category avoided eating with dentures placed with a mean score of 1.442 ± 1.092 as against lower age group having a mean of 0.878 ± 1.023, which was significant at P = 0.014. The other variables of unable to eat and interruption during meals were not significantly different between the age categories. None of the questions in the domain of psychological disability, social disability, and handicap showed any significant difference between age groups. Overall, it was seen that in the domain of functional limitation, denture wearers who were lesser than 65 years of age had lesser mean scores as compared to their older counterparts. This suggested that denture was better adapted in the younger age.
Table 3 presents OHRQoL and its different domains as related to gender. Males exhibited compromised OHRQoL in the domain of functional limitation. The mean scores for difficulty in chewing were much higher in males as compared to females with a mean of 1.600 ± 1.196 versus 0.320 ± 0.476 which was statistically significant at P < 0.001. The complaint of food catching was greater in females than males. Denture not fitting variable had a higher score in males with a mean of 1.483 ± 1.185 as against 0.320 ± 0.476 of females. In the physical pain domain, males had greater mean scores for uncomfortable to eat, sore spots, and uncomfortable dentures when compared to females, but their p-value was not significant. Painful aching was significantly higher in females with a mean of 1.506 ± 0.000 versus 0.883 ± 0.845 in males at P < 0.001. The domain of psychological discomfort was significantly higher in females at P = 0.009 for being worried and P = 0.049 for being self-conscious. In the physical disability domain, males significantly exhibited compromised quality with scores of 1.450 ± 1.199 as compared to females at P = 0.012.
Smoking status and OHRQoL among completely edentulous patients with dentures are demonstrated in Table 4. No significant differences were noted between smokers and nonsmokers for the variables of functional limitation such as difficulty in chewing, food catching, and dentures not fitting at P = 0.345, P = 0.084, and P = 0.246, respectively. Physical pain characteristics did show changes with smokers having higher mean scores for painful aching (1.040 ± 0.840 vs. 0. 450 ± 0.746) as compared to nonsmokers and for uncomfortable to eat (1.400 ± 1.290 vs. 0.716 ± 0.715) at P = 0.002 and P = 0.037, respectively. Sore spots were equally distributed in both the groups. Psychological discomfort quality of worried and self-conscious was also not significant. Interruption during meals was higher among smokers with a mean of 0.720 ± 0.978 as compared to. 000 ± 0.000 among nonsmokers which was significant at P < 0.0001. Against convention, nonsmokers were significantly more embarrassed with a mean score of 0.733 ± 0.899 when compared to their smoking counterparts. Smokers had compromised quality of life with smokers avoiding to go out to be significantly more as against nonsmokers. Smokers also felt that their life was more unsatisfying with a mean score of 2.040 ± 0.840 as against 1.450 ± 1.199 in the nonsmokers which was significant at P = 0.030. Overall, smokers demonstrated decreased quality of oral health as evaluated by OHIP-EDENT.
Complete tooth loss and alveolar bone resorption are regarded as oral health impairments that impede the stomatognathic system's ability to eat, speak, and look good. It has detrimental psychological and societal implications. Complete edentulism is becoming less common, although the number of patients who need rehabilitation with complete dentures is still higher than average in several nations. There are several factors that determine whether a denture is acceptable in terms of satisfaction and OHRQoL. Studies have discovered a variety of relationships between denture satisfaction and oral anatomy, patient psychology, technical proficiency, and dental communication abilities. Despite these positive and negative full denture success indications, many patients nevertheless find it difficult to adjust to a complete denture. Patients who have trouble accepting their missing teeth are more likely to suffer from sadness. The patient's personality, relationship with the dentist, and attitude toward the dentist and denture are further contributing aspects. These, however, are not often assessed. The patient and the dentist jointly decide on the course of therapy. The accumulated impact of patient satisfaction, socioeconomic status, psychological status, and physical traits such as age and gender among complete denture wearers in this part of the country is not well documented in the literature.
Higher age group of our study population was affected as compared to their younger counterparts. The findings are contradictory with those of Weinstein et al., who found that among all age categories, those in their 70s and older were the most contented. This conclusion may be connected to the fact that elderly people have a strong need for fulfillment at every level of everyday functioning. Another cause might be that they are reluctant to continuously report issues to the physician and instead try to deal with the small issues on their own. In their investigation of stereognosis in edentulous participants, Mantecchini et al. discovered that older subjects' stereognostic abilities are worse than those of younger persons. In comparison to participants with superior stereognostic ability, those with less stereognostic ability displayed higher levels of enjoyment.
On evaluating OHRQoL between genders, a significant difference was noted in the present study for the domain of functional limitation (Q1, Q2, and Q3) at P < 0.001. On the contrary, the study of Saddq et al. did not show differences in this domain. Males had higher means of functional limitation suggesting greater dissatisfaction among them as compared to females.
Functional limitations, such as mastication and capturing food capacity, were found to be considerably prevalent in the research population regardless of gender or age. The patient was unable to carry out his daily activities. This finding is consistent with earlier studies, which link functional limitations to edentulous patients' pain, the feeling of an ill-fitting denture, and food collection under dentures. Complete denture wearers require seven or eight times more chewing strokes than dentulous patients to remove food particles because of decreased masticatory forces as compared to dentate patients.
Psychological discomfort was noticed to be higher in the females of the present study. Q8 (worried) and Q9 (self-conscious) questions of psychological discomfort domain showed higher scores for females than males, which was significant. This is similar to the study of Saddq et al. Gender and psychological handicap were found to have a strong relationship; females were more disturbed and ashamed by their denture difficulties. Females appeared to be a little more sensitive than males in this study, preferring to stay at home and avoid going out in public settings in case of denture difficulties. This can be explained by physical or psychological variations between men and women, as well as physiological and hormonal alterations that have been claimed to have a role.
The findings of the current study demonstrated that while male patients complained of physical aspect or functional domain of OHRQoL, females had more troubles with psychological domain. This was not in line with Taylor and Doku's findings, which showed that male patients were happier with their dentures than female patients were. Male patients expressed greater satisfaction with their full dentures in terms of mastication, look, speech, and health, according to Singh et al.
Regarding the size, shape, and color of teeth chosen, female participants more frequently experienced esthetic concerns than their male counterparts. In accordance with their current dentures, patients reported increased speaking and esthetic satisfaction levels but higher mastication complaints which matched the findings of our investigation. This implies that healing from mastication issues is most challenging in the areas of mastication, speech, and esthetics. The current study found that smokers demonstrated decreased quality of oral health as evaluated by OHIP-EDENT. The results related to smoking and drinking habits require further research. Shao et al. in their study on elderly subjects with a history of smoking and drinking had higher GOHAI scores, which was similar to what we found.
The study poses few limitations. Owing to the cross-sectional pattern of the study design, a causal association between age, gender or smoking status, and OHRQoL cannot be established. When concerning personal choices and opinions, the respondents might not be accurate in their response. But still the study has greater merits considering the larger sample size and elaborateness in the study design.
The current study showed a statistically significant difference of OHRQoL with age, gender, and smoking status among edentulous patients rehabilitated with complete denture using OHIP-EDENT. Patients >65 years had higher scores for functional limitation than their younger counterparts. Assessment of OHRQoL could be used as a complementing measure along with clinical examination thus allowing the dental practitioner to make a thorough assessment that includes clinical outcomes and patient's perception towards oral health.
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Conflicts of interest
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