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Documente Profesional
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Oral Rehabilitation
ment, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, , Prosthodontic Department, School of Dentistry, Shiraz University
of Medical Sciences, Shiraz, Iran, Restorative Department, Melbourne Dental School, Melbourne University, Melbourne, Vic., Australia and
Dental Material Department and Biomaterial Research Centre, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
Introduction
Tooth loss is the outcome of various factors such as
caries, periodontal disease, pulpal pathology, trauma
and oral cancer and may result in chewing difficulties
that affect general health and quality of life (1). Several treatment options, such as implant, fixed or
removable prostheses, can be proposed to replace the
missing teeth. Although the interest in dental
implants is continuously growing, many edentulous
patients are still treated by conventional removable
prostheses. The removable partial denture (RPD) is
2014 John Wiley & Sons Ltd
meal
interruption
and
eating
discomfort,
respectively. OHIP-14 prevalence and OHIP-14 sum
were found to be significantly associated with
factors representing RPD wearers oral health such
as self-reported oral health and frequency of
denture
cleaning.
Furthermore,
OHIP-14
prevalence and OHIP-14 sum were significantly
associated with factors related to frequency of
denture use such as hours of wearing the denture
during the day and wearing the denture while
eating and sleeping. Therefore, it can be concluded
that the OHRQoL of the patients of the study was
generally not optimal and found to be strongly
associated with oral health.
KEYWORDS: oral health, quality of life, removable,
partial, denture
Accepted for publication 30 July 2014
practices. A package containing an information brochure explaining the aims and a consent form was
given to the selected participants in the study. The
following were the inclusion criteria: Patients wearing
either double or single RPD for at least 8 weeks old
with or without complete dentures. Questionnaires
were filled by interviewing with each patient.
This questionnaire consisted of two parts. The first
part was comprised of patients demographic characteristics (age, sex and self-reported oral health) and
denture-related factors (eight questions). The next
part consisted of all 14 questions of Persian version of
(OHIP-14) that has been validated by Navabi et al.
after translation into Persian and adaptation to the
Iranian culture. The authors speculated that it is a
precise, valid and reliable instrument for assessing oral
health-related quality of life among Iranian population (10).
Each question of the OHIP-14 questionnaire was
scored between zero and four (0 = never, 1 = hardly
ever, 2 = occasionally, 3 = fairly often, 4 = very
often). Two measures of interpreting the OHIP-14
scales, OHIP-14 sum and OHIP-14 prevalence, were
utilised to describe RPD wearers OHRQoL. The OHIP14 sum was calculated as sum of the 14 questions
scores. The scores had a possible range of 056; the
higher scores representing the worse OHRQoL. OHIP14 prevalence was determined as the percentage of
people reporting one or more OHIP-14 items, with a
fairly often/very often response.
The collected data were analysed by adapting the
SPSS package (version 18*). The independent sample
t-test, one-way ANOVA (with Tukey post hoc test) and
chi-square test were used to assess the relationship of
patients demographic characteristics and denturerelated factors with their OHQoL. To control the effect
of possible confounding factors, the variables were
entered in a multiple logistic regression model with
OHIP-14 prevalence as the dependent variable. An
alpha level of 005 was regarded as statistical significance.
Results
Of the 253 RPD wearers, who were invited for the
interview, 200 patients participated in the study
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S . S H A G H A G H I A N et al.
Table 1. Characteristics of studied partial removable denture
wearers (N = 200)
Characteristics
Number (%)
Sex
Male
Female
Age
<50 years old
50 years old
Number of arch
One partial denture
Two partial denture
One partial and one
complete denture
Duration of denture
experience
1 year
>1 year
Denture material
Only resin
Only Chromecobalt
One resin and one
Chromecobalt
Hours of wearing per day
78 (390)
122 (610)
90 (450)
110 (550)
110 (550)
84 (420)
6 (30)
102 (510)
98 (490)
76 (380)
110 (550)
14 (70)
39 (195)
03 h day
use
39 (195)
414 h day
use
85 (425)
1523 h day
use
37 (185)
24 h day 1 use
Wear when eating
Always
Sometime
Never
Wear when sleeping
Always
Sometime
Never
Cleaning frequency
98 (490)
68 (340)
34 (170)
27 (135)
52 (260)
121 (605)
35 (175)
01 time week
27 time week
97 (485)
68 (340)
>7 time week 1
Self-reported oral health
Good
Fair
Poor
Stability during chewing
and speaking
Always stable
87 (435)
58 (290)
55 (275)
49 (245)
Table 1. (continued)
Characteristics
Number (%)
Sometime stable
Never stable
Satisfaction of the denture
Yes
No
Not responding
135 (675)
16 (80)
122 (610)
70 (350)
8 (40)
(acceptance rate = 79%). One hundred and ten participants (55%) were 50 years old or older and 122
(61%) were women. Almost half of them had used
their denture more than 1 year. Self-reported oral
health of 435% of them was good and 61% were satisfied with their dentures (Table 1).
OHRQoL of RPD wearers
A total of 89 participants answered at least one item
as very often/fairly often, (OHIP-14 prevalence = 445%). The aspects of OHIP-14 in which the
participants had problems very often/fairly often were
widely different. The most problematic aspects were
physical disability and physical pain so that 27% and
24% of participants had interrupted meals and were
uncomfortable to eat, respectively. On the contrary,
the participants had little problem in handicap and
social disability aspects so that only 25% of them
were unable to function and a similar percentage had
difficulty doing jobs (Table 2). OHIP-14 sum for the
study participants was from 0 to 40 and the mean
was 1380 1008 (Fig. 1).
Relationship between patients characteristics and their
OHRQoL
There was not a statistically significant association of
OHIP-14 sum and OHIP-14 prevalence with the following variables: sex, number of arches and duration
of partial removable denture use (Table 3). Two variables, age and denture material, were significantly
related to OHIP-14 sum but not to OHIP-14 prevalence. However, both OHIP-14 prevalence and OHIP14 sum were significantly associated with denture stability. Patients whose dentures were always stable
during chewing and speaking had the lowest scores of
OHIP-14 prevalence (P < 0001) and OHIP-14 sum
2014 John Wiley & Sons Ltd
Table 2. Distribution of Oral Health Impact Profile-14(OHIP14) for each single item (N = 200)
OHIP-14 item
Functional limitation
Trouble
pronouncing
words
Taste worse
Physical pain
Painful aching
Uncomfortable
to eat
Psychological
discomfort
Self-conscious
Tense
Physical disability
Diet unsatisfactory
Interrupt meals
Psychological
disability
Difficult to relax
Been embarrassed
Social disability
Irritable with others
Difficulty doing jobs
Handicap
Life unsatisfying
Unable to function
Very often
& fairy
often
N (%)
Occasionally
N (%)
Hardly
ever & never
N (%)
15 (75)
25 (125)
160 (800)
15 (75)
38 (190)
147 (735)
38 (190)
48 (240)
50 (250)
56 (280)
112 (560)
96 (480)
15 (75)
40 (200)
32 (160)
38 (190)
153 (765)
122 (610)
47 (235)
54 (270)
34 (170)
67 (335)
119 (595)
79 (395)
42 (210)
7 (35)
44 (220)
24 (120)
114 (570)
169 (845)
7 (35)
5 (25)
19 (95)
10 (50)
174 (870)
185 (925)
6 (30)
5 (25)
11 (55)
9 (45)
183 (915)
186 (930)
100
Cumulative percent
80
75 percentile
60
40
25 percentile
20
8 10 12 14 16 18 20 22 24 26 28 30 32 35 37 40
Oral health impact profile-14 score
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S . S H A G H A G H I A N et al.
Table 3. Bivariate analysis showing factors affecting oral health-related quality of life of partial removable denture wearers (N = 200)
OHIP sum
Mean SD
Characteristics
Sex
Male
Female
Age
<50 years old
50 years old
Number of arches
One
Two
Duration of partial removable denture use
1 year
>1 year
Hours of wear
1
03 h day
414 h day
1523 h day
OHIP prevalence
P-value
N (%)
P-value
127 101
145 100
0213*
32 (41)
57 (467)
0429***
154 103
125 97
0047*
45 (50)
44 (40)
0157***
142 106
138 94
0793*
52 (473)
37 (411)
0383***
141 99
134 103
0635*
48 (471)
41 (418)
0458***
250 93a
<0001**
35 (897)
<0001***
use
1
166 75b
19 (487)
95 71c
23 (271)
88 88c
12 (324)
use
1
use
24 h day use
Denture material
Only resin
Only Chromecobalt
One resin and one Chromecobalt
Wear denture when eating
Always
Sometime
Never
Wear denture when sleeping
Always
Sometime
Never
Cleaning frequency
01 time week
27 time week
115 94a
155 105b
131 87ab
0030**
28 (368)
56 (509)
5 (357)
0131***
82 71a
158 83b
261 82c
<0001**
21 (214)
35 (515)
33 (971)
<0001***
78 74a
102 84a
167 102b
0001**
8 (296)
113 (250)
68 (562)
<0001***
261 76a
<0001**
32 (914)
<0001***
121 88b
37 (381)
99 79b
20 (294)
71 75a
156 91b
186 150b
<0001**
13 (265)
67 (496)
9 (563)
0013***
81 63a
127 82b
240 89c
<0001**
12 (138)
28 (483)
49 (891)
<0001***
SE
OR
95% CI for OR
Sex (/male)
Female
065 038 191
091403
Age (/50 years old)
<50 years old
008 037 109
053223
Number of arches (/two)
One
028 036 133
065271
Duration of partial removable denture use (/>1 year)
1 year
023 038 079
038168
Denture material (/resin)
Chromecobalt
005 039 095
044205
Hours of wear
(/24 h day 1)
048 068 062
016237
Lower than
24 h day 1
Wear when eating (/always)
Never or
185 041 637 2831433
sometime
Wear when sleeping(/always)
Never or
001 078 099
021463
sometime
Cleaning frequency (/once or more per day)
Lower than
127 043 309
133714
once per day
Stability during chewing and speaking(/always)
Never or
037 045 145
060350
sometime
0086
0822
0434
0547
0897
0486
<0001
0999
0008
0404
Discussion
For the majority of people, oral health has an impact
on the quality of life as it could influence comfort,
function and aesthetics. This study discloses some of
the variables that affect the quality of life of patients
treated with RPD. The duration of wearing RPD,
denture cleaning frequency, denture stability and
self-reported oral health were found to positively
contribute to OHRQoL. On the other hand, sex, age,
number of dentures, period of RPD wear and denture
material were found to minimally influence the
OHRQoL.
Overall, although the OHIP-14 values in this study
indicated favourable OHRQoL for patients with RPDs,
the prevalence of RPD-related problems was relatively
considerable. This observation was in accordance with
several studies that utilised OHIP to measure OHRQoL
for patients with RPDs (11, 12) Patients dissatisfaction
with RPD could be related to the nature of the RPD
treatment. RPD treatment consumes more clinical
time, and the patients will require high maintenance
rate (13). This was found to contribute to poor satisfaction with RPD and loss of patient motivation (14).
This finding is in accordance with a Korean study that
utilised OHIP and found the RPD users had higher
scores than complete denture users. Their participants
reported that the RPD was associated with more discomfort, social limitations and cleaning difficulties (6).
Likewise, a German study found that patients treated
with RPD tend to suffer from prosthesis related complaints for greater duration than patients treated with
fixed dental prostheses (12). The most common complaints were sore spots, painful gums, denture-related
discomfort and sore jaw (12). The results of our study
was comparable to that of Abuzar et al. (15); the
OHIP-14 prevalence in our study (445%) was slightly
higher than the OHIP-14 prevalence obtained from
Australian RPD wearers (431%) while the OHIP-14
sum in this study (138) was slightly lower than that
of Australian (148). Therefore, it is speculated that
the participants in Iran have similar reaction to RPD
in comparison with participants of some other studies
(15).
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S . S H A G H A G H I A N et al.
This study indicates that 50-year old participants or
older have less scores of OHIP sum than younger participants. In the literature, there is conflicting evidence about the impact of patient age on the
acceptance of RPD. Similar to the current studies, Wakabayashi et al. (16) found that younger patients
(<65 years) tend to be less aesthetically satisfied with
their denture than older patients. Likewise, Frank
et al. (17) found that younger patients (less 60) tend
be more dissatisfied about their denture treatment.
Kimura et al. found younger patients treated with
RPD have less OHRQoL. Such outcome could be
attributed to higher social demand and self-concerns
with aesthetics and oral function in comparison with
older patients (18). On the other hand, older patients
are more experienced to function with missing teeth
(19). On the contrary, Koyama et al. (20) found that
the older the patients (more than 65 years), the less
likely to wear their RPDs. They anticipated that older
individuals might have less aesthetic and social
demands and more impaired neuromuscular control,
which could make them more indifferent to the treatment.
There are signs that patients wearing acrylic partial
denture ranked their OHRQoL higher than those
wearing metal partial denture. This observation is
opposite to what many specialists would regularly recommend. However, in removable prosthodontics, discrepancies between clinician objective appraisal and
patient subjective preference is not uncommon (20).
Still, these results should be interpreted with caution.
In many instances, acrylic denture is indicated for
immediate aesthetic restorations, which can solve a
major patient concerns. Furthermore, acrylic dentures
are generally cheaper, require less treatment time and
are heavily used to restore missing anterior teeth.
These factors could explain why the reported OHRQoL by patients wearing acrylic partial denture
appears higher.
In addition, this study emphasises that drawbacks
of RPD are the physical problems such as pain and
lack of stability during chewing and speaking. This
could eventually influence patients comfort, eating
and meal interruption. The importance of RPD stability has been confirmed by a Japanese study, which
found that patients with more stable RPD had lower
OHIP scores (21). On that basis, improving RPD quality is very desirable (21) Thus it could be speculated
that restoring stability-related function by RPD, such
7.
8.
9.
Acknowledgments
The authors thank the Vice Chancellor of Shiraz University of Medical Sciences for supporting this
research (Grant # 4476).
Ethical considerations
The scientific and ethical aspects of the protocol were
reviewed and approved by the review board of the
Shiraz Dental School, the University of Medical Sciences, Shiraz, Iran. Informed consent was obtained
from all participants.
Funding
10.
11.
12.
13.
14.
15.
Conflicts of interest
No conflict of interests declared.
17.
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Correspondence: Rafat Bagheri, Dental Material Department and
Biomaterial Research Centre, Shiraz University of Medical Sciences,
Shiraz Dental School, Ghomabad, Ghasrodasht St, Shiraz, Iran.
E-mail: bagherir@unimelb.edu.au