Journal of

Oral Rehabilitation

Journal of Oral Rehabilitation 2014

Evaluation of psychological guidance impact on complete denture wearer’s satisfaction YUN ZOU*† & DESONG ZHAN*†

*Department of Cadres Clinic, School of Stomatology, China Medical University,

Shenyang, and †Department of Materials, School of Stomatology, China Medical University, Shenyang, China

SUMMARY The purpose of this study was to evaluate the impact of psychological intervention on edentulous patients’ satisfaction with complete clinically satisfactory complete dentures. The survey was conducted in China Medical University involving 84 individuals receiving complete dentures at this institution from August 2013 to March 2014. Participants were randomly allocated to intervention and control groups consisting of 42 subjects, respectively. In the intervention group, individuals received oral health education and psychological intervention before and after the whole process. In the control group, 42 cases received doctor’s regular advice after treatment. Satisfaction regarding aesthetic, speech, mastication, retention and comfort was rated in the first and third month after prosthesis treatment. Patients overall aesthetic, speech, mastication and retention were significantly

Introduction Complete dentures are the favoured treatment option for edentulous patients. They are commonly accepted because they provide a pleasing appearance and enable normal speech while also supplying occlusal support and adequate means for the mastication of food. Dentures should be comfortable for the wearer and contribute to the continuing health of the supporting tissues (1). Previous studies prove that the great majority of completely edentulous patients are satisfied with their complete dentures yet there is a group of patients who remain dissatisfied despite the clinical perfection of their prostheses (2–4). © 2014 John Wiley & Sons Ltd

improved in both intervention and control groups in 3 months later after prosthesis treatment when compared with the first month (P < 0
05). No significant difference existed for comfort in control group. Patient scores on aesthetic, speech, mastication and retention at both first and third month evaluations (P < 0
05) differed between the control and intervention groups. However, there was no difference for their scores related to comfort (P > 0
05) in first and third month. The study concludes that psychological intervention plays a significant role in improving patient satisfaction with complete dentures. KEYWORDS: psychological guidance, complete denture, case–control study Accepted for publication 17 May 2014

As the reasons for the difficulties in the acceptance of dentures are complex, the risk of the dissatisfaction should be considered. Satisfaction with complete dentures has been associated with several different denture-related, patient-related and oral-related factors (5). Among these factors, general health, aesthetics, phonetics, experiences with previous dentures and patient expectation regarding treatment were evaluated in previous studies (6–10). Although some studies found associations between those factors and complete denture satisfaction (8, 9), some did not (6, 7, 10). Some previous studies (11, 12), albeit not all (13), have revealed that patient satisfaction is unrelated to denture quality and to different complete denture-making techniques (14). doi: 10.1111/joor.12202

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Y. ZOU & D. ZHAN It has been widely acknowledged that psychological factors may influence the outcome of denture treatments. Some authors have found that the level of patient satisfaction with and adaptation to their dentures may depend on psychological conditions such as neuroses, but also on the influence of oral health education programme and of psychoeducation (15–20). This study makes use of questionnaires to assess the influence of an oral health education programme and psychological intervention on the level of patient’s general satisfaction with complete dentures before providing the prosthesis using questionnaires.

Materials and methods Study participants A total of 84 patients (46 men and 38 women) with an age range from 38 to 75 years participated in this study. The sample consisted of 84 systemically healthy individuals who attended China Medical University and sought new complete denture therapy from August 2013 to March 2014. The characteristics of the intervention group and control group are shown in Table 1. The patients selected to participate in the research were all edentulous and in good health so as to avoid the interference of any medical problems with their satisfaction with dentures. They all enjoyed adequate cognitive ability and capacity to answer questions and to complete a form. Inclusion and exclusion criteria are shown in Table 2. The Ethical Committee of the China Medical University approved the study protocols, and all participants signed an informed consent according to the Declaration of Helsinki. Procedures Participants were randomly allocated to either the intervention (n = 42) or the control (n = 42) group. The control group received doctor’s regular advice (21, 22), such as starting with soft and non-sticky food, cutting food into small pieces, chewing slowly using both sides of the mouth, keeping dentures clean and free from food that can cause stains, bad breath, or swollen gums, brushing dentures every day with a denture care product, taking dentures out of the mouth at night and putting them in water or a denture-cleansing liquid, contacting the dentist if dentures seem ill fitting or painful after treatment. The

intervention group received psychological intervention before the prosthesis. To complete initial interviews and the clinical examinations, the methods described by Sun et al. (23) were employed in this study. SZP was used to measure the mucosa thickness of the bilateral incisors and the alveolar ridge crest of the first molar. The alveolar ridge height between the bilateral incisors and the first molar was measured by height vemier calliper. For saliva flow rates, patients do one swallow first and then look down, followed by opening mouth slightly to let the saliva flow naturally. The saliva was collected for 5 min by a tube with a funnel inside. The complete initial interviews and the clinical examinations were conducted by the same graduate students, and the construction of the complete dentures was conducted by the same dental technician to ensure uniformity. A typical sequence of the procedures for denture fabrication (24, 25) includes (i) preliminary impressions for the development of diagnostic casts and custom impression trays, (ii) definitive impressions in the custom trays for fabrication of master casts, (iii) facebow transfers and maxillomandibular relationship records on trial bases and subsequent mounting of casts in adjustable articulators, (iv) one or more tooth try-in appointments for verifying maxillomandibular relationships and aesthetics, (v) denture insertion and posterior adjustment phase. The subjects of both groups had their dentures adjusted three times after insertion before 1 month post-insertion visits. Psychological intervention Group psychoeducation was provided to the intervention participants in a private clinic by specialists. Each group consisted of two to three patients, depending on the patient accrual and to minimise the waiting time. Each session lasted for about 30 min: the first 15 min were used for an instructive lecture, which was followed by group discussions between patients and dentists. The topics of the instructive lecture included ‘Epidemiology of Edentulous Jaws’, ‘Influence of Edentulous Jaws’, ‘Complete Denture’ and ‘Factors which influence the denture retention and stability’ (26–29). In addition, an educational textbook was developed describing the anatomical structure of edentulous jaws, principles of the retention and stability of complete dentures, maxillomandibular relationship or the relationship between jaw and the shape of © 2014 John Wiley & Sons Ltd

© 2014 John Wiley & Sons Ltd

Age (Year)

Height of lower residual ridge (mm)

Male 24 Female 18 Median 68 9
180 6
583 Interquartile 0
000 1
113 2
367 Range Maximum 75 11
880 8
956 Minimum 38 8
080 3
177 P (gender) P (age) P (height of upper residual ridge) P (height of lower residual ridge) P (thickness of upper residual mucous membrane) P (thickness of lower residual mucous membrane) P (salivary flow)

Gender (No.)

Height of upper residual ridge (mm)

Intervention group

1
893 0
439 2
321 1
198

3
142 1
067

Thickness of lower residual mucous membrane (mm)

2
393 0
489

Thickness of upper residual mucous membrane (mm)

Table 1. Characteristics in intervention group and control group

0
681 0
391

0
432 0
094

Salivary flow (ml/min)

0
827 0
223 0
207 0
466 0
179 0
124 0
120

22 20

Gender (No.)

75 38

68 0
750

Age (Year)

Control group

11
780 8
010

9
032 1
166

Height of upper residual ridge (mm)

8
456 3
023

6
565 2
083

Height of lower residual ridge (mm)

3
197 2
094

2
509 0
640

Thickness of upper residual mucous membrane (mm)

2
324 1
280

2
000 0
264

Thickness of lower residual mucous membrane (mm)

0
656 0
391

0
467 0
082

Salivary flow (ml/min)

PSYCHOLOGICAL GUIDANCE IMPACT ON DENTURES SATISFACTION 3

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Y. ZOU & D. ZHAN

Table 2. Inclusion and exclusion criteria Inclusion criteria

Exclusion criteria

1. Complete edentulousness, use of dentures for more than 5 years

1. History of diabetes, immunologic diseases, neurologic diseases, mental disorder, xerostomia and bruxism 2. Hyperplastic or inflammatory mucosal lesions 3. History of autoimmune diseases associated with recurrent mucosal ulcers

2. Presence of healthy denture-bearing tissues

artificial teeth (30, 31). For the purposes of the study, a video was made and shown to the participants illustrating the clinical procedure of complete dentures. In the group meetings, participants were encouraged to raise questions of any kind not only to answer any concerns they might have about the potential problems, limitations and possibilities of complete denture therapy but also to set up a harmonious patient and dentist relationship. The staff consisted of one professor of prosthodontics and one graduate student. The professor provided all the lectures and led the group meetings supported by the graduate student. Assessment of patient satisfaction after therapy The patients’ satisfaction with dentures was assessed using a patient denture satisfaction questionnaire (10, 32) (Table 3). Answers for each question had a range from 0 (worst possible outcome) to 10 (best possible outcome). One and three months after the first postinsertion visits, participants were asked to complete denture satisfaction questionnaires, covering five topics: aesthetics, speech, mastication, retention and comfort. All questions were explained to the patients enabling them to understand the meaning of each. Statistical analysis Statistical Package for the Social Sciences (SPSS) for Windows SPSS version 16.0* was used for statistical analysis. The Wilcoxon tests were used to compare the differences in characteristics of the clinical examinations outcome variables between the two groups. The

*SPSS Inc., Chicago, IL, USA.

Table 3. The questionnaire sent to all patients at first and third months following insertion of complete dentures. Answers for each question can range from 0 (worst possible outcome) to 10 (best possible outcome) How do you rate your appearance of your denture? How do you rate the quality of expression and phonetics? How do you rate the quality of your mastication? How do you rate the removal and insertion of your denture? How comfortable is your denture?

0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10

chi-square test was used to compare the differences between the patient gender of the two groups. In addition, the Wilcoxon signed rank test was employed to compare the score between first and third month in intervention group and control group when the twosample Kolmogorov–Smirnov test was used for comparing the differences of the score between the intervention group and control group in first and third month. Probabilities of 0
05) in control group in third month. The outcomes are presented in Table 5, which indicates that patient scores for aesthetic, speech, mastication and retention in both first and third month evaluations (P < 0
05) differed significantly between control and intervention groups, and the outcome of the intervention group exceeded the outcome of the control group. However, there was no difference for their scores related to comfort (P > 0
05) in both first and third month. The actual data for Tables 1, 4 and 5 are presented in Tables 6 and 7. © 2014 John Wiley & Sons Ltd

© 2014 John Wiley & Sons Ltd

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