journal of dentistry 42 (2014) 366–372
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Relationship between impacts of removable prosthodontic rehabilitation on daily living, satisfaction and personality profiles Mahmoud K. AL-Omiri a,*, Mohd G. Sghaireen b, Aladdin A. Al-Qudah c, Osama Abu Hammad a, Christopher D. Lynch d, Edward Lynch e a
Faculty of Dentistry, University of Jordan, Amman, Jordan Department of Prosthetic Dentistry, Faculty of Dentistry, AlJouf University, Sakaka, Saudi Arabia c Department of Restorative Dentistry, Faculty of Dentistry, Jordan University of Science & Technology, Irbid, Jordan d School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK e Warwick Dentistry, Warwick Medical School, Coventry CV4 7AL, UK b
article info
abstract
Article history:
Objectives: To investigate dental impacts on daily living and satisfaction with removable
Received 19 October 2013
complete and partial prosthodontic rehabilitations, and to identify their relationship with
Received in revised form
personality profiles.
7 December 2013
Methods: Sixty-eight patients (38 males and 30 females; mean age = 53.2 11.8 years)
Accepted 18 December 2013
received removable prostheses (32 complete dentures and 36 removable partial dentures). Clinical success of prostheses was assessed according specific criteria. The Dental Impact on Daily Living (DIDL) questionnaire was utilized to assess satisfaction with prostheses and
Keywords:
impacts on daily living. NEO Five Factor Inventory (NEO-FFI) was utilized to assess patients’
Impacts on daily living
personality profiles.
DIDL
Results: Participants’ total satisfaction and satisfaction with appearance, pain tolerance,
NEO-FFI
oral comfort, and eating improved after treatment ( p < .05). Position of prosthesis and age
Personality
had no significant relationships with satisfaction or personality scores ( p > .05). Females
Satisfaction
were less satisfied with appearance ( p < .05). Patients who received partial dentures were
Removable denture
more satisfied with eating and scored higher total satisfaction scores than those who had complete dentures ( p < .05). Before treatment; Neuroticism and Openness scores were associated with dental satisfaction and impacts ( p < .05). After treatment, Conscientiousness and Extraversion scores were associated with dental satisfaction and impacts ( p < .05). Conclusions: Patients satisfaction with oral condition improved following using removable prosthetic rehabilitation with RPD having better impacts than CD. Psychological profiles (e.g. Neuroticism, Extraversion, Openness and Conscientiousness) might play a role and explain prosthetic impacts on daily living and patients’ satisfaction with prostheses. # 2013 Elsevier Ltd. All rights reserved.
* Corresponding author at: Faculty of Dentistry, University of Jordan, Amman 11942, Jorda. Tel.: +962 79 5571629. E-mail address: [email protected] (M.K. AL-Omiri). 0300-5712/$ – see front matter # 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jdent.2013.12.010
journal of dentistry 42 (2014) 366–372
1.
Introduction
Prosthetic rehabilitations are expensive and lengthy treatment and it is a must to ensure patients’ acceptance of and satisfaction with this lengthy procedure before going any further.1–7 Satisfaction with dental prosthesis was extensively studied in the literature.1–16 Fixed implant supported prosthesis were found to be more satisfactory for patients than removable implant supported prosthesis and conventional removable denture treatment.13–15 Satisfaction with complete and removable dentures was found to be associated with Oral health related quality of life.16–18 Metal based removable partial dentures were associated with better satisfaction and impacts on oral health related quality of life in comparison to acrylic based RPDs or complete dentures.15 Satisfaction with dental prostheses and oral conditions was associated with the presence of certain personality traits and tendencies.1–6,8–10,19–22 However, other studies found no such relation.11,12,23–25 The controversy still exists and the evidence based knowledge in this regard is still inconclusive; therefore, further studies are required. Oral health related quality of life was found to be associated with general health related quality of life.26 Also, oral health status impacts on patient’s daily living; consequently, assessment of dental needs should be associated with assessment of clinical status and psychological dimensions.19,20 Nevertheless, some studies showed that being clinically successful and excellent dental prosthesis might not be satisfactory to patients.8,19,20 The reason for this observation might be the presence of underlying personality patterns or traits that affect patients’ satisfaction with their dentition and/or dental prostheses.3,5,6,21,22 Many previous studies used non-reliable tests to measure personality traits and satisfaction. In order to establish a relationship between satisfaction and personality; valid and reliable tests must be used carefully.2–6 Since certain personality traits were found to associate satisfaction with some dental treatments3,5,6,27; it is worth investigating the probability of presence of this association in case of prosthetic rehabilitations to achieve the best treatments possible. This study aimed to measure the relationship between impacts of complete and partial removable prosthodontic rehabilitations on daily living, dental satisfaction and patients’ personality profiles. The null hypothesis was set to be that there are no relationships between personality profiles, dental satisfaction and impacts of complete and partial removable prosthodontic rehabilitations on daily living.
2.
Materials and methods
Sixty-eight patients who attended dental clinics to replace their missing teeth and were scheduled to receive complete or partial removable prosthetic rehabilitations were recruited into this study. Patients were included in this study if they were above 18 years old, and have their prosthesis successful with no clinical problems or failures throughout the study. To
367
be included the patient should also have no mental retardation and no severe medical illness that might affect their ability to understand/complete the questionnaires or to cooperate with the investigator. Patients’ informed consent was obtained before going any further in the study. The study was ethically approved by Deanship of Research, University of Jordan (Amman, Jordan). Two previously published and widely used questionnaires were used in this study. The first is called the NEO Five Factor Inventory (NEO-FFI)28 and was used to assess patients’ personality factors. The second is called Dental Impact on Daily Living (DIDL) questionnaire20 and was used to assess patients’ satisfaction with their dentition and/or dental prosthesis. Each patient completed the questionnaires before fabrication of the prosthesis. Then patients received upper and lower complete dentures (32 participants) or removable partial dentures (36 participants). After fitting the prosthesis, each patient was examined to ensure the clinical success of the prosthesis before completion of the questionnaires again. The specific clinical criteria used by previous studies6,27 to assess clinical success of a removable denture were expanded and modified before being used for the purpose of this study. Therefore, the assessed criteria included assessment of appearance, retention, stability, support, speech, occlusion, and health of supporting tissues. It was decided to exclude patients with any prosthesis associated with poor extensions; poor retention, stability or support; poor speech, poor aesthetics (including tooth size, shape, colour, arrangement and position); infections beneath the prosthesis; presence of trauma or lesions related to the prosthesis; and problems in vertical dimension, centric relation, or occlusion. Also, patients with ill fitting, inadequately functioning, fractured or cracked prosthesis were excluded. Patients’ personality profiles and levels of satisfaction were assessed before and three months after insertion of the prosthesis. The DIDL and NEO-FFI questionnaires were administered to the patients, and the process of completing the questionnaires was supervised by the investigator. Each patient was provided with a full explanation of the dimensions as well as the methods of scoring each questionnaire. One investigator performed all clinical examinations and carefully assessed each patient. Intra examiner reliability was executed on five duplicate examinations using Kappa statistics. Kappa was .92 indicating significant agreement as examination criteria were clear and simple. Inter-examiner reliability was also assessed by examining the same five patients by another consultant prosthodontist and Kappa was found to be .9 indicating high inter-examiner reliability. Inter-examiner reliability was assessed to make sure that the examiner who assessed all patients was not making any mistakes during the examination, and to make sure that other examiners can perform and follow the examination criteria set for this study.
2.1.
Statistical analysis
The data were analysed using the SPSS computer software (Statistical Package for the Social Sciences, version 19.0, SPSS
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journal of dentistry 42 (2014) 366–372
Table 1 – Distribution of participants by satisfaction with DIDL total score and individual dimension scores before and after treatment. DIDL dimension
Dissatisfied (%) Before treatment
Total satisfaction Appearance Pain Oral comfort General performance Eating and chewing
24 22 19 27 20 27
(35.3) (32.4) (27.9) (39.7) (29.4) (39.7)
Relatively satisfied (%)
After treatment 7 1 11 11 25 13
Before treatment
(10.3) (1.5) (16.2) (16.2) (36.8) (19.1)
Inc., Chicago, IL, USA). Pearson Correlation test was used to identify the relationship between personality factors, satisfaction with prosthetic rehabilitations, gender, age and type and position of the prosthesis. Paired samples t-test was used to compare satisfaction and personality scores before and after treatment. For all statistical analysis, the significance level was set at p .05. In order to ensure the use of the most appropriate statistical methods and to avoid statistical errors; the statistical analyses methods used in the current study are supported with the conclusions and recommendations suggested by Hannigan and Lynch.29
3.
Results
Sixty-eight (38 males and 30 females) patients participated in this study. Participants’ age ranged between 30 and 77 years old (mean age = 53.2 11.8 years). Before treatment; total satisfaction scores ranged between .71 and 1.00 with mean score of .2 .45. After treatment, total satisfaction scores ranged between .41 and 1.00 with mean score of .50 .36. The mean score of total satisfaction with oral condition was higher after receiving the prosthetic treatment.
33 7 18 7 4 5
(48.5) (10.3) (26.5) (10.3) (5.9) (7.4)
Satisfied (%)
After treatment 37 2 6 1 1 4
(54.4) (2.9) (8.8) (1.5) (1.5) (5.9)
Before treatment 11 39 31 34 44 36
(16.2) (57.4) (45.6) (50.0) (64.7) (52.9)
After treatment 24 65 51 56 42 51
(35.3) (95.6) (75) (82.4) (61.8) (75)
Table 1 shows patients total satisfaction and satisfaction with each dimension of the DIDL questionnaire before and after treatment. Before treatment 24 (35.3%) of the participants were dissatisfied with their oral condition meanwhile only 7 (10.3%) participants were dissatisfied with their oral condition. The numbers of completely satisfied participants were increased for each DIDL dimension after treatment (Table 1). Table 2 presents the distribution of mean scores of personality profiles among the study population before and after treatment. Table 3 shows the distribution of each NEOFFI personality domain scores among the study population before and after the treatment. Position and type of prosthesis were correlated with satisfaction and personality scores using Pearson’s correlation test. Position of prosthesis had no significant relationships with satisfaction scores ( p > .05). However, type of prosthesis was found to have significant relationships with total satisfaction with the prosthesis (r = .286, p = .018) and satisfaction with eating using the prosthesis (r = .375, p = .002). Patients who received partial removable dentures were more satisfied with eating and scored higher total satisfaction scores than those who had complete dentures. Nevertheless, type and position of the prosthesis had no relationships with personality profiles ( p > .05).
Table 2 – The distribution of personality profiles among the study population before and after treatment. Personality domain
Before treatment
After treatment
Mean score (SD)
Range
Mean score (SD)
Range
23.16(6.88) 29.38(4.88) 20.97(3.47) 26. 90(4.4) 34.97(5.17)
8–36 18–41 13–28 16–36 24–46
21.91(7.3) 29.79(5.4) 20.68(3.38) 27.99(4.15) 36.37(5.42)
9–36 3–42 14–29 18–36 24–46
Neuroticism Extraversion Openness Agreeableness Conscientiousness
Table 3 – Distribution of study population (n = 68) according their NEO-FFI (personality domains) scores before and after treatment. Personality domain
Low score (%) Before treatment
Neuroticism Extraversion Openness Agreeableness Conscientiousness
8(11.8) 10 (14.7) 52 (76.5) 49 (72.1) 8 (11.8)
Average score (%)
After treatment 10 8 54 44 10
(14.7) (11.8) (79.4) (64.7) (14.7)
Before treatment 18(26.5) 32 (47.1) 0 (0) 0 (0) 39 (57.4)
After treatment 23 33 0 0 32
(33.8) (48.5) (0) (0) (47.1)
High score (%) Before treatment 42(61.8) 26 (38.2) 16 (23.5) 19 (27.9) 21 (30.9)
After treatment 35 27 14 24 26
(51.5) (39.7) (20.6) (35.3) (38.2)
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journal of dentistry 42 (2014) 366–372
Table 4 – Correlations between NEO-FFI and DIDL scores among the study population before and after treatment. DIDL dimensions
NEO-FFI dimensions Neuroticism
1. Total satisfaction Before treatment After treatment
2. Appearance Before treatment After treatment
3. Pain Before treatment After treatment
4. Oral comfort Before treatment After treatment
After treatment
Openness
Agreeableness
Conscientiousness
R= P= R= P=
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
R= P= R= P=
.353* .003 NS
NS
NS
NS
NS
NS
NS
NS
NS
R= P= R= P=
NS
NS
NS
NS
NS
NS
.258 .034* NS
NS
.248* .041
R= P= R= P=
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
.257* .035
NS
NS
NS
5. General performance R= Before treatment P= R= After treatment P= 6. Eating Before treatment
Extraversion
R= P= R= P=
R = Pearson’s correlation coefficient, P = probability levels, * = significant relation, NS = not significant relation.
Pearson correlation test was also used to correlate gender and age with the DIDL and NEO-FFI scores. Females were less satisfied with appearance (r = .243, p = .046) than males. Moreover, females scored higher on Neuroticism (r = .265, p = .029), and lower on Openness (r = .268, p = .027) personality domains before treatment. However after treatment, females scored higher Agreeableness scores than males (r = .492, p = .000). Moreover, age had no relationships with satisfaction scores or personality profiles ( p > .05). Table 4 presents the correlations between personality profiles and satisfaction dimensions before and after treatment. Before treatment; lower Neuroticism scores were associated with higher satisfaction with appearance ( p = .003), and higher openness scores were associated with less pain tolerance and satisfaction ( p = .034) (Table 4). On the other hand and after treatment; higher Conscientiousness scores were associated with more pain tolerance and satisfaction ( p = .041), and higher Extraversion scores were associated with higher satisfaction with eating ( p = .035) (Table 4). Table 5 shows the comparison of satisfaction scores and personality profiles before and after treatment. Participants’ total satisfaction and satisfaction with appearance, pain tolerance, oral comfort, and eating after treatment were higher than that before treatment ( p < .05). Also, participants’
conscientiousness scores after treatment were higher than those scored before treatment ( p < .05) (Table 5).
4.
Discussion
The results of this study demonstrated that a removable prosthesis impacts on patients’ daily living and satisfaction. Also, psychological traits had significant relationships with impacts of removable prostheses on patients’ daily living and satisfaction. Therefore, the null hypothesis of the study was rejected. The DIDL questionnaire was previously tested for Jordanian and non-Jordanian populations and was found to have adequate reliability, validity, accuracy and reproducibility.1– 4,20 Furthermore, it was considered efficient to use, relatively short, simple, and easy to understand and score. The Dental Impact on Daily Living test is a socio-dental instrument that was used in this study because unlike other socio-dental indicators, it measures dental impacts on daily living, relative importance that respondents assign to each dimension, and different aspects of oral status. Also, it points out whether a problem is completely internal or has interpersonal or social impacts. Moreover, as impacts rarely happen individually, a single impact score is provided to
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Table 5 – Paired samples t-test for comparison of participants’ satisfaction scores and personality profiles before and after treatment. Correlated pairs
Paired differences Mean
SD
Std. error mean
.383 .905 .950 .910 1.223 1.226 7.187 5.011 3.898 4.541 5.486
.046 .111 .115 .111 .148 .149 .872 .608 .473 .551 .665
t
.295 .701 .412 .537 .103 .426 1.250 .412 .294 1.088 1.397
Sig. (2-tailed)
67 66 67 66 67 67 67 67 67 67 67
.000 .000 .001 .000 .490 .005 .156 .500 .536 .052 .039
95% confidence interval of the difference Lower
Total satisfaction B–total satisfaction A Appearance B–appearance A Pain B–pain A Comfort B–comfort A G Performance B–G performance A Eating B–eating B Neuroticism B–neuroticism A Extraversion B–extraversion A Openness B–openness A Agreeableness B–agreeableness A Conscientiousness B–conscientiousness A
df
.388 .922 .642 .759 .193 .723 .490 1.625 .649 2.187 2.725
Upper .203 .481 .182 .315 .399 .130 2.990 .801 1.238 .011 .069
6.369 6.346 3.574 4.833 .694 2.870 1.434 .678 .622 1.976 2.100
B = before treatment, A = after treatment, SD = standard deviation, t = t test statistic, df = degree of freedom, G performance = general performance.
evaluate total oral impact. Quality of life and clinical oral status are closely related; therefore, the considerable impacts should be used to evaluate needs. The DIDL weigh dimension scores and then add them into a single score, a characteristic that is not available by many instruments such as the Oral Health Impact Profile (OHIP).1 DIDL is suitable to use in studies that investigate the relationship between dental impacts on daily living, oral health related quality of life, dental satisfaction and personality profiles and personality. Therefore, it provides a more satisfactory assessment of the effects of teeth on daily living and satisfaction with oral cavity, and it is more sensitive to the effects of variations in psychological profiles.1,4 The NEO-FFI test was used in this study because it provides a comprehensive measurement of the five dimensions of personality; it is simple and can be completed in a short time; it is valid, reliable, and easy to use statistically.28,30 This questionnaire was validated for Jordanian population in previous studies and was found valid and reliable.2–5 Previous studies used different psychological tests to assess the relationship between personality profiles and satisfaction with dentures. However, these tests suffered from some defects mainly related to comprehensiveness, reliability, validity and suitability to use.2–5 Females were less satisfied with appearance and this could be due to that females are more aware of aesthetics, take aesthetics as higher priority and seek treatment for aesthetic defects. This concurs the findings of previous studies.3–5,31 However, it opposes other studies that found no relationship between gender and satisfaction with complete denture.6,27,32,33 Religious and cultural backgrounds and the use of comprehensive measures with high validity and reliability might justify this difference. Females were found to be more neurotic and less open than males. This can be explained by that females are more self conscious and lead more stressful life than males; and they had suffered some shortcomings related to their compromised dentition that led to some effects on their quality of life and
contact with people and thus they became more neurotic and less open. This result concur the results of previous studies that found females to be more neurotic and less open.6 In this study, age had no relationship to satisfaction with dentures. This finding concur the findings of previous studies.27,32,33 However, it contrasts with other studies that found that older patients were less satisfied with complete dentures than younger ones.6,34 Cultural and religious factors and the use of valid, reliable and comprehensive measures might be the reason for this difference from other studies. In this study, patients’ satisfaction with their oral cavity increased following the insertion of prosthetic rehabilitations. This could be explained on the basis that the prosthesis improved the compromised oral function and status and thus improved patient satisfaction with their oral condition and treatment. Nevertheless and despite their dentures were technically and functionally successful; 10.3% of the patients were dissatisfied following their removable denture treatment in general and some patients were dissatisfied with their appearance, pain tolerance, oral comfort, general performance and eating. This could be explained by patients’ psychogenic factors. Before treatment, the results of this study showed that the higher the neuroticism scores the less the satisfaction with appearance. Furthermore, the higher the openness scores the less the pain tolerance. On the other hand and after treatment, the higher the conscientiousness scores the higher tolerance to pain. Also, the higher the extraversion scores the higher the satisfaction with eating. The above relations between personality profiles and removable dentures impacts on daily living and satisfaction with denture treatment might be justified on the bases that the more neurotic the patient the more they will be concerned about their oral cavity and thus the more they report negative impacts of oral cavity on their appearance. Also, the more open the patient the more they will talk about their pain experience and report any pain related issues. Furthermore, conscious patients are devoted to perform things in perfect
journal of dentistry 42 (2014) 366–372
way and thus they report any positive impacts of denture treatment on their satisfaction with pain tolerance. In addition, extraverted people are more outgoing and report the positive effects of the denture treatment on their satisfaction with eating. The above findings agreed with previous studies that used the DIDL and NEO-FFI instruments in other dental situations and treatments and revealed the presence of some role of psychological factors in determining impacts of dental treatment on daily living and shaping patients’ satisfaction with dental status and treatment.1–6 Also, it agreed with studies on the relation between denture satisfaction and personality factors.6,12,27,35,36 However, it disagrees with other studies that reported no relation between personality profiles and denture satisfaction.11,23,24 This could be due to that previous studies used non-standardized, custom-made questionnaires or personality tests that have problems with validity, reliability, comprehensiveness, and suitability to use. Also, different study designs and sample sizes might explain such differences. This study revealed that Neuroticism, Extraversion, Openness and Conscientiousness personality traits were useful in predicting removable partial and complete denture impacts on daily living as well as satisfaction with removable denture treatment. This agrees with previous studies that demonstrated a role for personality traits in prediction of dental impacts on daily living and patient satisfaction with their dentition and different types of dental treatment and conditions.1–3,6,27 Economy, religion, cultural values and social conditions might have potential effects on satisfaction with denture treatment, and might alter the relationship between personality and impacts of removable denture treatment on daily living and satisfaction with denture treatment. Further studies are required to discover the potential effects of cultural or religious factors in this regard. Also, further research is required on larger samples particularly to evaluate the effects of factors such as treatment costs in a private versus university settings as well as outcomes of being treated by general practitioners versus experienced specialists and clinicians. This study used valid and reliable NEO-FFI and DIDL instruments to explore the relationship between personality profiles and removable partial and complete denture impacts on daily living and satisfaction with removable denture treatment. The evaluation of personality features might be useful in predicting patient behaviour and may have an impact on the provision of therapy. Therefore, before starting prosthodontic treatment it might be sensible to suggest evaluating patients’ personality profiles and if some profiles are identified then clinicians can be more aware of patients’ expectations and reaction to the presented treatment. This might avoid extra costs and save efforts and time of both the dentists and the patient.
5.
Conclusions
Psychological profiles (e.g. Neuroticism, Extraversion, Openness and Conscientiousness) might play a role and clarify the
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impacts of removable partial and complete prosthetic rehabilitations’ on daily living and patients’ satisfaction with their oral status and treatment; therefore, might be used to predict satisfactory outcomes of prosthetic treatment. In this regard, technical features of prostheses are less critical when the prosthesis is clinically acceptable.
Conflict of interests The authors have no conflict of interests.
Acknowledgments The authors would like to thank The University of Jordan and Al-Jouf University for making this study possible. This work has been carried out during sabbatical leave granted to the author (Mahmoud AL-Omiri) from the University of Jordan during the academic year 2011–2013. The study was ethically approved by the Deanship of Scientific Research, University of Jordan, Amman, Jordan (Reference number 1-5-2-610/2012). The study has no source of funding.
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ScienceDirect journal homepage: www.intl.elsevierhealth.com/journals/jden
Relationship between impacts of removable prosthodontic rehabilitation on daily living, satisfaction and personality profiles Mahmoud K. AL-Omiri a,*, Mohd G. Sghaireen b, Aladdin A. Al-Qudah c, Osama Abu Hammad a, Christopher D. Lynch d, Edward Lynch e a
Faculty of Dentistry, University of Jordan, Amman, Jordan Department of Prosthetic Dentistry, Faculty of Dentistry, AlJouf University, Sakaka, Saudi Arabia c Department of Restorative Dentistry, Faculty of Dentistry, Jordan University of Science & Technology, Irbid, Jordan d School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK e Warwick Dentistry, Warwick Medical School, Coventry CV4 7AL, UK b
article info
abstract
Article history:
Objectives: To investigate dental impacts on daily living and satisfaction with removable
Received 19 October 2013
complete and partial prosthodontic rehabilitations, and to identify their relationship with
Received in revised form
personality profiles.
7 December 2013
Methods: Sixty-eight patients (38 males and 30 females; mean age = 53.2 11.8 years)
Accepted 18 December 2013
received removable prostheses (32 complete dentures and 36 removable partial dentures). Clinical success of prostheses was assessed according specific criteria. The Dental Impact on Daily Living (DIDL) questionnaire was utilized to assess satisfaction with prostheses and
Keywords:
impacts on daily living. NEO Five Factor Inventory (NEO-FFI) was utilized to assess patients’
Impacts on daily living
personality profiles.
DIDL
Results: Participants’ total satisfaction and satisfaction with appearance, pain tolerance,
NEO-FFI
oral comfort, and eating improved after treatment ( p < .05). Position of prosthesis and age
Personality
had no significant relationships with satisfaction or personality scores ( p > .05). Females
Satisfaction
were less satisfied with appearance ( p < .05). Patients who received partial dentures were
Removable denture
more satisfied with eating and scored higher total satisfaction scores than those who had complete dentures ( p < .05). Before treatment; Neuroticism and Openness scores were associated with dental satisfaction and impacts ( p < .05). After treatment, Conscientiousness and Extraversion scores were associated with dental satisfaction and impacts ( p < .05). Conclusions: Patients satisfaction with oral condition improved following using removable prosthetic rehabilitation with RPD having better impacts than CD. Psychological profiles (e.g. Neuroticism, Extraversion, Openness and Conscientiousness) might play a role and explain prosthetic impacts on daily living and patients’ satisfaction with prostheses. # 2013 Elsevier Ltd. All rights reserved.
* Corresponding author at: Faculty of Dentistry, University of Jordan, Amman 11942, Jorda. Tel.: +962 79 5571629. E-mail address: [email protected] (M.K. AL-Omiri). 0300-5712/$ – see front matter # 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jdent.2013.12.010
journal of dentistry 42 (2014) 366–372
1.
Introduction
Prosthetic rehabilitations are expensive and lengthy treatment and it is a must to ensure patients’ acceptance of and satisfaction with this lengthy procedure before going any further.1–7 Satisfaction with dental prosthesis was extensively studied in the literature.1–16 Fixed implant supported prosthesis were found to be more satisfactory for patients than removable implant supported prosthesis and conventional removable denture treatment.13–15 Satisfaction with complete and removable dentures was found to be associated with Oral health related quality of life.16–18 Metal based removable partial dentures were associated with better satisfaction and impacts on oral health related quality of life in comparison to acrylic based RPDs or complete dentures.15 Satisfaction with dental prostheses and oral conditions was associated with the presence of certain personality traits and tendencies.1–6,8–10,19–22 However, other studies found no such relation.11,12,23–25 The controversy still exists and the evidence based knowledge in this regard is still inconclusive; therefore, further studies are required. Oral health related quality of life was found to be associated with general health related quality of life.26 Also, oral health status impacts on patient’s daily living; consequently, assessment of dental needs should be associated with assessment of clinical status and psychological dimensions.19,20 Nevertheless, some studies showed that being clinically successful and excellent dental prosthesis might not be satisfactory to patients.8,19,20 The reason for this observation might be the presence of underlying personality patterns or traits that affect patients’ satisfaction with their dentition and/or dental prostheses.3,5,6,21,22 Many previous studies used non-reliable tests to measure personality traits and satisfaction. In order to establish a relationship between satisfaction and personality; valid and reliable tests must be used carefully.2–6 Since certain personality traits were found to associate satisfaction with some dental treatments3,5,6,27; it is worth investigating the probability of presence of this association in case of prosthetic rehabilitations to achieve the best treatments possible. This study aimed to measure the relationship between impacts of complete and partial removable prosthodontic rehabilitations on daily living, dental satisfaction and patients’ personality profiles. The null hypothesis was set to be that there are no relationships between personality profiles, dental satisfaction and impacts of complete and partial removable prosthodontic rehabilitations on daily living.
2.
Materials and methods
Sixty-eight patients who attended dental clinics to replace their missing teeth and were scheduled to receive complete or partial removable prosthetic rehabilitations were recruited into this study. Patients were included in this study if they were above 18 years old, and have their prosthesis successful with no clinical problems or failures throughout the study. To
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be included the patient should also have no mental retardation and no severe medical illness that might affect their ability to understand/complete the questionnaires or to cooperate with the investigator. Patients’ informed consent was obtained before going any further in the study. The study was ethically approved by Deanship of Research, University of Jordan (Amman, Jordan). Two previously published and widely used questionnaires were used in this study. The first is called the NEO Five Factor Inventory (NEO-FFI)28 and was used to assess patients’ personality factors. The second is called Dental Impact on Daily Living (DIDL) questionnaire20 and was used to assess patients’ satisfaction with their dentition and/or dental prosthesis. Each patient completed the questionnaires before fabrication of the prosthesis. Then patients received upper and lower complete dentures (32 participants) or removable partial dentures (36 participants). After fitting the prosthesis, each patient was examined to ensure the clinical success of the prosthesis before completion of the questionnaires again. The specific clinical criteria used by previous studies6,27 to assess clinical success of a removable denture were expanded and modified before being used for the purpose of this study. Therefore, the assessed criteria included assessment of appearance, retention, stability, support, speech, occlusion, and health of supporting tissues. It was decided to exclude patients with any prosthesis associated with poor extensions; poor retention, stability or support; poor speech, poor aesthetics (including tooth size, shape, colour, arrangement and position); infections beneath the prosthesis; presence of trauma or lesions related to the prosthesis; and problems in vertical dimension, centric relation, or occlusion. Also, patients with ill fitting, inadequately functioning, fractured or cracked prosthesis were excluded. Patients’ personality profiles and levels of satisfaction were assessed before and three months after insertion of the prosthesis. The DIDL and NEO-FFI questionnaires were administered to the patients, and the process of completing the questionnaires was supervised by the investigator. Each patient was provided with a full explanation of the dimensions as well as the methods of scoring each questionnaire. One investigator performed all clinical examinations and carefully assessed each patient. Intra examiner reliability was executed on five duplicate examinations using Kappa statistics. Kappa was .92 indicating significant agreement as examination criteria were clear and simple. Inter-examiner reliability was also assessed by examining the same five patients by another consultant prosthodontist and Kappa was found to be .9 indicating high inter-examiner reliability. Inter-examiner reliability was assessed to make sure that the examiner who assessed all patients was not making any mistakes during the examination, and to make sure that other examiners can perform and follow the examination criteria set for this study.
2.1.
Statistical analysis
The data were analysed using the SPSS computer software (Statistical Package for the Social Sciences, version 19.0, SPSS
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journal of dentistry 42 (2014) 366–372
Table 1 – Distribution of participants by satisfaction with DIDL total score and individual dimension scores before and after treatment. DIDL dimension
Dissatisfied (%) Before treatment
Total satisfaction Appearance Pain Oral comfort General performance Eating and chewing
24 22 19 27 20 27
(35.3) (32.4) (27.9) (39.7) (29.4) (39.7)
Relatively satisfied (%)
After treatment 7 1 11 11 25 13
Before treatment
(10.3) (1.5) (16.2) (16.2) (36.8) (19.1)
Inc., Chicago, IL, USA). Pearson Correlation test was used to identify the relationship between personality factors, satisfaction with prosthetic rehabilitations, gender, age and type and position of the prosthesis. Paired samples t-test was used to compare satisfaction and personality scores before and after treatment. For all statistical analysis, the significance level was set at p .05. In order to ensure the use of the most appropriate statistical methods and to avoid statistical errors; the statistical analyses methods used in the current study are supported with the conclusions and recommendations suggested by Hannigan and Lynch.29
3.
Results
Sixty-eight (38 males and 30 females) patients participated in this study. Participants’ age ranged between 30 and 77 years old (mean age = 53.2 11.8 years). Before treatment; total satisfaction scores ranged between .71 and 1.00 with mean score of .2 .45. After treatment, total satisfaction scores ranged between .41 and 1.00 with mean score of .50 .36. The mean score of total satisfaction with oral condition was higher after receiving the prosthetic treatment.
33 7 18 7 4 5
(48.5) (10.3) (26.5) (10.3) (5.9) (7.4)
Satisfied (%)
After treatment 37 2 6 1 1 4
(54.4) (2.9) (8.8) (1.5) (1.5) (5.9)
Before treatment 11 39 31 34 44 36
(16.2) (57.4) (45.6) (50.0) (64.7) (52.9)
After treatment 24 65 51 56 42 51
(35.3) (95.6) (75) (82.4) (61.8) (75)
Table 1 shows patients total satisfaction and satisfaction with each dimension of the DIDL questionnaire before and after treatment. Before treatment 24 (35.3%) of the participants were dissatisfied with their oral condition meanwhile only 7 (10.3%) participants were dissatisfied with their oral condition. The numbers of completely satisfied participants were increased for each DIDL dimension after treatment (Table 1). Table 2 presents the distribution of mean scores of personality profiles among the study population before and after treatment. Table 3 shows the distribution of each NEOFFI personality domain scores among the study population before and after the treatment. Position and type of prosthesis were correlated with satisfaction and personality scores using Pearson’s correlation test. Position of prosthesis had no significant relationships with satisfaction scores ( p > .05). However, type of prosthesis was found to have significant relationships with total satisfaction with the prosthesis (r = .286, p = .018) and satisfaction with eating using the prosthesis (r = .375, p = .002). Patients who received partial removable dentures were more satisfied with eating and scored higher total satisfaction scores than those who had complete dentures. Nevertheless, type and position of the prosthesis had no relationships with personality profiles ( p > .05).
Table 2 – The distribution of personality profiles among the study population before and after treatment. Personality domain
Before treatment
After treatment
Mean score (SD)
Range
Mean score (SD)
Range
23.16(6.88) 29.38(4.88) 20.97(3.47) 26. 90(4.4) 34.97(5.17)
8–36 18–41 13–28 16–36 24–46
21.91(7.3) 29.79(5.4) 20.68(3.38) 27.99(4.15) 36.37(5.42)
9–36 3–42 14–29 18–36 24–46
Neuroticism Extraversion Openness Agreeableness Conscientiousness
Table 3 – Distribution of study population (n = 68) according their NEO-FFI (personality domains) scores before and after treatment. Personality domain
Low score (%) Before treatment
Neuroticism Extraversion Openness Agreeableness Conscientiousness
8(11.8) 10 (14.7) 52 (76.5) 49 (72.1) 8 (11.8)
Average score (%)
After treatment 10 8 54 44 10
(14.7) (11.8) (79.4) (64.7) (14.7)
Before treatment 18(26.5) 32 (47.1) 0 (0) 0 (0) 39 (57.4)
After treatment 23 33 0 0 32
(33.8) (48.5) (0) (0) (47.1)
High score (%) Before treatment 42(61.8) 26 (38.2) 16 (23.5) 19 (27.9) 21 (30.9)
After treatment 35 27 14 24 26
(51.5) (39.7) (20.6) (35.3) (38.2)
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journal of dentistry 42 (2014) 366–372
Table 4 – Correlations between NEO-FFI and DIDL scores among the study population before and after treatment. DIDL dimensions
NEO-FFI dimensions Neuroticism
1. Total satisfaction Before treatment After treatment
2. Appearance Before treatment After treatment
3. Pain Before treatment After treatment
4. Oral comfort Before treatment After treatment
After treatment
Openness
Agreeableness
Conscientiousness
R= P= R= P=
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
R= P= R= P=
.353* .003 NS
NS
NS
NS
NS
NS
NS
NS
NS
R= P= R= P=
NS
NS
NS
NS
NS
NS
.258 .034* NS
NS
.248* .041
R= P= R= P=
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
.257* .035
NS
NS
NS
5. General performance R= Before treatment P= R= After treatment P= 6. Eating Before treatment
Extraversion
R= P= R= P=
R = Pearson’s correlation coefficient, P = probability levels, * = significant relation, NS = not significant relation.
Pearson correlation test was also used to correlate gender and age with the DIDL and NEO-FFI scores. Females were less satisfied with appearance (r = .243, p = .046) than males. Moreover, females scored higher on Neuroticism (r = .265, p = .029), and lower on Openness (r = .268, p = .027) personality domains before treatment. However after treatment, females scored higher Agreeableness scores than males (r = .492, p = .000). Moreover, age had no relationships with satisfaction scores or personality profiles ( p > .05). Table 4 presents the correlations between personality profiles and satisfaction dimensions before and after treatment. Before treatment; lower Neuroticism scores were associated with higher satisfaction with appearance ( p = .003), and higher openness scores were associated with less pain tolerance and satisfaction ( p = .034) (Table 4). On the other hand and after treatment; higher Conscientiousness scores were associated with more pain tolerance and satisfaction ( p = .041), and higher Extraversion scores were associated with higher satisfaction with eating ( p = .035) (Table 4). Table 5 shows the comparison of satisfaction scores and personality profiles before and after treatment. Participants’ total satisfaction and satisfaction with appearance, pain tolerance, oral comfort, and eating after treatment were higher than that before treatment ( p < .05). Also, participants’
conscientiousness scores after treatment were higher than those scored before treatment ( p < .05) (Table 5).
4.
Discussion
The results of this study demonstrated that a removable prosthesis impacts on patients’ daily living and satisfaction. Also, psychological traits had significant relationships with impacts of removable prostheses on patients’ daily living and satisfaction. Therefore, the null hypothesis of the study was rejected. The DIDL questionnaire was previously tested for Jordanian and non-Jordanian populations and was found to have adequate reliability, validity, accuracy and reproducibility.1– 4,20 Furthermore, it was considered efficient to use, relatively short, simple, and easy to understand and score. The Dental Impact on Daily Living test is a socio-dental instrument that was used in this study because unlike other socio-dental indicators, it measures dental impacts on daily living, relative importance that respondents assign to each dimension, and different aspects of oral status. Also, it points out whether a problem is completely internal or has interpersonal or social impacts. Moreover, as impacts rarely happen individually, a single impact score is provided to
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journal of dentistry 42 (2014) 366–372
Table 5 – Paired samples t-test for comparison of participants’ satisfaction scores and personality profiles before and after treatment. Correlated pairs
Paired differences Mean
SD
Std. error mean
.383 .905 .950 .910 1.223 1.226 7.187 5.011 3.898 4.541 5.486
.046 .111 .115 .111 .148 .149 .872 .608 .473 .551 .665
t
.295 .701 .412 .537 .103 .426 1.250 .412 .294 1.088 1.397
Sig. (2-tailed)
67 66 67 66 67 67 67 67 67 67 67
.000 .000 .001 .000 .490 .005 .156 .500 .536 .052 .039
95% confidence interval of the difference Lower
Total satisfaction B–total satisfaction A Appearance B–appearance A Pain B–pain A Comfort B–comfort A G Performance B–G performance A Eating B–eating B Neuroticism B–neuroticism A Extraversion B–extraversion A Openness B–openness A Agreeableness B–agreeableness A Conscientiousness B–conscientiousness A
df
.388 .922 .642 .759 .193 .723 .490 1.625 .649 2.187 2.725
Upper .203 .481 .182 .315 .399 .130 2.990 .801 1.238 .011 .069
6.369 6.346 3.574 4.833 .694 2.870 1.434 .678 .622 1.976 2.100
B = before treatment, A = after treatment, SD = standard deviation, t = t test statistic, df = degree of freedom, G performance = general performance.
evaluate total oral impact. Quality of life and clinical oral status are closely related; therefore, the considerable impacts should be used to evaluate needs. The DIDL weigh dimension scores and then add them into a single score, a characteristic that is not available by many instruments such as the Oral Health Impact Profile (OHIP).1 DIDL is suitable to use in studies that investigate the relationship between dental impacts on daily living, oral health related quality of life, dental satisfaction and personality profiles and personality. Therefore, it provides a more satisfactory assessment of the effects of teeth on daily living and satisfaction with oral cavity, and it is more sensitive to the effects of variations in psychological profiles.1,4 The NEO-FFI test was used in this study because it provides a comprehensive measurement of the five dimensions of personality; it is simple and can be completed in a short time; it is valid, reliable, and easy to use statistically.28,30 This questionnaire was validated for Jordanian population in previous studies and was found valid and reliable.2–5 Previous studies used different psychological tests to assess the relationship between personality profiles and satisfaction with dentures. However, these tests suffered from some defects mainly related to comprehensiveness, reliability, validity and suitability to use.2–5 Females were less satisfied with appearance and this could be due to that females are more aware of aesthetics, take aesthetics as higher priority and seek treatment for aesthetic defects. This concurs the findings of previous studies.3–5,31 However, it opposes other studies that found no relationship between gender and satisfaction with complete denture.6,27,32,33 Religious and cultural backgrounds and the use of comprehensive measures with high validity and reliability might justify this difference. Females were found to be more neurotic and less open than males. This can be explained by that females are more self conscious and lead more stressful life than males; and they had suffered some shortcomings related to their compromised dentition that led to some effects on their quality of life and
contact with people and thus they became more neurotic and less open. This result concur the results of previous studies that found females to be more neurotic and less open.6 In this study, age had no relationship to satisfaction with dentures. This finding concur the findings of previous studies.27,32,33 However, it contrasts with other studies that found that older patients were less satisfied with complete dentures than younger ones.6,34 Cultural and religious factors and the use of valid, reliable and comprehensive measures might be the reason for this difference from other studies. In this study, patients’ satisfaction with their oral cavity increased following the insertion of prosthetic rehabilitations. This could be explained on the basis that the prosthesis improved the compromised oral function and status and thus improved patient satisfaction with their oral condition and treatment. Nevertheless and despite their dentures were technically and functionally successful; 10.3% of the patients were dissatisfied following their removable denture treatment in general and some patients were dissatisfied with their appearance, pain tolerance, oral comfort, general performance and eating. This could be explained by patients’ psychogenic factors. Before treatment, the results of this study showed that the higher the neuroticism scores the less the satisfaction with appearance. Furthermore, the higher the openness scores the less the pain tolerance. On the other hand and after treatment, the higher the conscientiousness scores the higher tolerance to pain. Also, the higher the extraversion scores the higher the satisfaction with eating. The above relations between personality profiles and removable dentures impacts on daily living and satisfaction with denture treatment might be justified on the bases that the more neurotic the patient the more they will be concerned about their oral cavity and thus the more they report negative impacts of oral cavity on their appearance. Also, the more open the patient the more they will talk about their pain experience and report any pain related issues. Furthermore, conscious patients are devoted to perform things in perfect
journal of dentistry 42 (2014) 366–372
way and thus they report any positive impacts of denture treatment on their satisfaction with pain tolerance. In addition, extraverted people are more outgoing and report the positive effects of the denture treatment on their satisfaction with eating. The above findings agreed with previous studies that used the DIDL and NEO-FFI instruments in other dental situations and treatments and revealed the presence of some role of psychological factors in determining impacts of dental treatment on daily living and shaping patients’ satisfaction with dental status and treatment.1–6 Also, it agreed with studies on the relation between denture satisfaction and personality factors.6,12,27,35,36 However, it disagrees with other studies that reported no relation between personality profiles and denture satisfaction.11,23,24 This could be due to that previous studies used non-standardized, custom-made questionnaires or personality tests that have problems with validity, reliability, comprehensiveness, and suitability to use. Also, different study designs and sample sizes might explain such differences. This study revealed that Neuroticism, Extraversion, Openness and Conscientiousness personality traits were useful in predicting removable partial and complete denture impacts on daily living as well as satisfaction with removable denture treatment. This agrees with previous studies that demonstrated a role for personality traits in prediction of dental impacts on daily living and patient satisfaction with their dentition and different types of dental treatment and conditions.1–3,6,27 Economy, religion, cultural values and social conditions might have potential effects on satisfaction with denture treatment, and might alter the relationship between personality and impacts of removable denture treatment on daily living and satisfaction with denture treatment. Further studies are required to discover the potential effects of cultural or religious factors in this regard. Also, further research is required on larger samples particularly to evaluate the effects of factors such as treatment costs in a private versus university settings as well as outcomes of being treated by general practitioners versus experienced specialists and clinicians. This study used valid and reliable NEO-FFI and DIDL instruments to explore the relationship between personality profiles and removable partial and complete denture impacts on daily living and satisfaction with removable denture treatment. The evaluation of personality features might be useful in predicting patient behaviour and may have an impact on the provision of therapy. Therefore, before starting prosthodontic treatment it might be sensible to suggest evaluating patients’ personality profiles and if some profiles are identified then clinicians can be more aware of patients’ expectations and reaction to the presented treatment. This might avoid extra costs and save efforts and time of both the dentists and the patient.
5.
Conclusions
Psychological profiles (e.g. Neuroticism, Extraversion, Openness and Conscientiousness) might play a role and clarify the
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impacts of removable partial and complete prosthetic rehabilitations’ on daily living and patients’ satisfaction with their oral status and treatment; therefore, might be used to predict satisfactory outcomes of prosthetic treatment. In this regard, technical features of prostheses are less critical when the prosthesis is clinically acceptable.
Conflict of interests The authors have no conflict of interests.
Acknowledgments The authors would like to thank The University of Jordan and Al-Jouf University for making this study possible. This work has been carried out during sabbatical leave granted to the author (Mahmoud AL-Omiri) from the University of Jordan during the academic year 2011–2013. The study was ethically approved by the Deanship of Scientific Research, University of Jordan, Amman, Jordan (Reference number 1-5-2-610/2012). The study has no source of funding.
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