Top Fears of Denture Wearers How To Overcome Them To Maintain A Quality Lifestyle

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1 An Integra Institute Special Report The Integra Institute Center for Advanced Dental Learning Top Fears of Denture Wearers How To Overcome Them To Maintain A Quality Lifestyle Affecting Your Appearance, Health and Aging In This Report: Startling Information About Aging And Appearance The Halo Effect. What Is It and How It Pre-Determines Social Outcomes Lifestyle Changes You Can Expect When Succumbing To A Denture The Denture Handicap and Denture Wearers Nightmares Overcoming Edentulism and Maintaining Your Quality of Life

2 We understand the serious challenges you are facing in regards to your quality of life. We want to help you navigate these difficult choices by educating you with the most contemporary research. In this report we identify some serious conditions that are affecting your appearance, health, and aging. The great thing is these conditions are correctable. Included are strategies to help you succeed. This Report Focuses On Your Health and Appearance As It Relates To Living Without Teeth. Edentulous. The term means to be without teeth. Edentulism is a condition of living without natural teeth. Tooth loss and edentulism is a reality that a significant percentage of the population faces as they enter into their late adulthood. Edentulism involves anatomical loss, abnormality in structure and/or psychological disturbance1 33% of americans 65 and older are edentulous. 1 Currently there are 35 million Americans who wear complete dentures. The World Health Organization (WHO) predicts that the number of people who will need complete dentures will increase to 38 million in According to the National Health and Nutrition Examination Survey 53% of adults age wear full or partial dentures. 2 Edentulism affects an individual in 3 primary ways, that is, appearance, nutrition and psychological. The loss of teeth leading to edentulism was once accepted in society as an inevitable part of the aging process.. Edentulism As It Relates To Appearance. The Halo Effect The Halo Effect is a subjective bias about a person's one outstanding trait extending to influence the total judgment of that person. It involves judging a person or an event by a single trait or characteristic to create a bias about that person such as sociability, intelligence, or appearance. Once a person has formed an opinion of another person based on a single trait, he, or she, is likely to see that person in the same light again and again. Halo Effects can be positive or negative. We automatically categorize others before having an opportunity to evaluate their personalities, based on cultural stereotypes which say attractive people must be intrinsically good, and ugly people must be inherently bad. But Elliot Aronson, a social psychologist at Stanford University, believes in self-fulfilling prophecies - in which a person's confident self-perception, further perpetuated by healthy feedback from others which plays a role in success as well. Aronson suggests, based on the self-fulfilling prophecy that people who feel they are attractive are just as successful as their counterparts who are judged to be good-looking.

3 A lasting first Impression is a Halo Effect. The first impression overrides all subsequent impressions. Facial qualities are so useful in guiding adaptive behavior. Thus, striving to appear attractive may not be such a vain endeavor after all. Could It be that your single most outstanding trait is an unattractive, negative one? A single undesirable trait can cause one to subsequently be judged to have many poor traits, allowing a single weak point or negative trait to influence the perception of the person, or brand they represent. This is known as the Negative Halo Effect according to L. Zebrowitz, and J. Montepare in Social Psychological Face Perception:Why Appearance Matters Edentulism and dentures can contribute to a negative halo effect. In a report of the Surgeon General titled Oral Health In America(2000) it was noted that the overall affects of a poor appearance may: Cause stress Create feelings of depression Hurt your self-esteem Undermine your self-image Discourage social interaction Overall effects of edentulism and dentures may: Alter self-image, dislike of appearance Lower self-confidence Inability to discuss this taboo subject Alter behavior in socializing and forming close relationships Contribute to premature aging Studies investigating the effect of edentulism on patients quality of life reveal that some patients regard edentulism as a disfigurement7,8. This can perpetuate a negative halo effect. Some feel that they look different from other people, and some are ashamed by their tooth loss. This feeling of inadequacy may interfere with The Self-Validation Hypothesis or more simply stated thought confidence. The Journal of Psychology reported a person s attitude towards themselves and their ability to persuade others were enhanced by smile confidence. Your smile is a core component of life and living. Many edentulous patients feel dissatisfied with conventional dentures and believe that they just need to accept the problems they encounter as part of the denture wearing experience. 7 9 A denture worn too long can really do damage to the facial appearance. Long term wear of an old denture can force huge changes in the muscles of the face which affect not only facial appearance, but functional changes in the way the patient uses the jaws. A ten year study suggests: A smile protects you from heart disease

4 People who are unhappy are at a 22% higher risk of heart disease The study suggests that it might be possible to help prevent heart disease by enhancing people s positive emotions. Dr. Davidson, Herbert Irving Associate Professor of Medicine & Psychiatry and Director of the Center for Behavioral Cardiovascular Health at Columbia University Medical Center. Source: European Heart Journal Edentulism And The Denture Handicap According to the World Health Organization criteria, edentulism is considered a physical impairment since important body parts have been lost. Many patients with this condition may be identified as disabled due to their impaired ability to perform two essential life tasks, namely, speaking and eating. For others, it is truly a handicap because significant changes are needed in order to communicate. This impairment has all the characteristics of a chronic disease it is incurable, functionally and psychologically disruptive Locker reported that 39% of edentulous individuals indicated that they could not eat the foods that they would like to eat and that 29% enjoyed food less than before they lost their teeth. 2 Food avoidance or dietary restriction usually involves the hard fibrous foods that are difficult to chew, and this is well described inedentulous individuals3 5. Thus, all edentulous patients are impaired, and this impairment often renders them disabled, as they are frequently unable to eat certain foods1. In addition to the dietary limitations, edentulism causes many individuals to avoid social functions in which food is offered6. This fulfills the WHO definition of a handicap1. Edentulism can substantially affect general health as well as overall quality of life, including enjoyment of food and overall nutrition (5). The loss of all teeth, even with dentures, reduces masticating efficiency and affects food taste, food preferences, and food consumption patterns (6-12). Edentulism may also be associated with suboptimal intakes of various nutrients (13, 14) incresasing the risk of chronic illnesses such as cancer, diabetes, hypertension, and heart disease. Is There An Association Between Edentulism and Nutritional State? BHutton, et. al. J Can Dent Assoc. 2002; 68(3):182-7 Several studies have shown that edentate elderly consume fewer fruit and vegetables; less dietary fiber, carotene, calcium, and protein; and more cholesterol and saturated fat than do their dentate counterparts (8, 13, 14, 17-23) Top Fears of Denture Wearers Some people, who believe they have "bad teeth", may think it is in their best interests to have all their teeth extracted and complete dentures placed. However, statistics show that the majority of the people who actually receive this treatment wind up regretting they did so. Berg et al found that 66% of complete denture wearers were dissatisfied with their complete dentures due to poor retention, discomfort and pain. Also, complete dentures have only 15% of the chewing power of natural teeth,

5 which makes chewing a much more laborious task. Because of this residual ridge resorption continues to be the primary intraoral complication of edentulism. 1. Dentures require maintenance. Every day when they take your dentures out of your mouth to clean them you are reminded of what it is like to be without teeth. 2. Enjoying your favorite food will not be the same. Eating will never be the way you are used to eating, because exceptional flavors are lost. A denture covers your palette. This dials down the flavor of foods. Food textures change. The only way to enjoy the taste of your favorite favorite foods again is to eat without your dentures. 3. You become Orally Challenged. It will take you 1 month to learn how to speak again without drooling or spitting on someone. 4. It takes on average 6 months to learn how to chew again with dentures. You will learn to chew on both sides of you mouth at the same time. 5. Anxiety and Embarrassment. What will others think of me? 6. Anxiety and Embarrassment. I cannot possibly speak at the meeting... my dentures may fall out! 7. Fear of Intimacy. I cannot possibly kiss again. They may slip or fall out! 8. Isolation and Lost Confidence. The feeling of No one else is like me. 9. Daily discomfort and pain. You will routinely develop sore spots making it painful to chew. Overcoming Edentulism. Many people do not know they have alternatives to edentulism. The All-On Four is a dental implant technique that is one of the most important breakthrough in oral rehabilitation. The dental implant technique has gone on to literally rescue the quality of life of people suffering from tooth loss and edentulism. While assessing quality of life is complex, simply stated, its attributes include adequate functional and psychological health, life satisfaction, and self esteem. People who are unable to cope and adapt to denture prostheses can experience severe psychological consequences, as well as a compromised quality of life. People who elect the ALL ON FOUR procedure will 1. never have to take their teeth out. 2. never have their palette covered so their favorite foods taste and feel like they always have. 3. maintain 95% of their chewing force capacity. 4. never have a fear of intimacy. 5. never worry about their teeth slipping or falling out in awkward situations. 6. maintain their current nutritional state. 7. never have residual ridge resorption, the primary complication of denture wearers. 8. never have a denture handicap.

6 9. have a smile that will contribute to a positive halo effect. 10. increase their thought confidence level. References 1. World Health Organization. International Classifi- cation of Impairments, Disabilities and Handicaps. Gene- va: WHO, Locker D. The burden of oral disorders in a popu- lation of older adults. Community Dent Hlth 1992; 9: Osterberg T, Steen B. Relationship between dental state and dietary intake in 70-year-old males and females in Goteborg, Sweden: a population study. J Oral Rehabil 1982; 9: Sheiham A, Steele JG, Marcenes W et al. The impact of oral health on stated ability to eat certain foods; findings from the National Diet and Nutrition Survey of Older People in Great Britain. Gerodontology 1999; 16: Geissler CA, Bates JF. The nutritional effects of tooth loss. The American J Clin Nutrition 1984; 39: Hyland R, Ellis JS, Thomason M et al. Qualitative research into patient perspectives of how conven- tional and implant-supported dentures affect eating and the enjoyment of food. J Dent 2009; 48: Davis DM. The shift in the therapeutic paradigm: osseointegration. J Prosthet Dent 1998; 79: Fiske J, Davis DM, Frances C et al. The emotional effects of tooth loss in edentulous people. Br Dent J 1998; 184: discussion MacEntee MI, Hole R, Stolar E. The significance of the mouth in old age. Soc Sci Med 1997; 45: van Waas MA. Determinants of dissatisfaction with dentures: a multiple regression analysis. J Prosthet Dent 1990; 64: Berg E. The influence of some anamnestic, demo- graphic, and clinical variables on patient acceptance of new complete dentures. Acta Odontol Scand 1984; 42: Feine JS, Carlsson GE, Awad MA et al. The McGill Consensus Statement on Overdentures. Montreal, Quebec, Canada. May 24 25, Int J Prosthodont 2002; 15: Thomason JM, Feine J, Exley C et al. Mandibular two implant-supported overdentures as the first choice standard of care for edentulous patients the Ó 2010 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2011; 28: J. S. Ellis et al. York Consensus Statement. Br Dent J 2009; 207:

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