Impact on prosthodontic needs at the time and after tooth loss

Research Article Impact on prosthodontic needs at the time and after tooth loss Ashish R. Jain* ABSTRACT Background: Tooth loss can cause many changes to an individual; it can be a functional, esthetic, psychological, and social impact. Patient choices on receiving prosthodontic treatment can vary accordingly. Factors such as location of absent teeth, age, gender, impaired function, discomfort, and dissatisfaction with appearance play an important role in decision-making. Aim: The aim of the study was to assess the patient self-perceived impact and prosthodontic needs at the time and after tooth loss. Materials and Methods: Prospective cohort study was designed which involved questionnaires at the time of extraction and after extractions. About 120 random patients were selected and ensured they are recalled after extraction. Patient s selfperception was examined by a questionnaire that includes questions about functional, esthetic, and psychological impacts associated with tooth loss and need for prosthodontic treatment. Statistically, the data were analyzed. Results: Patients perception of impact associated with dental concern is high at the time of extraction is 79.2%. Patients perception of impact associated with dental concern is low as 65% after extraction majority of the patients in our study gave economic reasons for not replacing teeth. 50.9% of patients expressed a desire for immediate reposition. About 93.3% of patient had chewing difficulty after extraction has been done. Conclusion: The present results may serve as a baseline for the future evaluation of attitudes toward the replacement of teeth. The findings indicate that awareness needs to be created regarding the other functions of teeth such as esthetics and phonetics because many subjects in this study were only aware of the masticatory function performed by teeth, especially among individuals in the lower socioeconomic group. KEY WORDS: Edentulous, Extraction, Missing tooth, Tooth loss INTRODUCTION The goal of modern dentistry is to restore normal function, comfort, esthetics, speech, and health to individuals who are missing teeth. Given that our population is both aging and growing, an increasing number of people are being affected by the loss of teeth. [1] However, the more teeth a person are missing, the more challenging this task can become. As a result of continued research in the development of diagnostic tools and innovative treatment, predictable success is now a reality in many challenging dental situations. This is a blessing because tooth loss has some serious consequences. Self-perceived prosthodontic needs are determined by a sort of functional, esthetic, psychological, and social impacts due to tooth loss. [1,2] However, not all patients with incomplete dental arch need treatment to perceive their condition as harmful Access this article online Website: jprsolutions.info ISSN: 0975-7619 or with consequences. [3] Clinical factors such as number and location of absent teeth, age, gender, impaired function, discomfort and dissatisfaction with appearance, and other sociodemographic, cultural and financial factors influence perceived treatment needs and clinical decision-making. [4] Another issue that influences demand for prosthodontic treatment is the time between tooth loss and seek for treatment. It was hypothesized that self-perceived need and expressed desire for replacement are greater at the time of tooth loss. [5] This study assessed patients perceived impacts of tooth loss and prosthodontic needs at the time of extraction and if their perceptions change after a shortterm interval. MATERIALS AND METHODS A questionnaire was developed to elicit this information. The questionnaire includes 7 general questions, 9 questions at the time of extraction, and 9 questions after extractions. A short-term prospective cohort study was designed. Data were collected at two Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha University, Chennai, Tamil Nadu, India *Corresponding author: Dr. Ashish R. Jain, Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha University, Poonamallee High Road, Chennai 600 127, Tamil Nadu, India. Phone: +91-9884233423. E-mail: dr.ashishjain_r@yahoo.com Received on: 20-03-2018; Revised on: 19-04-2018; Accepted on: 27-05-2018 1340

stages: At the time of extraction and after extraction has been done. Random patients who walk into the hospital for extraction of the tooth due to varies reason such as dental caries with pulpitis, mobile tooth, periodontally compromised tooth were selected with the exception of third molar extraction, extraction for orthodontic purpose and emergency dental problems. About 120 random patients were selected and ensured they are recalled after extraction. Informed consent was obtained from every patient before the extraction was start. Clinical examination was performed at the tooth extraction appointment. General information such as age, gender, decayed, missing, and filled teeth (DMFT) score, number of previous extraction, and whether the missing space has been replaced is noted down. Patient s self-perception was examined by a questionnaire that includes questions about functional, esthetic, and psychological impacts associated to tooth loss and need of prosthodontic treatment. After few days before extraction, patients were contacted by phone and questions were asked if the patient had replaced their teeth and if not, the reason why they did not demand immediate replacement [Table 1]. RESULTS A total of 120 patients were included in the study (66.7% of male and 33.3% female). Age ranged from 20 to 72 years, and 66.7% were aged 30 years or more. DMFT score range from 2 to 8, about 50% of patients had edentulous space, and almost 66.7% of patient had non-treated edentulous space. Mean value of teeth that have been extracted is 10.4 ± 7.4. About 75% of the patient has undergone the previous extraction. 8.3% of patients had treated their missing space with fixed appliances. Table 1: Sample questionnaire survey S. No Questionnaire Response Yes/no 1. Age? 2. Gender 3. DMFT 4. Previous extraction done? If yes, how many teeth have been extracted? 5. Have you treated missing space/edentulous space? If yes, what kind of treatment have you done? (a) Fixed, (b) Removable, (c) Both At the time of extraction 6. Any chewing difficulty? 7. Are you satisfied with your appearance? 8. Are you concern about your dental condition? 9. Do you consider that immediate tooth replacement is mandatory? 10. Are you aware of consequences after extraction? 11. Do you believe prosthodontic solve all potential problem caused by tooth loss? 12. Are you interest in replacing your missing tooth? If no, why is it so? (a) Poor interest, (b) Poor motivation, (c) Financial problem, (d) Not satisfied with previous replacement, (e) Do not feel it s necessary 13. Do you need the prosthesis immediately after extraction? After Extraction 14. Is it difficult to chew any food? 15. Are you satisfied with your appearance? 16. Are you satisfied with your dental condition? 17. Are you concern about your dental condition? 18. Does this affect your general health and digestion? 19. Do you feel you need a replacement for missing teeth? If no why is it so? (a) Poor interest, (b) Poor motivation, (c) Financial problem, d) Not satisfied with previous replacement, (e) Do not feel it s necessary 20. If you desire a replacement, which prosthesis would you prefer? (a) FPD, (b) TPD, (c) Implant, (d) Others 21. Wearing a denture cause any problem or risk to your? (a) Surrounding structure, (b) Esthetic, (c) Chewing problem 1341

At the Time of Extraction Patients perception of impact associated with dental concern is high at the time of extraction is 79.2%. About 70.8% of patients had chewing difficulty at the time of extraction, and 29.2% of the patient does not have any chewing difficulty. Concerning of appearance satisfaction at the time of extraction, 90.8% of patients are satisfied, and 9.2% are not satisfied. 50.9% of patient considers immediate tooth replacement is mandatory, yet 6.7% of patients consider immediate tooth replace are not mandatory. 54.3% of patient are aware of consequences after extraction, and 45.8% of patient are not aware of those consequences. 83.3% of patients believe that prosthodontic solve all potential problem caused by tooth loss and 16.7% patient does not believe prosthodontic solve all potential problem caused by tooth loss. About 80.8% of patients intended to replace their missing tooth whereas 19.2% had no interest in replacing their missing tooth due to poor interest (39.1%), poor motivation (8.6%), and financial problem (30.4%) [Table 2]. Although 93.3% of patient consider immediate tooth replacement after extraction, only 32.7% of patient intended prosthesis immediately after extraction [Figure 1]. After Extraction Patients perception of impact associated with dental concern is low as 65% after extraction. About 93.3% of patient had chewing difficulty after extraction has been done. Concerning of appearance satisfaction after extraction, 89.1% of patient are satisfied, and 10.8% of patient are not satisfied. Only 54.2% of patients are satisfied with their dental condition [Figure 2]. Related to general health and digestion, about 16.7% of patients responded that it is affected meanwhile 83.3% of patients responded that it is not has been affected before extraction. About 79.2% of patients feel there is a need to replace their missing teeth and 20.8% of patient feels it s unnecessary to replace their missing teeth due to poor interest (88%), poor motivation (12%), and financial problem (40%). Majority of 63.2% of patients who considered replacing their teeth preferred implant followed by FPD (5.3%) and TPD (31.6%) [Figure 3]. DISCUSSION Extraction of teeth is the most common procedure carried out in oral surgery clinics. The final consequence of most dentoalveolar diseases is tooth loss, mostly through routine tooth extraction. Reasons for routine tooth extractions have been widely reported in medical literature. [6] We live in a social world and how we look influences our interactions with others. [2] The face and smile play a crucial role in the creation and maintenance of positive attitudes about one s self and have a tremendous emotional significance. [7,8] The face has become a symbol for the total self. A smile is a window into one s personality. [6] Today, a modern view of dentistry is one that recognizes the emotions or psychological essence of the patient in relationship to the dental situation, dental health care, and, especially, esthetics. [9-11] The attitude toward tooth loss is changing. Adults have greater expectations of their dental health Figure 1: At the time of extraction Table 2: Reason given by patient for lack of interest in replacing missing tooth At the time of extraction (%) After extraction (%) Poor interest 39.1 Poor interest 8.8 Poor motivation 8.6 Poor motivation 12 Financial problem 30.4 Financial problem 40 Not satisfied with previous treatment 0 Not satisfied with previous treatment 0 1342

Figure 2: After Extraction Figure 3: Treatment desire of the patient than in the past. Research has demonstrated that several non-disease factors such as attitude, behavior, dental attendance, and characteristics of the healthcare system play an important role in the decision to become edentulous. [12,13] At the time of extraction selfperception, patients expressed desire for immediate reposition (50.9%). The psychological effects of tooth loss and previous experiences of different degrees of missing space justify the extent of these frequencies. [14] Most patients (75%) had previous tooth loss, and 66.7% had replaced their missing tooth. Our study is a contrast to study made by Lineia and Claudio at which great part of patients expressed desire for immediate reposition (72.5%). Sociocultural characteristics and access to dental service may explain discrepancies in expressed desire for teeth reposition. [15] The majority of the patients in our study gave economic reasons for not replacing teeth. Cost was the main barrier for obtaining dentures and is in agreement with the findings of Lineia and Claudio. Very few patients expressed lack of knowledge regarding replacement of teeth. [16] Association with clinical variables reinforces that oral function and esthetics are important elements of quality of life. Few occluding pairs of posterior teeth are associated with chewing difficulties. [3] Desire for replacement of lost teeth appears to be independent from time interval after extraction, as observed in this shortterm study. The demand for replacement of missing teeth is strongly related to the position of the missing teeth. [17] Replacement of missing posterior teeth and cosmetic dental treatment in general, depends on the perception of the patient. [18-20] Even in countries with highly developed dental care systems, open spaces in the premolar and molar regions are well accepted by people of all ages. The prospect of a good esthetic result frequently motivates the patient to wear a new denture, and esthetics can be more important than function for many individuals. [21] In our study, patients who had lost teeth only in the anterior segment needed tooth replacement for esthetics; those who had lost teeth only in the posterior segment needed tooth replacement for mastication; and patients with teeth missing in both the anterior and posterior segment needed tooth replacement for mastication. These findings could be explained by the fact that most people in India are aware of only the mastication function served by the teeth. They are less aware of the esthetics and phonetics functions of teeth. CONCLUSION The present results may serve as a baseline for the future evaluation of attitudes toward the replacement of teeth. The findings indicate that awareness needs to be created regarding the other functions of teeth such as esthetics and phonetics because many subjects in this study were only aware of the masticatory function performed by teeth, especially among individuals in the lower socioeconomic group. REFERENCES 1. Levinson NA. Psychological facets of esthetic dental health care: A developmental perspective. J Prosthet Dent 1343

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