|Year : 2022 | Volume
| Issue : 2 | Page : 227-232
Assessment of quality and the utilization of the dental prosthesis and their impact on patient satisfaction
Mallika S Shetty, Hasan Sarfaraz, Kamalakanth K Shenoy
Department of Prosthodontics and Crown and Bridge, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, India
|Date of Submission||13-Jul-2022|
|Date of Acceptance||15-Sep-2022|
|Date of Web Publication||23-Dec-2022|
Dr. Mallika S Shetty
Department of Prosthodontics and Crown and Bridge, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
Background and Aim: Assessing patient satisfaction with dental prosthesis is usually difficult if the prosthesis does not fulfill the treatment need of the patient, and in most cases, the professionals' assessment of the prosthesis differs from the patients' perception of quality and treatment outcome. Patient satisfaction is important for the proper utilization of the prosthesis which helps improve the patients' overall quality of life and that remains the professionals' ultimate goal. The aim of this study was to assess the quality and utilization of dental prostheses and their impact on patient satisfaction. Materials and Methods: A cross-sectional survey was conducted on 1312 participants aged 18 years and above using a house-to-house approach among the rural population of Mangalore taluk. The study involved the completion of a predesigned and structured pro forma based on the WHO oral health assessment form. Evaluation of the prosthesis, and its quality was done by the professional. Fisher's exact test and odds ratio were conducted to find the significance of variables. P < 0.05 was considered statistically significant. Results: It was found that the retention and chewing efficiency of the complete denture had a positive comparison that was statistically significant. The retention of the partial denture wearers had a positive correlation between the patient perception and the professional assessment. In fixed partial dentures candidates, there was a statistically significant comparison between their perception and professionals' assessment with regard to hygiene and periodontal health. Conclusion: Most of the completely edentulous patients residing in the rural population of Mangalore taluk are quite satisfied with their prosthesis, whereas the professional assessment revealed that the older denture lacked retention, occlusion, and hygiene.
Keywords: Dental prosthesis, patient satisfaction, professional assessment
|How to cite this article:|
Shetty MS, Sarfaraz H, Shenoy KK. Assessment of quality and the utilization of the dental prosthesis and their impact on patient satisfaction. Arch Med Health Sci 2022;10:227-32
|How to cite this URL:|
Shetty MS, Sarfaraz H, Shenoy KK. Assessment of quality and the utilization of the dental prosthesis and their impact on patient satisfaction. Arch Med Health Sci [serial online] 2022 [cited 2023 Jan 31];10:227-32. Available from: https://www.amhsjournal.org/text.asp?2022/10/2/227/364953
| Introduction|| |
Oral health is of paramount importance in maintaining good general health of an individual. Among the rural population in India, oral health is not paid enough attention and is usually perceived to be less important than general health. Oral facial pain is the only condition that drives them to seek dental health care, and removal of teeth is the only treatment option that is opted for. A neglected oral health can cause chronic inflammatory changes of the gastric mucosa and higher rates of peptic duodenal ulcers.,
Compromised oral function has been linked to decreased self-esteem and a decline in psychosocial well-being. Hence, the preservation of natural dentition for lifetime has always been the goal of the dental profession. There have been many studies that have been conducted to assess the prosthetic need of the rural population. All these studies found that the need for dental prostheses was high.,,,,,
The literature search revealed that studies on patient satisfaction and professional assessment or evaluation were sparse. Assessing patient satisfaction with dental prosthesis is usually difficult if the prosthesis does not fulfill the treatment need of the patient, and in most cases, the professionals' assessment of the prosthesis differs from the patients' perception of quality and treatment outcome.
Thus, this study aims to assess the quality and the utilization of dental prosthesis and their impact on patient satisfaction, to understand the need for the remake of prosthesis, and also the scope for providing a better treatment option or plan.
| Materials and Methods|| |
Mangaluru is one among the five taluks of Dakshina Kannada District, Karnataka, India, with a population of 499,487 located in southwestern part of Karnataka. The rural population of Mangalore Taluk has 210,033 as obtained from the Census of India. As per the information obtained from the Karnataka district profile, Mangalore Taluk has 74 villages and 49-gram panchayats.
A cross-sectional survey was conducted on 1312 participants aged 18 years and above using a house-to-house approach. Before beginning with the survey, official permission was obtained from the District Health Officer of Mangalore Taluk. Ethical clearance to conduct a study was obtained from the institutional review board.
The sample size of 1312 was determined based on the prevalence of oral and prosthetic status (22.7%) according to the Dental Council of India.
Out of 49-gram panchayats, 16-gram panchayats were selected randomly. In the first stage, the taluk was arbitrarily divided into two geographical zones North and South. In the second stage, from each of the geographical zone, eight-gram panchayats were selected by simple random sampling (lottery method). In the third stage, based on the inclusion criteria, a door-to-door survey was conducted in every house till a target of 82 individuals was achieved.
All residents aged 18 years and above who have been residing in the selected village for at least 10 years and above with one or more teeth missing or received any prosthetic treatment were included in the study.
The study involved the completion of a predesigned and structured pro forma based on the WHO oral health assessment form. The Survey Pro Forma was designed to collect information from the participant regarding the demographic profile and to collect information regarding the type of prosthesis, quality and satisfaction with the prosthesis, and duration of wear. Evaluation of the prosthesis for its quality was done by the professional. If more than 60% of the variables were positive then the quality of prosthesis was considered good. Anything below 40% was considered inadequate and needs replacement.
Data obtained were analyzed using the statistical package IBM SPSS Statistics for windows, version 22.0. (Armonk, NY: IBM Corp). Fisher's exact test and odds ratio were conducted and results were obtained and P < 0.05 was considered statistically significant.
| Results|| |
A cross-sectional survey was carried out to determine the incidence of edentulism and its restoration among the rural population of Mangalore taluk. A total of 1312 participants were examined, which comprised 520 males (40%) and 792 females (60%) in the age group of 18 years and above.
The edentulous condition was assessed and it was found that, of 1312 total participants, 299 were completely edentulous and 949 were partially edentulous of which 59 and 85 were Kennedy's class I, 102 and 115 were Kennedy's class II, 416 and 485 were Kennedys class III, and 29 and 30 were Kennedys class IV in the maxillary and mandibular arch, respectively.
Assessment of the type of prosthesis delivered to the patient population revealed that 90.3% of the completely edentulous patients had a complete denture as prosthetic replacement. Only 31.2% of the total partially edentulous arches had been replaced with removable partial dentures, 8.4% replaced with fixed prostheses, and 3.1% of them with combination of the prosthesis. Sixty-four participants had received a single prosthetic crown.
A descriptive data on the duration of prosthesis use showed that the majority of the prosthesis was in services for a duration of <5 years irrespective of the type of prosthesis [Table 1].
The dental prosthesis was assessed by a professional and was compared with the perception of satisfaction by the participants.
It was found that the retention and chewing efficiency (occlusion) of the complete denture had a positive comparison that was statistically significant [Table 2].
|Table 2: Professional assessment and participants' perception of the complete removable prosthesis in association with the duration of prosthesis|
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The retention of the partial denture wearers had a positive correlation between the patient perception and the professional assessment (P < 0.0173) (P < 0.0333), respectively [Table 3].
|Table 3: Professional assessment and participants' perception of the partial removable prosthesis in association with duration of prosthesis|
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In fixed partial dentures (FPD) candidates, according to the professional assessment, hygiene and periodontal health showed statistically significant results. The assessment of the marginal integrity showed a larger number of FPDs having poor margins that was statistically significant (P < 0.0349) [Table 4].
|Table 4: Professional assessment and participants' perception of the fixed prosthesis in association with the duration of prosthesis|
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| Discussion|| |
This study aims to assess the quality and utilization of the dental prosthesis and their impact on patient satisfaction, Literature survey reveals that not much research has been carried out among the rural population with regard to the nature of edentulism, quality of prosthesis, patient satisfaction, and professional assessment of the prevailing prosthetic status. Most of the studies were conducted in hospital settings or in geriatric institutions, whereas the present study was a community-based survey, involving a larger sample size. In the present study (22.7%) of the study participants were completely edentulous.
In the present study, the dental prosthesis was in use for as long as 28 years. The duration of use of dental prosthesis showed that the majority of the participants wore the prosthesis for a duration <5 years (78.3%) and (21.7%) wore for more than 5 years. Similar studies conducted to assess the denture age and quality of existing dental prostheses found that the majority of the population used their dentures for more than 5 years.,, Although the service age of the removable denture prosthesis is 2–4 years, the majority of the population preferred not to have them replaced.
The professional evaluation of the complete removable prosthesis in association with duration of prosthesis revealed that esthetics was found to be satisfactory among majority of the participants. It was found to be high among those wearing the prosthesis for a duration of <5 years (93.4%). In comparison with the professionals' opinion, the study participants were found to have high expectations with the esthetics among all the age groups. This indicates that visual appearance is more important for most participants than function of prosthesis.
Professionals found that the retention was not satisfactory among those who wore the prosthesis for a duration more than 5 years (87.4%). The results are in accordance with the findings of Ribeiro et al., and Bilhan et al. who revealed a significant association between denture quality and years of denture use. Occlusion was found to be highly unsatisfactory among those who wore the prosthesis for more than 5 years (93%). When the hygiene of the prosthesis was evaluated by the professional, participants wearing the prosthesis for a duration of more than 5 years were found to have unsatisfactory hygiene. Dikbas et al. in his study found that older prostheses were unhygienic (88.1%).
The participants were satisfied with the quality of the complete dentures. It may be because majority of the study participants have been wearing the complete denture for more than a year (73.7%) and the function is taken over by the oral and jaw muscles and thus the participants have adjusted well with the dentures and feel comfortable and manage with the denture. This finding is in agreement with Nevalainen et al., who found that according to the dentists' evaluation, the elderly (84%) wore inadequate and poor dentures, but according to the participants' opinion 69% were satisfied with their dentures and 10% dissatisfied and 21% could not formulate an opinion. In their study, the dentures worn were as old as 30 years which showed that the longer the denture was worn the better was the acceptance and tolerance by the patient. de Baat et al., also revealed that there was difference in the opinions among the professionals and participants wherein participants showed 75% satisfaction with their dentures. Celebić et al. also found that the participants were mostly satisﬁed with the quality of their complete dentures (92.8%), but in the assessment of retention of maxillary complete dentures, older patients and patients with a longer period of being edentulous and a greater number of previous dentures gave lower ratings than younger patients with a shorter time of being edentulous. This can be justified as resorption of residual alveolar ridges, which reduces maxillary denture retention, and progresses with edentulousness and age. He also found that younger patients with the lowest number of previous dentures, the smallest period of being edentulous, and the best quality mandibular denture-bearing areas assessed the retention of their mandibular complete dentures with lower scores. This points out that the patients with the best residual alveolar ridges in the mandible gave the worst scores. This could be due to the long period necessary for the muscles of the lips, cheek, and tongue, which surround the lower denture, to adapt their function to the denture ﬂanges.
The professional evaluation of the partial removable prosthesis in association with the duration of prosthesis revealed that esthetics was found to be satisfactory. The participants were less satisfied with the esthetics compared to professional. Pietrokovski et al. found that the satisfaction of the patients with their RPD was greater than was justified by the clinicians grading.
Professional found that retention was not satisfactory. Occlusion was poor among majority of the participants who wore the prosthesis for a duration of <5 years (72.7%). The majority of the participants wearing prosthesis were found to have an unhygienic prosthesis. It was high among those wearing the prosthesis for more than 5 years (87.5%). The results show that longer the denture ages, the retention and hygiene get compromised. The participants need to be motivated for regular checkups, replacements, and maintenance of oral hygiene. New denture wearer was more dissatisfied than an old denture wearer. In the study by Cosme et al., there was positive correlation between the patient and the professional evaluations, except in hygiene where the professional evaluations showed dissatisfactory scores. According to a study by Sharma and Tabassum, the majority of the patients (78%) reported excellent esthetics, comfort, hygiene, masticatory efficacy, and retention.
The professional evaluation of the fixed prosthesis in association with the duration of prosthesis revealed that esthetics was most favorable among those who wore the prosthesis for duration of <5 years. According to Alshiddi et al., the overall result of the professionals' satisfaction to esthetics was lower than the participants' satisfaction. This reflects the ability of the professional to detect the esthetic failures in the prosthesis. According to a study by Kashbur and Bugaighis (2019), the majority of the patients (80.9%) were satisfied with their fixed prosthesis, and nearly, one-fifth (19.1%) were not satisfied. Similar finding was reported by Geiballa et al. This high satisfaction level could be attributed to the fact that fixed restorative treatment might have restored the feeling of “normality” to the patient, as participants felt the prosthesis more like a natural tooth.
The results reveal that newer the fixed prosthesis better is the quality; over a period due to the occlusal stresses, the wearing of the material takes place. The maintenance of hygiene mainly depends on professional advice and the participants' awareness and attitude.
| Conclusion|| |
It can be concluded from this study that most of the completely edentulous patients residing in the rural population of Mangalore taluk are quite satisfied with their prosthesis, whereas the professional assessment revealed that the older denture lacked retention, occlusion, and hygiene. This indicates that the complete denture prosthesis that is older than 5 years needs to be remade. Kennedy's class 3 was found to be predominant. There is a good number of partially edentulous cases falling in Kennedy's class 1 and class 2 categories which are replaced by removable prosthesis. These may be converted to a fixed prosthesis by proposing an implant-supported treatment plan. The participants' satisfaction with FPDs was relatively high, whereas the professional assessment revealed that the majority of the prosthesis had poor marginal integrity and over-contoured restorations leading to compromised periodontal health. Data thus gathered will be used to educate the patients on the quality of the prosthesis and how it can affect the long-term status of their oral health. Participants will also be made aware of the contemporary treatment options that are available to rehabilitate their edentulous condition and necessary arrangement will be made to provide them with the suggested treatment options.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| Survey Pro Forma|| |
Location Date Identification no.
Name: Age in years: Gender (M-1, F-2)
Self-reported oral health status; 1-Very good, 2-Good, 3-Average, 4-Bad, 5-Very bad □
Type of Prosthesis: 1-CD, 2-RPD,3-CROWN,4-FPD □
Duration of use of Prosthesis: 1-less than 1 year, 2-1-5yrs, 3-more than 5yrs □
DENTURE QUALITY: (Fixed &Removable Prosthesis)
Patients' opinion (Patient satisfaction): Ratings (0–10 where 0 is the worst possible outcome & 10 is the best possible outcome)
Retention (Fit) □
Ability to chew normally □
Prosthesis hygiene □
DENTISTS EVALUATION OF PROSTHESIS:
PARTIAL REMOVABLE PROSTHESIS: Ratings (0–10 where 0 is the worst possible outcome & 10 is the best possible outcome)
Esthetics (appearance of a dental restoration, as achieved through its color or form) □
Retention (resistance of a denture to vertical movement away from the tissues) □
Occlusion (the equalization of the occlusal contacts that prevents tooth movement after mandibular closure) □
Prosthesis hygiene □
COMPLETE REMOVABLE PROSTHESIS: Ratings (0–10 where 0 is the worst possible outcome & 10 is the best possible outcome)
Prosthesis hygiene □
FIXED PROSTHESIS/CROWNS – (using explorers) Ratings (0–10 where 0 is the worst possible outcome & 10 is the best possible outcome)
Good marginal fit □
Inflammation around the FPD/Crown □
Open contacts between prosthesis & adjacent tooth □
Faulty Occlusion (there are interceptive or defective contacts of occluding surfaces) □
Food lodgment around the FPD/Crown □
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[Table 1], [Table 2], [Table 3], [Table 4]