| dc.description.abstract | Background: Previous qualitative studies indicated that although many patients cope well with tooth loss and removable dentures, some might have less psychological resilience and capacity to adapt to new changes. Those individuals may endure negative emotions and psychological morbidities. There have been few quantitative studies to assess the psychological impact of tooth loss and dentures. There has also been a lack of suitable or validated tools to screen and measure such impact.
Aims: To investigate the psychological impact associated with tooth loss, and the effect of provision of dentures on this psychological impact
Method: Phase one included the development and validation of a disease-specific measure to assess the psychological impact associated with tooth loss, and the effect of provision of dentures on this psychological impact. Inclusion criteria included adults (age ≥18) with tooth loss and technically successful removable dentures. The quality of these dentures was assessed by a calibrated clinician (ZK). Exclusion criteria included patients with a history of psychotic mental illness or patients who had treatment with dental implants. 128 participants (100 patients - 28 clinicians) were recruited to participate in the development and validation of the questionnaire. The development processes included the following steps: Defining the aims/target population of the questionnaire, generating a pool of items, defining the constructs to be measured, adapting psychological morbidity screening tools, Items reduction,
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content validation, face validation, establishing construct validity, pilot testing and establishing reliability.
Phase two, the validated questionnaire was distributed to a sample of patients with tooth loss and technically successful removable dentures (n=70) and a control group of patients who had tooth loss with no dentures (n=68). For this study, the phase one criteria were also used for inclusions and exclusions. The short-form revised Eysenck personality questionnaire was distributed to assess the impact of personality traits on denture acceptance.
Results: In phase one, face and content validation indicated that the questionnaire was an appropriate tool to measure the impact of tooth loss and related psychological morbidities. Reliability analysis (Test re-test reliability/internal consistency) demonstrated that the questionnaire has satisfactory reliability (correlation >0.7). Testing the theoretical hypothesis structure of the impact of tooth loss has also enhanced the construct validity of the questionnaire (domains correlated mildly (r>5 & <3) to strongly (r>5). Pilot testing confirmed the scale adequacy and wording clarity (>90% of respondents). Results indicated that the developed questionnaire has adequate psychometric properties.
Phase two: There was a significant difference in body image dissatisfaction between the denture and control groups (χ2 =7.72, p value=0.005). The denture group had 5.75 times a higher probability to suffer from body image disturbance related to dentures than the control. There was no significant difference in
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psychological disturbance between the denture and control groups. However, participants in both groups presented with somatic symptoms related to depression or anxiety, which is nearly double of that, recorded in the general population (15.7% and 7.8% respectively). Furthermore, participants who complained about body image impairment were more likely to have higher scores on the neuroticism scale (OR=3.64).
Conclusion: Tooth loss and dentures could be associated with psychological morbidity. Therefore, planning for patient centred-care is paramount before extracting any teeth and providing replacement options, especially removable dentures. | en_US |
