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Table of Contents   
ORIGINAL RESEARCH  
Year : 2010  |  Volume : 21  |  Issue : 4  |  Page : 564-567
Needs and demands of prosthetic treatment among two groups of individuals


1 Department of Prosthodontics, Royal Medical Services, and Jordan University of Science and Technology, Amman, Jordan
2 Department of Oral and Maxillofacial Surgery, Royal Medical Services, Amman, Jordan
3 Department of Pedodontics, Royal Medical Services, Amman, Jordan

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Date of Submission22-Jul-2009
Date of Decision06-Jan-2010
Date of Acceptance22-Jul-2010
Date of Web Publication24-Dec-2010
 

   Abstract 

Objectives: The level of knowledge, awareness, and attitude about teeth-replacement options among a group of medical and paramedical subjects and to compare them with the general population.
Materials and Methods: A self-administered questionnaires using simple Arabic language were distributed to two groups of subjects. Questions focused on the willingness to replace the missing teeth, the preferable methods of choice for replacement, and the reasons for these choices. The first group (G-I) was from the medical and paramedical staff who work in a military hospital at Jordan Royal medical services, the dental staff was excluded from the study. The other group (G-II) was from the general population who attended the dental department in the same hospital with comparable level of education. All the participants were partially edentulous excluding the third molars. Clinical examination was done by qualified prosthodontist to evaluate the possible prosthetic treatment options for replacement. A total of 612 questionnaires were distributed, of which 533 questionnaires were returned (response rate 87.09%). The results were analyzed and comparison was made between the two groups.
Results: Responses to questions about awareness and attitude about prosthetic management of missing teeth revealed that G-I have more awareness than G-II to the probable causes for tooth/teeth replacement and limitation of the preferable method for replacement (P<0.05). More than 80% of the participants believed that replacement of anterior teeth is more important than the posterior teeth. Implants and fixed partial denture (FPD), respectively, were more preferable than removable prosthesis, although clinically was not indicated in cases (P<0.05). There was no clinical benefit from replacement of missing teeth in 33.4% while only 6% believe this.
Conclusions: This study showed that the awareness and attitude between the medical and paramedical staff to prosthetic needs is better than between general populations. The demands for dental replacement by patients were significantly different when compared with the actual needs.

Keywords: Implants, oral hygiene, prosthetic replacements

How to cite this article:
Mukatash GN, Al-Rousan M, Al-Sakarna B. Needs and demands of prosthetic treatment among two groups of individuals. Indian J Dent Res 2010;21:564-7

How to cite this URL:
Mukatash GN, Al-Rousan M, Al-Sakarna B. Needs and demands of prosthetic treatment among two groups of individuals. Indian J Dent Res [serial online] 2010 [cited 2020 Feb 23];21:564-7. Available from: http://www.ijdr.in/text.asp?2010/21/4/564/74221
Prosthetic treatment differs widely depending on a number of factors. For example, it may involve the replacement of few missing teeth in a healthy but incomplete dentition, the functional replacement of nearly all teeth in a badly damaged dentition, or restoring function by means of removable or FPDs, implants, complete dentures, or overdentures. The traditional approach in prosthetic dentistry resulted in uniform and extensive treatments based on the principle that missing teeth should always be replaced. [1] Recently, requirements such as esthetics and functional comfort are considered more important and more easily achieved. [2],[3],[4] A combination of factors may reduce the dental care possibilities, such as poor general health, declining income, and an accumulation of dental problems.

One of the methods for evaluating treatments for patients other than clinical dental examination by an expert includes patient's demand for treatment and objective oral status of the patients.

In general, there is a direct relationship between the number of teeth present and total satisfaction with oral status. [5],[6] However, the challenge is mainly to satisfy the patient's demand and replace the missing teeth for both function and esthetics, without harming the remaining teeth or gingival tissue. [7] Today, implant supported restoration can be considered the treatment of choice from the perspective of occlusal support, preservation of adjacent teeth, and avoidance of a removable partial denture (RPD). [8],[9],[10]

The present study was carried out in order to provide information for analysis about the level of knowledge, attitude, and behavior of a group of Jordanian population aged 35-54 years toward the options available for replacing missing teeth. In particular, this investigation focused on the factors that discourage persons from seeking teeth replacement.


   Materials and Methods Top


Study population

This study included a total number of 612 subjects (52.7% male, 47.3% female). It should be noted that the sample was selected from the medical and paramedical staff work in Queen Alia Military Hospital in Jordan and from the general population attending to the dental clinics at the same hospital during the year 2008. All the participants were partially edentulous aged between 35 and 54 years (the mean age was 37.8 years). At least a high school educational level was requested from the randomly selected studied groups to be examined and fill the questionnaire. The dentist, dental technicians, and assistants were excluded from the study.

Questionnaires

A self-administered questionnaire in simple Arabic language was formulated and distributed between groups after full instructions [Table 1]. The study sample was divided into Group-I (G-1): medical and paramedical staff in the hospital, the dental staff was excluded from the study; Group II (G-II): selective group from the general population with the same level of education (high school, college, or university level but not medical or dental). A total of 612 questionnaire forms were distributed and 533 were returned back (response rate was 87.09%).
Table 1: Characteristic features of the studied population regarding awareness and attitude toward prosthetic management's possibilities

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Demographic information was recorded by the subjects. The questionnaire consisted of questions related to demographics, tooth replacement knowledge, attitude, and awareness of the treatment options available for tooth replacement and the justification of selecting an option over another.

All questions were presented in a forced-choice format and were designed to assess mainly the level of knowledge between the medical and paramedical staff and to compare their knowledge with the second group from the general population. This will improve knowledge of general population about the prosthetic services that intended to improve their oral health condition.

Clinical examination

The clinical examination was performed for the studied groups to evaluate the possibilities of prosthetic treatment (RPD, FPD, implant or no clinical need for replacement) without considering the insurance possibilities of constructing an RPD only and the patient's desire.

Statistical analysis

Responses to all questions were collected and analyzed using the SPSS ver. 13 statistical program. Frequencies were generated and then comparisons between the two groups for all responses were performed to determine their significance. t tests were used to identify significant relationships between frequencies. A P value is the probability to obtain the observed data. P value less than 0.05 was considered statistically significant.


   Results Top


Of the 612 participants, only 533 completed the questionnaire (response rate was 87.09%). G-I consisted of 272 medical and paramedical staff. G-II consisted of 261 persons from the general population. The demographic information of the study population is summarized in [Table 2]. Age was ranging from 35 to 54 years with a mean age of 37.8 years with 52.7% males and 47.2% females having the same educational level. Clinical evaluation of options of prosthetic treatment that can be successfully offered without considering the insurance or patient's desire is summarized in [Table 3], which includes RPDs, FPDs, implants, no clinical need or demand or both for replacement. Clinical options of prosthetic treatment without considering the insurance or patient's desire are presented in [Table 3]. Responses to all questions and evaluating prosthetic knowledge and awareness are summarized in [Table 1]. Two hundred forty-eight (91.2%) participants from the medical and paramedical staff (G-I) vs 170 (65.1%) from general population (G-II) could give correct or partially correct answers for the probable causes of tooth replacement. About 76% of the subjects believe in the importance of prosthetic hygiene. When asked "What are the most important teeth for replacement?" 434 participants (81.4%) answered the anterior teeth, whereas 99 participants (18.5%) answered posterior teeth. Implants and FPD, respectively, were more preferable than RPDs [Table 1]. Comparison between the clinical need and patient's desire is presented in [Table 4] and [Figure 1].
Figure 1: Comparison between clinical needs and patient's desire

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Table 2: Demographic characteristics of the studied subjects (number, age, and sex distribution)

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Table 3: Clinical options of prosthetic treatment (without considering the insurance or patient's desire)

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Table 4: Comparison between the clinical need and patient's desire in the studied population*

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   Discussion Top


When considering replacement of missing teeth the treatment is ultimately based on knowledge of alternatives and careful assessment of the patient's status. Perceived needs are important determinants in assessing the requirements for prosthetic replacement of missing teeth. [10],[11],[12] In this study, the level of knowledge, awareness, and attitude about prosthetic treatment modalities have been evaluated among medical and paramedical population and compared with the general population. In general the results indicate that medical and paramedical staff has more awareness than the general population about the indication for prosthetic methods and their advantages and disadvantages. They also have a superior attitude toward the hygiene and the regular check up of their prosthesis by profession. This necessitates more efforts to educate our society.

Nomura et al, [7] in a study of characteristics and willingness of patients to pay for dental treatment in Japan concluded that the likelihood of attending dental treatment is related to sociodemographic background rather than household income. Smith and Sheiham [13] found that clinically, 78% of the subjects needed some form of the dental treatment, whereas 42% thought they needed it. They found even at the lowest level of oral health status (15 missing teeth and deep pockets) 40% of the individuals still felt their oral health was good or excellent. In this study, about one quarter of the participants considered that the economic status was an important factor for the method of choice for tooth replacement. About 70% participants agreed that the general health condition and dental condition were considered important factors in the method of choice for tooth replacement providing that the current insurance system in Jordan does not provide for all possibilities of prosthetic available ways.

Regarding the most important teeth to be replaced, most participant (81%) were more concerned about missing anterior teeth and having anterior rather than posterior teeth replaced. Esthetics is more important than function for a great majority of individuals. However, certain sociodemographic factors, such as age and gender, can change the subjective need for replacement of missing teeth. [14] Agerberg and Carlsson [15] found that only 7% of individuals with 8-20 teeth considered their chewing ability poor and they claimed that they could not chew all kinds of food. Some studies have proposed alternatives to the replacement of missing teeth, such as the shortened dental arch concept. [2],[15] Ellias and Sheiham [5] found that about 54% of the surveyed Brazilian subjects without any pairs of posterior teeth were stratified with their dental condition, 98% were satisfied when four or more premolar and molar pairs were present, whereas 78%-80% persons with RPD wearers were satisfied with their dental status, confirming the trends, that the position of the missing teeth has more implications in the replacement of missing teeth. [4],[10],[12],[14] Agerberg and Carlsson [16] found that spaces in the premolar-molar areas do not always constitute the main indication for replacement. According to Owal and Taylor, [17] it is a common procedure in Sweden to use fixed partial bridges to replace only the anterior missing teeth, leaving the posterior spaces untreated.

Regarding the sources of information, about 45% of the studied population where from dentists and little from other sources like magazines, newspapers, T.V., radio and friends. This result confirmed that family and friends were significant motivators for oral maintenance in general and tooth replacement in particular. Thus, Jordanian mass communication program should be strengthened at district and local levels to stimulate the development of awareness toward the indications and contraindications of the options available to do replacement of missing teeth, which can satisfy esthetic and functional needs.

This study is congruent with the previous studies regarding the type of prosthetic replacement that can be used according to the patient's preference. Perceived satisfaction seldom coincides with clinical assessments of professional treatment needs. [14] The reason for this difference between health professionals and individuals can be attributed to unequal development of clinical, in comparison with subjective criteria and the adaptation of those subjects to their changed oral health. [18] The most frequent reasons for visits of the dentist were mostly either due to tooth ache, perceived need for dental extraction, or prosthetic treatment. [7]

It has been reported that about 18% of Saudi female patients demand replacement of missing teeth [19] compared with approximately 9% in a group of male patients of different population. [20] This reflects the effect of gender on the awareness to prosthetic needs. Fixed prosthesis was the choice of 85% patients, whereas 69.3% opted for removable prosthesis. There was no clinical benefit from replacement of missing teeth in 33.4%, only 6% was the patient's desired, which reflects that demand for prosthetic replacement by patients was much less than their actual need. [21] Therefore, the dental profession should be responsible to improve prosthodontic awareness among different groups of populations in order to reduce treatment needs significantly regardless of the demand.


   Conclusions Top


Within the limitation of this study, the following conclusions can be made.

  • Fixed prosthesis was more preferable than removable prosthesis and tooth replacement of missing teeth is more preferable than none even if there was no clinical or indication benefit from the replacement.
  • The clinical possibilities to prosthetic replacement for each patient according to the missing teeth were significantly different from their patient desire (without considering the insurance or the patient preferable method of prosthetic replacement).
  • Systemic community-based oral health promotion should be strengthened, which stress upon the possibilities and limitations of any prosthetic replacement a patient may prefer utilizing different available media.


 
   References Top

1.Zarb GA, Bergman B, Clayton JA, Mocky HF. Prosthodontic treatment for partially edentulous patients. United state of America: Mosby; 1978. p 56-62.  Back to cited text no. 1
    
2.Kδyser AF. Shortened dental arches and oral function. J Oral Rehabil 1981;8:457-62.  Back to cited text no. 2
    
3.Witter DJ, Van Elteren P, Kδyser AF, Van Rossun GM. The effect of removable partial dentures on the oral function in shortened dental arches. J Oral Rehabil 1989;16:27-33.  Back to cited text no. 3
    
4.Kalk W, Kδyser AF, Witter DJ. Needs for tooth replacement. Int Dent J 1993;43:41-9.  Back to cited text no. 4
    
5.Ellias AC, Sheiham A. The relationship between satisfaction with mouth and number, position and condition of teeth: Studies in Brazilian adults. J Oral rehabil 1999;26:53-71.  Back to cited text no. 5
    
6.Beijing LZ, Petersen PE, Wag HY, Bain JY, Zhang AX. Oral health knowledge, attitude and behavior of adults in China. Int Dent J 2005;55:231-41.  Back to cited text no. 6
    
7.Normura YY, Teraoka K, Nishikahara F, Motigi M, Tsurumoto A, Hanada N. Characteristics and willingness of patients to pay for regular dental check - ups in Japan. J Oral Sci 2004;46:127-33.  Back to cited text no. 7
    
8.Stanford CM. Application of oral implants to the general dental practice. J Am Dent Assoc 2005;136:1092-100.  Back to cited text no. 8
    
9.Jivraj S, Chee W. Treatment planning of implants in posterior quadrants. Br Dent J 2006;201:13-23.  Back to cited text no. 9
    
10.Davenport JC, Basker RM, Heath JR, Ralph JP, Glantz PO. Need and demand for treatment. Br Dent J 2000;189:364 -8.  Back to cited text no. 10
    
11.Osborne J, Maddick I, Gould A, Ward D. Dental demand of old people in Hampshire. Br Dent J 1979;5:351-5.  Back to cited text no. 11
    
12.Reisine ST. The impact of dental conditions on social functioning and the quality of life. Annu Rev Puplic Health 1988;9:1-19.  Back to cited text no. 12
    
13.Smith JM, Sheiham A. How dental conditions handicap the elderly. Community Dent Oral Epidemiol 1980;7:305-10.  Back to cited text no. 13
    
14.Ellias AC, Sheiham A. The relationship between satisfaction with mouth and number and position of teeth. J Oral rehabil 1998;25:649-61.  Back to cited text no. 14
    
15.Fayyad MA. Replacement of missing teeth in sites with insufficient space: A case report. Quintessence Int 1993;24:493-6.  Back to cited text no. 15
    
16.Agerberg G, Carlsson GE. Chewing ability in relation to dental and general health. Analysis of data obtained from questionnaires. Acta Odontol Scand 1981;39:147-53.  Back to cited text no. 16
    
17.Owal BE, Taylotic RL. A survey of dentitions and removable partial dentures constructed for patients in North America. J Prosthet Dent 1989;61:465-70.  Back to cited text no. 17
    
18.Witter DJ, De Haan AF, Kδyser AF, Van Rossum GM. Shortened dental arches and periodontal support. J Oral Rehabil 1991;18:203-12.  Back to cited text no. 18
    
19.Al-Fawaz AA. Needs and demands for dental treatment among Saudi female patients in the dental school in Riyadh. Saudi Dent J 1999;11:120-3.  Back to cited text no. 19
    
20.Zakrzewsska JM. Women as dental patients: Are there any gender differences. Int Dent J 1996;46:548-57.  Back to cited text no. 20
    
21.Shugar DA, Bader JD, Phillips W, White A, Brantley F. The consequences of not replacing posterior tooth. Am Dent Assoc 2000;131:1317-23.  Back to cited text no. 21
    

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Correspondence Address:
Gadeer Nimri Mukatash
Department of Prosthodontics, Royal Medical Services, and Jordan University of Science and Technology, Amman
Jordan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.74221

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