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Table of Contents   
ORIGINAL RESEARCH  
Year : 2012  |  Volume : 23  |  Issue : 2  |  Page : 149-151
Evaluation of complete denture patients using graphoanalysis: A clinical study


1 Department of Prosthodontics, Peoples Dental Academy, Bhanpur–Bypass, Bhopal, India
2 Department of Prosthodontia, MGPGI, Puducherry, India

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Date of Submission16-Apr-2010
Date of Decision30-Jun-2011
Date of Acceptance13-Oct-2011
Date of Web Publication3-Sep-2012
 

   Abstract 

Purpose of the Study: The purpose was to analyze and classify behavioral pattern of complete denture patients and to identify difficult patients.
Materials and Methods: Fifty complete denture patients were randomly selected for the study. Their behavioral pattern was categorized using House classification as philosophic, indifferent, exacting and hysterical. The above behavioral classification was based on two methods namely interview and questionnaire and graphoanalysis. Accuracy of the above-mentioned two methods in predicting behavior of complete denture patients was statistically evaluated.
Results: On analyzing the data it was found that a significant correlation exists between handwriting pattern and behavior of an individual. Further it was noticed that chances of identifying difficult patients such as hysterical was more effective by employing graphoanalysis than questionnaire and interview method.
Conclusion: Graphoanalysis in addition with properly structured interview and questionnaire is useful in evaluation of behavior of an individual especially for recognizing difficult patients.

Keywords: Complete denture, graphoanalysis, handwriting analysis, patient assessment

How to cite this article:
Murthy VJ, Singh S, Shastri M, Rajaram S. Evaluation of complete denture patients using graphoanalysis: A clinical study. Indian J Dent Res 2012;23:149-51

How to cite this URL:
Murthy VJ, Singh S, Shastri M, Rajaram S. Evaluation of complete denture patients using graphoanalysis: A clinical study. Indian J Dent Res [serial online] 2012 [cited 2021 Sep 19];23:149-51. Available from: https://www.ijdr.in/text.asp?2012/23/2/149/100417
An interplay of various factors determines satisfaction with complete dentures. These factors can be biologic, anatomic, constructional, and psychologic. [1] Careful observation and listening in a structured interview [2] and questionnaire [3],[6] [Table 1] provide ample information to the dentist. This information pertains to patient's problems or expectations regarding dentures, his/her emotional and physical conditions, the health of oral tissues and associated structures and whether the present dentures are fulfilling the requirement of the patient. However interview and questionnaire may not reveal true personality of the patient, as he/she may pretend or hide the real problems. If an aid like graphoanalysis [7] it provide additional information to identify the difficulties which a dentist may encounter while treating such patient. Given adequate samples, time, expertise, and purpose there is very little that a writer can disguise from an expertly trained graphologist. We therefore designed a study comparing handwriting analysis and detailed interview and questionnaire to assess the behavioral pattern of complete denture patients.
Table 1: Questionnaire

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   Materials and Methods Top


Complete denture patients who attended the outpatient department during the span of 1 year were included in the study. Fifty patients involved in this study were informed and prior consent was obtained. Routine case history and properly structured interview were conducted during the first appointment. Patients psychology and approach toward treatment were considered and based on the assessment on the interview, they were categorized according to House classification. [8]

Patients were required to complete a questionnaire which enquired about their expectations from complete denture treatment. The handwriting samples were obtained. Detailed analyses of all basic element [Figure 1] were performed. Based on that the subjects were classified into four categories as per House classification. [8] Subsequently the results obtained from the interview were compared statistically with those results obtained by graphoanalysis using suitable statistical analysis like chi-square test, Spearman rank correlation and Mann-Whitney 'U' test. The effectiveness of both methods in recognizing behavioral pattern of the patients were evaluated.
Figure 1: Elements of handwriting and its importance

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   Results Top


In the present study, behavior of subjects were assessed by two methods namely interview and questionnaire and graphoanalysis to assess which method is effective in identification of difficult patients.

Data analysis revealed evidence that the philosophic cases from graphoanalysis was 18 against the expected cases of 27, whereas interview and questionnaire the number of philosophic cases were more than expected (33 against expected 27). The same relationship was maintained in 'indifferent' cases against both experiences. However, with regard to "exacting" and "hysterical" the observed cases were more than expected for graphoanalysis, whereas they were less than expected in the case of interview and questionnaire [Table 2]. This envisages the clear effect of graphoanalysis in ascertaining difficult patients. That is, the identification of "exacting" and "hysterical" subjects by graphoanalysis is more than those from interview and questionnaire. Further the calculated chi-square value of 7.36 was greater than 6.24, which was considered the table value for 3 degrees of freedom at 10% level. This in turn indicated that the graphoanalysis significantly helps in identifying difficult patients. We performed Spearman rank correlation to find out correlation between Graphoanalysis results and interview and questionnaire results. From the [Table 3] it is evident that Spearman R value of 0.4698 and 't' value of 3.76 was significant at 1% level and thus a significant correlation exists between graphoanalysis results and interview and questionnaire results in classification of subjects. Further Mann-Whitney 'U' test was performed to find out comparison between graphoanalysis results and interview and questionnaire results. Mann-Whitney 'U' value of 904.5 indicates that there was significant difference between graphoanalysis classification and interview and questionnaire classification of the sample [Table 4]. The rank sum of graphoanalysis result (2865.9) was more than that of interview and questionnaire (2080.5) and the difference between the rank sum was highly significant at 1% level. Therefore, one can be 99% confident that the classification of subjects by graphoanalysis and interview and questionnaire differs significantly and thus graphoanalysis helps in identifying highly difficult patients.
Table 2: Classification of subjects based on graphoanalysis report and interview and questionnaire

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Table 3: Results of spearman rank correlation

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Table 4: Results of Mann-Whitney 'U' test

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After concluding that graphoanalysis is more effective than interview and questionnaire, we decided to investigate if there existed any coinciding results between the two [Figure 2]. It was found that coincidence of results was less for difficult patients as hysterical. The calculated chi-square value of 9.48, which was significant at 5%level, was more than 7.62 which was the table value for 3 degrees of freedom at 5% level. This shows that the chances of observing highly critical cases were more from graphoanalysis that by interview and questionnaire.
Figure 2: Graph depicting relationship between assessment of behavior by interview and questionnaire and graphoanalysis

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   Discussion Top


Patients suffering from various medical conditions often have associated emotional problems and such patients are more difficult to satisfy with dentures. [9] The attitude of the patient frequently determines success or failure regardless of the care and ability of the dentist. [10] It is important for the prosthodontists to understand the personality of the patient for adequate mutual interaction [11]

According to Crumbaugh J.C and Stockholm E [12] subjectivity of graphoanalysis makes statistical analysis difficult. However we took a sample of 50 patients so that it could be subjected for statistical analysis.

In this study 50 patients were selected at random to assess their behavior rather than difficult patients being referred by other dentists. [7]

We evaluated patients by using interview and questionnaire, unlike Potgeiter and Carey who evaluated patients based on the attitudes and reactions during course of treatment.

In the previous studies either interview [2] or questionnaire [3],[6] or graphoanalysis [7] were used to identify behavior of the patients. In this study we evaluated both the above methods and also compared and correlated the methods.

Although graphoanalysis does pinpoints behavior traits, it cannot give information regarding age sex, race or nationality, writing of handicapped individuals who may use their teeth or toe to write. Also it cannot discern writing of illiterate individuals.

To conclude it is evident from the present study that graphoanalysis along with other methods provides a simple, quick and inexpensive tool in identification of difficult patients. Simply by observing some prominent traits in handwriting, treating dentist can effectively foresee the problems in managing a difficult patient. By identifying such difficult patients, measures like counseling and positive approach can be planned well in advance.

 
   References Top

1.Langer A, Michman J,Seifert I. Factors influencing satisfaction with complete denture in geriatric patients. J.Prosthet Dent 1961;11:1019-31  Back to cited text no. 1
    
2.Koper A. The initial interview with complete-denture patients: Its structure and strategy. J Prosthet Dent 1970;23:590-7.  Back to cited text no. 2
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3.Levin B, Landesman HM. A practical questionnaire for predicting denture success or failure. J Prosthet Dent 1976;35:124-30.  Back to cited text no. 3
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4.Bolender CL, Swoope CC, Smith DE. The Cornell Medical Index as a prognostic aid for complete denture patients. J Prosthet Dent 1969;22:20-9.  Back to cited text no. 4
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5.Celebic A, Knezovic-Zlataric D, Papic M, Carek V, Baucic I, Stipetic. Factors related to patient satisfaction with complete denture therapy. J Gerontol A Biol Sci Med Sci 2003;58:948-53.  Back to cited text no. 5
    
6.Carlsson GE, Otterland A, Wennstrom A. Patient factor in appreciation of complete dentures. J Prosthet Dent 1967;17:322-8.  Back to cited text no. 6
    
7.Potgieter PJ, Carey PD. The use of graphoanalysis for complete denture patient evaluation. J Prosthet Dent 1983;50:623-6.  Back to cited text no. 7
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8.House MM. Full dentures technique. In: Conley FJ, Dunn AL, Quesnell AJ, Rogers RM, editors. Classic prosthodontic articles: A collectors item. Vol. 3 rd . Chicago: American College of Prosthodontics; 1978. p. 2-24.  Back to cited text no. 8
    
9.Guckes AD, Smith DE, Swoope CC. counseling and related factors influencing satisfaction with dentures. J Prosthet Dent 1978;39:259-67.  Back to cited text no. 9
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10.Landa JS. Practical Full Denture prosthesis. Brooklyn: Dental Items of interest Publishing Co. Inc.; 1947. p. 20-4.  Back to cited text no. 10
    
11.Alvi HA, Agarwal NK, Chandra S, Rastogi MR. comparative analysis of personality of dental patients in relation to their natural and artificial dentitions. J Prosthet Dent 1986;56:369-78.  Back to cited text no. 11
    
12.Crumbaugh JC,Stockholm E. validation of graphoanalysis by "global" of "holistic 'method. Percept Mot Skills 1977;44:403-10.  Back to cited text no. 12
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Correspondence Address:
Varsha J Murthy
Department of Prosthodontics, Peoples Dental Academy, Bhanpur–Bypass, Bhopal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.100417

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