The Consequence of Complete Dentures on Quality of Life of Edentulous Patients in the South-Indian Population Based on Educational and Socioeconomic Grades

Purpose The purpose of this study was to establish the level of denture satisfaction with socio-demographic variables and educational status of the patients rehabilitated with complete denture. Materials and method A total number of 250 completely edentulous patients were selected who fulfilled the inclusion and exclusion criteria. The patients had no past medical history which affects the oral condition; they were first-time denture wearers with period of edentulousness altering between six months to one year and were in the age group of 40-50 years, and were willingly involved in the study. The subjects were grouped according to their socioeconomic status such as employment, education and income level. The correlations were statistically determined using regression analysis. Results Statistical analysis was done using Statistical Package for Social Sciences (SPSS, Chicago, Illinois, USA), version 16.0. The significance of percentage error of the two groups was tested by Student t test and p value denoted level of significance (p<.05). Based on the education level, 30.47% of the population were under primary level of education, 57.82% completed higher secondary education and 11.72% of the population were graduates. Based on employment status, 53.12% of the population was unemployed, 32.03% were employed while 14.84% of the population were pensioners. Based on income per month, the population was classified as 6.25%, 31.25%, 21.09%, 22.66%, 18.75% for no income, less than 3000, 5000, 8000 and more than 10000 respectively. Psychological comfort, social ability, and functional improvement was better with higher secondary education level, employed and lower income individuals. Conclusion Rehabilitation of an elderly individual not only includes clinician skills but also the personal perception by the patient. The study concludes that the though there was no statistically significant difference, the individual with secondary level of education and with employed low socioeconomic status had better denture satisfaction than the other category.


Conclusion
Rehabilitation of an elderly individual not only includes clinician skills but also the personal perception by the patient. The study concludes that the though there was no statistically significant difference, the individual with secondary level of education and with employed low socioeconomic status had better denture satisfaction than the other category.

Introduction
Management of edentulous patients during rehabilitation with complete dentures is still lacking with respect to patients based on educational level and socioeconomic status [1]. The need for thought of oral health-related quality of life (QoL) has been increasingly accepted over the last decades, and many studies highlight the psychosocial impacts of oral conditions. This study is based on considerations in making of complete dentures of different sociodemographic variables such as age, gender, literacy level, socio-economic and educational status may affect satisfaction towards dentures. To assess this, a consistent questionnaire that included questions from domains such as mastication, appearance, speech, comfort, health, denture care and social status is used to establish level of denture satisfaction with sociodemographic variables and educational status of the patients.
The removable denture prosthesis (RDP) must be able to restore the chewing function, aesthetics and phonetics to compensate partial edentulism [2]. Considering the biomechanics involved allows the specialist to design a removable partial denture prosthesis by establishing and maintaining lift, stabilization and retention termed the Housset triad. With these imperatives taken into account, and depending on the number of teeth lost and the type of edentulous areas bounded by remaining teeth or without posterior tooth support, the constraints on the prosthesis will be different and functional rehabilitation altered. One such method is by measuring food bolus granulometry before swallowing, associated with analysis of the kinematic parameters developed to distinguish patients with normal mastication from those with badly impaired mastication [3]. Impaired chewing function leads to raise of food bolus particle size, measured by the median particle size of the food bolus at swallowing. It has been revealed that adults with impaired mastication could be distinguished from those with normal function if the median particle size of the bolus that they produced, when chewing raw carrot reached a cut-off value of 4 mm, called the masticatory normative indicator (MNI) [4]. The adjustment of chewing behaviour to food hardness can also characterize healthy mastication. Adaptation to increasing food hardness marks in an augmented number of chewing cycles and an increase in the chewing sequence duration, with no modification of the chewing frequency (number of cycles per second) in healthy subjects [5,6]. The mean chewing frequency is slowed down in subjects with chewing deficiencies while eating any type of resistant food. Earlier studies on the chewing ability of dentally impaired subjects showed that a decrease in the number of functionally paired teeth and oral rehabilitation with removable dentures were linked to a decreased masticatory values [7,8]. But, the physiological impact of RDP rehabilitation has been seldom studied. Also, the objective of this work was to estimate the impact of partial edentulous areas rehabilitation by removable partial denture prosthesis with a socioeconomic and educational point of view.
Beside the therapist's ability and the quality of dentures, individual factors connected with the patient are very important for the final satisfaction with dentures. Patients are sometimes not satisfied with the constructions which are best, according to the therapist's judgment. Satisfaction with dentures seems to have multiclausal character. According to the results of Frank's studies, the most frequent areas of dissatisfaction were as follows: fit (33.6%), mastication (29.5%), natural tooth problems (26.3%), overall perception (26,2%), oral cleanliness (20.4%), speech (17.9%), appearance (17.8%), denture cleanliness (15.3%) and odour (13.2%) [9,10]. In different studies concerning satisfaction or dissatisfaction with partial removable dentures, more concern was placed on upper partial dentures. Dentists consider dentures to be successful when they meet certain methodological standards, whereas patients assess them from the viewpoint of personal satisfaction. The capability to adapt to new dentures will usually reduce in proportion to the individual status. To assess this, a consistent questionnaire that included questions from domains such as mastication, appearance, speech, comfort, health, denture care and social status was used to determine level of denture satisfaction with socio-demographic variables of completely edentulous patients rehabilitated with prosthesis.

Materials And Methods
The study was conducted at the Department of Prosthodontics, Sri Ramachandra Institute of Higher Education and Research (SRIHER) with the approval of the ethics committee. A total number of 250 completely edentulous patients were selected who fulfilled the inclusion and exclusion criteria. The patients had no past medical history which affects the oral condition, first-time denture wearers, period of edentulousness altering between six months to one year and Class I edentulous state as classified by American College of Prosthodontics and in the age group of 40-50 years who were willingly involved in the study was selected. The subjects were grouped according to their socioeconomic status such as employment, education and income level. According to the employment level, they were divided into Employed, Self-Employed, Unemployed and Pensioners. According to education level, they were separated as Primary (till standard five), Secondary (till standard nine), and Tertiary education. Income level they are divided into low, middle, and high-income group. The removable prosthesis was fabricated in the Department of Prosthodontics and their quality were assessed based on the method given by Sato et al [11]. The patients were interviewed at 2-3 months post-treatment. A single person conducted all the questionnaire surveys to reduce the discrepancy. A standardized questionnaire, with 19 questions based on denture satisfaction level and masticatory capacity in the domains of Functional limitation, Psychological discomfort, Psychological disability, and Social disability was administered [12]. All the questions were calculated in scale of satisfied, moderately satisfied and hardly ever. The denture satisfaction questions were only asked at the post-treatment interview and relevant to the satisfaction of their new maxillary/mandibular complete dentures the patients received according to the Likert scale. Statistical analysis was done using Statistical Package for Social Sciences (SPSS, Chicago, Illinois, USA), version 16.0. Significance of percentage error of two groups was tested by Student t test and p value denoted level of significance (p<.05).

Distribution of sample
Based on the education level, 30.47% of the population were under primary level of education, 57.82% of the population have done higher secondary education and 11.72% of the population were graduates. Based on employment status, 53.12% of population was unemployed, 32.03% of the population were employed while 14.84% of the population were pensioners. Based on income per month population were classified as 6.25%, 31.25%, 21.09%, 22.66%, 18.75% for no income, less than 3000, 5000, 8000 and more than 10000 respectively.

Psychological discomfort
On postoperative evaluation based on education, the satisfactory level for psychological comfort was higher for higher secondary educated persons followed by primary education and graduate persons. The distribution of sample was Higher secondary -41, primary -22 and graduate -8 for satisfaction level questionnaire (SAQ)4 and SAQ5, Higher secondary -55, primary -29 and graduate -10 for SAQ9. Based on masticatory ability, the distribution of sample was Higher secondary -42, primary -20 and graduate -2 for masticatory ability questionnaire (MCQ)9 and Higher secondary -56, primary -24 and graduate -12 for MCQ12. Though there was no statistical significance, the psychological comfort was better with Higher secondary education level (

Social disability
On postoperative evaluation based on education, the satisfactory stage for social ability were higher for Higher secondary educated individuals followed by primary education and graduate individuals. The distribution of sample was Higher secondary-49, primary -25 and graduate -9 for SAQ3, Higher secondary-51, primary -23 and graduate -8 for SAQ7. Based on masticatory ability, the distribution of sample was Higher secondary-49, primary -24 and graduate -12 for MCQ10, Higher secondary-57, primary -23 and graduate -13 for MCQ11 and Higher secondary-54, primary -25 and graduate -9 for MCQ13. Though there was no statistical significance, the social ability was better with Higher secondary education level ( Table 4).

Functional limitation
On postoperative assessment based on education, the satisfactory level for functional improvement was higher for Higher secondary educated individuals followed by primary education and graduate individuals. The distribution of sample was Higher secondary-49, primary -25 and graduate -9 for SAQ1, Higher secondary-51, primary -23 and graduate -8 for SAQ2. Based on masticatory ability, the distribution of sample was Higher secondary-47, primary -28 and graduate -10 for MCQ1, Higher secondary-42, primary -21 and graduate -8 for MCQ2, Higher secondary-46, primary -26 and graduate -7 for MCQ3, Higher secondary-40, primary -27 and graduate -6 for MCQ4, Higher secondary-52, primary -25 and graduate -10 for MCQ5, Higher secondary-57, primary -23 and graduate -13 for MCQ6 and Higher secondary-46, primary -23 and graduate -8 for MCQ7. Though there was no statistical significance, the functional improvement was better with Higher secondary education level ( Table 7).

Discussion
Psychological assessments of patients have been found to be without influence on patients' judgment of dentures, whereas, others have been reported to distinguish significantly between satisfied and dissatisfied denture wearers [13,14]. Several studies demonstrated that the patient's judgment can be predicted by information related to patient perceptions, expectations, and prior experiences [15]. Denture quality is defined in relation to a number of areas difficult to assess and no generally accepted standards exist. Accordingly, the validity and reliability of recordings of the quality of complete dentures are often doubtful [16]. Edentulism is considered a handicap with impacts on quality of life and nutrition. Provision of new complete dentures improves oral health-related quality of life. Patient's satisfaction with their dentures is likely to be affected by their ability to perform certain tasks with them [17]. The present study was done to evaluate whether education level and socioeconomic status have an effect on the satisfaction level of the patient. Studies in edentulous subjects strongly support the concept that patient-based measures are more sensitive than functional measures for detecting differences between treatments [18].
The present study revealed that patient satisfaction was better with employed individuals but with the low-income group compared to the high-income group. In addition, the secondary level of educated individual had better satisfaction. This is contradictory to Poljak-Guberina et al. who found that age, education, marital status, income state, size of the residence and regional affiliation did not have a significant influence on satisfaction of patients with the prosthesis [19]. Also, not wearing prostheses was not linked to neuroticism. On the contrary, some researchers found no relationship between denture satisfaction and personality [20].
However, they used incomprehensive personality tests and paid little attention to reliability, validity, and suitability of the used tests. Moreover, Lowental and Tau found no relation between denture satisfaction and personality found no relationship between denture satisfaction and personality when denture satisfaction was assessed using denture satisfaction questionnaire [21].

Conclusions
Rehabilitation of an elderly individual not only includes clinician skills but also the personal perception by the patient. The study concludes that though there was no statistically significant difference, the individual with a secondary level of education and with employed low socioeconomic status had a better denture satisfaction than the other categories.

Additional Information
Disclosures