Patients’ Attitudes toward Tooth Replacement

Running title:

Keywords: missing teeth, replacement, dental, Saudi Arabia

Abstract:

Aim

The aim of the study is to assess patient knowledge and attitude toward replacing missing teeth with prosthesis in eastern province, Saudi Arabia.

Materials and Methods

This is a cross-sectional study. The study subjects were recruited from: University of Dammam in Dammam City, Primary Health Care Centers in Alhasa City, and health educational campaigns in the same area. Date was collected through Self-administered surveys. In the self-administered survey following information was obtained: demographic information, systemic diseases, the need to replace missing teeth, the effect of losing teeth on appearance, the effect of losing teeth on chewing ability, causes of teeth loss, preferred treatment option, Factors create hindrances for treatment. Also, Professional assessment of patients’ needs was done by trained dentists through examination sheet to assess the need of esthetic or functional restoration. Statistical analyses were performed using the SPSS (Statistical Package for the Social Sciences).

Results

Majority of the participants (94.2%) reported their need to replace missing teeth. Most of the participants stated that losing tooth (teeth) has affected their ability to chew food and their appearance with (82.6%) and (61.6%) respectively. Dental caries was the main reason behind teeth extraction in (77.9%) of the study sample. Fixed partial prosthesis was the first treatment option preferred with (33.7%) followed by implant supported prosthesis with (25.6%) to replace the missing teeth. Only 3.5% prefer not to restore the missing teeth. Professional screening shows that (48.8%) of the participants has one missing anterior tooth or more which dictate the need for esthetic restoration and (58.1%) of the participants have three missing posterior teeth or more which dictate the need functional restoration.

Conclusions

Patient’s perception of functional and esthetic needs was variable among the population in comparison to professional assessment of patients needs. Dental caries preventive measures application will reduce loss of teeth significantly. The result of this study will be a baseline data for any further future studies.

Keywords:

missing, teeth, replacement, dental, Saudi, Arabia

1. Introduction:

Assessment of prosthodontic patients need based according to the location and length of edentulous space (Bjorn and Owall, 1979, Smith and Sheiham, 1980).  (Bjorn and Owall, 1979) reported that social and esthetic reasons were the basics for restoring missing teeth and not only relies on professional assessment. Several studies stated the presence of disagreement between dentists and patients assessments (Locker and Slade, 1994, Palmqvist et al., 1991, Smith and Sheiham, 1980, Vigild, 1987).

Replacement of missing teeth to restore function and esthetic had different modalities of treatment which is dental implant, fixed partial denture and removable partial denture. Each modality has its own advantages and disadvantages (Christensen, 2000). The final treatment decision is affected by several factors and its case dependent. If more than one option possible, the definitive prosthesis will depend on patient’s decision. It is considered to assess knowledge and attitude toward prosthesis just to ensure patient satisfaction (Kvale et al., 2004, Udoye et al., 2005). Therefore, the final decision of treatment cannot depend on the opinion of dentist alone, but should be discussed closely with the patient (Sheiham et al., 1982).

Teeth play a major role in reflecting the personality and the positive attitude regarding self-image. Loosing of teeth will reduce the quality of life affecting psychologically, socially, and emotionally. Nowadays, the dentistry correlate the emotions and psychologically of patients in relation to dental situations especially esthetics (Levinson, 1990).  Losing of teeth is very traumatic which can disturb social activity that requires significant psychological readjustment (Fiske et al., 1998, Omar et al., 2003).

In Europe, the frequency of removable dentures varied between 13-29%, with 3-13% wearing upper and lower complete dentures (Zitzmann et al., 2007). Due to lack of oral health care of Sudanese adult population, replacement of missing teeth by prosthesis was uncommon. 57% of the study subjects are in need for prosthetic replacement (Khalifa et al., 2012). The prevalence of prosthodontics replacement on Chinese adult population was founded that 62% of the subjects had no tooth replacement, 30% replaced by FDP and 11% replaced by RDP. 3% of the subjects had both FDP and RDP. Most of the subjects replacing missing one or two teeth by FDP but if more than two teeth are missing were replaced by RDP (Zhang et al., 2012). In a local study conducted in Riyadh in 2003, the result shows that the most commonly missing tooth was mandibular first molar followed by mandibular second molar. This study reveals that 63% of the study subjects (Saudi males) did not replace their missing teeth (Akeel, 2003).

The aim of the study is to assess patient knowledge and attitude toward replacing missing teeth with prosthesis and compare it with professionally assessed clinical needs in eastern province, Saudi Arabia.

2. Materials and Methods:

Study Type:

This is a cross-sectional study. This study was conducted between April 2014 and August 2014 through self-administered surveys.

Study Subjects:

The subjects were divided into 4 age groups: 18-25, 26-35, 36-45, and <45 years The study sample recruited from: University of Dammam (College of Dentistry) in Dammam City, Primary Health Care Centers in Alhasa City, and health educational campaigns in the same area.

Data Collection

   Self-administered survey:

In the self-administered survey following information was obtained: Age, gender, level of education, occupation, economic status, marital status, nationality, systemic diseases, the need to replace missing tooth/teeth, the effect of losing teeth on appearance, the effect of losing teeth on chewing ability, causes of tooth/teeth loss, preferred treatment option, Factors create hindrances for treatment.

    Clinical Assessment:  

Professional assessment of patients’ needs was done by trained dentists through examination sheet. Examination sheet reflect the following information: number of missing anterior or posterior teeth. The need for functional or esthetic restoration according to the following criteria: At least 1 missing anterior tooth (incisor, canine, or premolar) constituted a need for esthetic restoration. At least 3 missing posterior teeth (premolar, first molar, second molar) constituted a need for functional restoration. Also, the provided prosthesis type was recorded if the missing tooth was restored.

Statistical analyses were performed using the SPSS (Statistical Package for the Social Sciences) data analysis software package version 18.0 and a P-value of less than 0.05 was considered significantly different. The study was approved by the Ethics Committee of the College of Dentistry, University of Dammam.

3. Results:

The mean age of the study sample was 42.26 (+-14.975) years ranging from 16 to 77 years. Maximum numbers of teeth restored with FPD were 8. Maximum numbers of teeth restored with RPD were 28. Maximum numbers of teeth restored with Implant were 4. 46.1% (47 participants) of the participants were males while 53.9% (55 participants) were females. 33.3% of participant’s level of education was secondary school and 18.6% was elementary school. 61.8% of the participant were either retire or not working and 38.2% working (20.6% Governmental and 17.6% Private). 38.2% of participant income level was between 1000-5000 SR, and 39.2% Less than 1000 SR and only 9.8% above 10000 SR. 74.5% of the participant were married and only 25.5% were Single. The entire participants were Saudi. 60.8% of the participant did not have any chronic systemic disease. 15.7% of the participant has Hypertension. 20.6% of the participant has Diabetes. 13.7% of the participant has other chronic disease. 94.1% of the participant reported their need to replace missing teeth. 66.7% of the participant reported that losing tooth (teeth) has affected their appearance. 83.3% of the participant reported that losing tooth (teeth) has affected their ability to chew food. 79.4% of the participant reported that dental caries was the main reason for extracting their teeth. 18.6% of the participant reported that periodontal problems were the reason for extracting their teeth. 8.8% of the participant reported that Trauma was the reason for extracting their teeth [Table 1]. 34.3% of the participants prefer Fixed Partial Denture to replace the missing teeth. 25.5% of the participants prefer Implant supported prosthesis to replace the missing teeth. 27.5% of the participants prefer anything suitable type of restoration to replace the missing teeth. 9.8% of the participants prefer Removable Partial Denture to replace the missing teeth. 2.9% prefer not to restore the missing teeth [Figure 1]. 61.8% most of the participants know about the treatment option from a dentist. 27.5% of the participants know about the treatment option from a friend. Only 4.9% of the participants did not seek treatment because of fear from dental procedures. Only 2.0% of the participants did not seek treatment because of complicated dental procedures. 33.3% of the participants did not seek treatment because of high cost dental treatment. 53.9% of the participants did not seek treatment because of inaccessible free dental appointments. 8.8% of the participants did not seek treatment because of time of dental appointments. 14.7% of the participants did not seek treatment because of other reasons [Figure2]. 52.9% of the participants have 1 missing anterior tooth or more which dictate the need for esthetic restoration. 58.8% of the participants have 3 missing posterior teeth or more which dictate the need functional restoration.

4. Discussion:

Patient centered prosthetic treatment planning has become promising approach in replacement of missing teeth to achieve patient satisfaction (Elias and Sheiham, 1998, Rosenoer and Sheiham, 1995). This study aimed to evaluate patient knowledge and attitude toward replacing missing teeth with prosthesis in relation to clinical professional assessment.

Patient’s self-assessment of the impact of missing teeth on appearance varied among subjects.  In our study 66.7% of the subjects had esthetics concerns about losing of teeth. This is in agreement with earlier studies that reported wide variations in the impact of tooth loss (Locker and Slade, 1994, Rosenberg et al., 1988, Sheiham et al., 1982).

2.9% of our study population prefers not to restore their missing teeth. In a Malaysian study, whether the losing anterior of posterior teeth the subjects not concerned in replacing of that teeth (Razak et al., 1990). Liedberg et al. (1991) found in a Swedish population no perceived to replace the high prevalence loss of premolar and molar teeth. Gradual losing of teeth over the time allow for patient to adapt with his appearance and chewing ability that is why the geriatric population may not perceive the need for replacing missing teeth (Pallegedara and Ekanayake, 2005).

Many of the participants 26 participants  (25.49%) had an esthetic concerns of missing molars while 12 participants (11.76%) did not had concerns about losing of premolars. Rosenberg et al. (1988) noted that esthetic is priority for the patient followed by the functional factors in replacing missing teeth.

Kayser et al. (1988) stated that the perceived needs for replacing missing teeth only if it’s affect appearance or mastication. In other hand, the old people by multi-missing teeth give the priority to the mastication rather than appearance (Shigli et al., 2007). In our study 83.3% of the subjects reported his mastication were affected by losing of teeth. 31% of the participants considered his chewing ability affected by losing of any tooth while 6% of the study subjects no perceived needs for functional restoration by losing of three or more molars teeth.

Patient perceived need for replacement of missing teeth affected by socioeconomic status. Individuals who had a lack of education, low financial resources and needs for preventive services more appropriate to have a neglected dental health care (Marcus et al., 1996). The availability of governmental centers that provide free dental treatment made the major reason for non-replacing missing teeth was the late appointment which was 53.9% followed by 33.3% of study subjects gave an economic reason.

The main cause of losing teeth is a dental caries in our study that correlate with other studies (Corbet and Davies, 1991, Khalifa et al., 2012). It is inaccuracy to be known about the reason of extraction because it relies on subjective information that provided by individual. Also, molar considered the most loss teeth and mainly due to dental caries, rather than lower incisors that loss mainly due to other than dental caries (Kida et al., 2006, Manji et al., 1988).

5. Conclusions:

Patient’s perception of functional and esthetic needs was variable among the population in comparison to professional assessment of patient’s needs. Dental caries preventive measures application will reduce loss of teeth significantly. The result of this study will be a baseline data for any further future studies.

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[Table 1] Causes of teeth lose

[Figure 1] Preferred Treatment Option

[Figure2] Causes of not replacing missing teeth