Oral health related quality of life of complete denture patients treated by UG students-A university hospital based study

Priyadharshini Suresh Babu1, Marian Anand Bennis*2, Geo Mani3 1Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu 600077, India 2Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu 600077, India 3Department of Pedodontics and Preventive Dentistry, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu 600077, India


INTRODUCTION
Geriatric dentistry deals with the handling of elderly people. Due to the increase in life expectancy, the population of elderly people is increasing worldwide. In dentistry, the oral health status of elderly people is becoming an area of growing interest (Freitas et al., 2008;Duraisamy et al., 2019). The World Health Organisation's (WHO) de inition of Oral health states that "An individual would be considered to have good oral health if he/she retains, throughout the life at least 20 natural teeth which are functional, aesthetic and not needing prosthesis". Thus this signi ies the importance of retaining teeth to lead a healthy and productive life (Jain et al., 2017). Therefore in today's ageing world, the concept of retention of teeth acquires greater signi icance (Kosuru et al., 2017;Ashok et al., 2014).
Loss of teeth has a signi icant impact on the quality life of individuals (Hewlett et al., 2015;Visscher et al., 2014). The effect of loss of teeth is related to people's lives by affecting their aesthetics, psychology, mastication and social impact, loss of natural teeth can be identi ied by prosthetic treatment (Dable et al., 2013;Kannan and Venugopalan, 2018).
Despite the several advances in preventive and curative dentistry, the common problem of the elderly population is the occurrence of edentulousness which is attributed to the prevalence of caries and periodontal disease (Nalçacı et al., 2007;Venugopalan et al., 2014).
Complete dentures are the most common treatment for the rehabilitation loss of total teeth. The rehabilitative treatment is successful only when the patients are aware of correct prosthesis use and hygiene (Budtz-Jorgensen, 1981;Ajay et al., 2017).
In this scienti ically progressing world dental implants are present, people prefer the complete denture accounting for its easy access, low cost compared to implants, facilitating social engagement and leading an aesthetically acceptable life (Perea et al., 2013;Piampring, 2007).
Teeth replaced by denture serves as an indispensable part of the patient as it can help him/her in following ways of mastication, aesthetics, communication and self-esteem (Singh et al., 2014;Ashok and Suvitha, 2016;Ganapathy et al., 2017).
The oral health of the patient greatly depends on the patient's maintenance of denture (Allen et al., 2001;Zarb et al., 2013). Cleaning of the dentures play an important role in the longevity of prosthesis and greatly involves the oral health condition of the patients (Dikbas et al., 2006;Peracini et al., 2010).
The aim of the present study is to evaluate the oral health-related quality of life among complete denture patients treated by undergraduate students.

Study setting
The study was based on a University study setting dealing with the complete denture patients treated by undergraduate students.
After obtaining the approval of the Scienti ic Review Board of Saveetha Institute and Technical Sciences, the study was initiated.

Sampling method
The list of patients who had undergone complete denture treatment from Saveetha Dental Hospital was obtained by reviewing patient's records and analysed the data of 86,000 patients during the period of June 2019 to March 2020. A total of 320 cases were obtained. Patients who underwent complete denture therapy on both the arches and people aged 50 and above were included in the study. A total of 107 complete denture cases were then included in the study. A questionnaire consisting of basic questions related to the Oral Health related quality of complete denture patients was created. The questionnaire was administered through telephonic conversation and with two reviewers (Kappa statistics was performed for inter reviewer reliability and was found to be 0.90). Inclusion of all available data and tabulated in the excel sheet. Sampling bias was reduced and randomised. Internal validity was adequate and external validity included systematic sampling.

Analysis
The data obtained were tabulated in Microsoft Excel and transferred to statistical SPSS software for statistical analysis. Chi-squared test was then performed to check for the effect of any demographic data. The variables assessed were demographic detail, age group, the period of edentulousness, history of any previous extraction, year of study (operational), number of visits taken, the average number of days from the irst visit of the patient until denture delivery, number of days taken for postdelivery review, number of review visits, referral to postgraduate, clinic post insertion of denture, correlation, cross tab and descriptive analysis was done.

RESULTS AND DISCUSSION
Among the data collected, 59% of the patients were male whereas 41% of patients were female. Based on the age group, 39.2% of the patients belonged to 50-60 years of age, 41.1% belonged to the age 61-70 years of age and 19.7% belonged to 71-80 years of age. When questioned about the removal process of denture whether removal of denture is easy or dif icult, 70% of patients opted for easy removal whereas 30% of patients found the removal of dentures to be dif icult. The patients' opinion on the dif iculty in phonetics varied 36.45% patients suggested that there was no dif iculty in communication, 14% suggested hardly ever, 29% occasionally, 8.41% fairly often and 12.14% very often.
In Figure 1, X-axis represents gender predilection of complete denture patients. Y-axis represents the percentage of participants. Male were predominantly wearing complete dentures compared to females. In Figure 2, X-axis represents the patient's opinion on phonetics dif iculties. Y-axis represents the percentage of participants. Majority of the complete denture patients faced no dif iculties during phonetics. In Figure 3, X-axis represents the patient's opinion on discomfort faced while wearing denture.Y-axis represents the percentage of participants. Majority of the patients had no discomfort wearing dentures. In Figure 4, X-axis represents the patient's opinion on whether food sticks to the denture. Y-axis represents the percentage of participants. Majority of the patients experienced occasional sticking of food to denture. In Figure 5, Xaxis represents the patient's opinion on dif iculties during mastication. Y-axis represents the percentage of participants. Majority of the patients faced dif iculties during mastication occasionally. In Figure 6, X-axis represents gender predilection of complete denture patients based on age group as 50-60 years (blue), 61-70 years (green), 71-80 years (yellow). Y-axis represents the number of participants. Increase in male patients of the age group 61-70 years was observed. Analysing through Chisquare test the p-value was found to be 0.6 >0.05. There was no signi icant difference in age between males and females. In Figure 7, X-axis represents gender predilection of complete denture patients based on the patient's opinion never (blue), hardly ever (green), occasionally (orange), fairly often (violet), very often (yellow). Y-axis represents the number of participants. Increased number of male patients had dif iculties occurring occasionally during phonetics. Analysing through Chi-square test p-value was found to be 0.732 >0.05. There was no signi icant difference in communication dif iculties between males and females. In Figure 8, X-axis represents gender predilection of complete denture patients based on the patient's opinion never (blue), hardly ever (green), occasionally (orange), fairly often (violet), very often (yellow). Y-axis represents the number of participants. More male patients had dif iculties occurring occasionally during mastication. Analysing through Chi-square test p-value was found to be 0.073 > 0.05. There was no signi icant difference in mastication dif iculties between males and females.
Variables such as age, gender play an important role in the satisfaction of complete dentures (Seenivasan et al., 2019;Ariga et al., 2018). The study reveals that the complete dentures are more common in male and they belong to the age group of 61-70 years as depicted in Table 1, Figure 1 and Figure 6. According to previous literature (Shigli and Hebbal, 2010), similar evidence is seen in which it states that the denture wearers are common in male and with the mean age group of 69 years.
Denture replaces the missing teeth which enable patients to communicate better. Improvement is seen pronouncing the words containing sibilants fricatives (Jyothi et al., 2017). The study reveals that the majority of the patients had no dif iculty during communication as depicted in Figure 2 and Figure 7, which is because of an intense try in procedure protocol that ensures that phonetics and aesthetics are evaluated prior to processing the inal denture. The patients are encouraged to talk as much as they can whilst the student and the instructor listen intently. According to the previous literature, (Wearers, 2001), similar evidence was observed which stated that complete denture wearers are well satis ied with their communication and different evidence is seen in (Allen and Mcmillan, 2003) which states that complete denture wearers complaints of phonetics.
After the insertion of the complete denture, patients may experience excessive salivation, the occurrence of sore spots due to compression, gagging re lex which leads to discomfort (Selvan and Ganapathy, 2016). This study reveals that the majority of the patients had no discomfort while wearing denture as depicted in Figure 3. This could possibly be because of good post insertion instructions given by undergraduate students which is a part of their curriculum. According to previous literature, different evidence was seen in Souza et al. (2007) which states that dentures loosely it and not many studies correlate to no discomfort while wearing dentures.
One of the major reasons for poor oral hygiene is the accumulation of food and plaque in the denture and leads to gingivitis infections Basha et al., 2018). This study reveals that the majority of the patients did not experience sticking of food particles to the denture as depicted in Figure 4. This could be attributed to the postinsertion care and maintenance provided by both the patient and student, and frequent follow-ups which are mandated in the student's undergraduate curriculum. According to previous studies, different evidence is seen in Fujimori et al. (2002) which states that there is food retention under denture base and external surface. And not many studies correlate with the fact that food does not stick to the denture.
Edentulous patients are forced to choose soft and easy to chew foods, the complete denture insertion has improved the quality of life of edentulous patients (Subasree et al., 2016). The denture enhances the patients for better food intake and ability to chew hard foods (Vijayalakshmi and Ganapathy, 2016) This study reveals that there are no disturbances during mastication as the high points and immature contacts are eliminated immediately post-processing as depicted in Figure 5 and Figure 8. According to previous literature, similar evidence is seen in Laurina and Soboleva (2006) which states that complete denture wearers are comfortable during mastication with the denture.

Limitations
The limitations of the study are that it is a single centred study and does not represent the population as a whole.

Future Scope
The future scope must focus on conducting similar multi-centred trials across various teaching centres in India.

CONCLUSION
In this study, it is observed that the complete denture patients treated by UG students on the whole experienced positive outcome after the denture placement such as no dif iculty during phonetics and mastication while wearing dentures. The outcome of the complete denture is variable and relies on the attitude towards edentulousness and denture and the process is highly in luenced by patients expectations. In addition, ef icient and regular procedures of cleaning of complete denture are important for maintaining the oral health and longevity of prosthesis. It is extremely important that patients return regularly to the dentist for oral health maintenance and evaluation of denture.