|Ahead of print publication
Patient awareness about dental implants and satisfaction with conventional complete dentures fabricated by undergraduate and postgraduate students
Greeshma Sunny1, Ramesh Chowdhary1, Sunil Kumar Mishra2
1 Department of Prosthodontics, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
2 Department of Prosthodontics, Rama Dental College Hospital and Research Centre, Kanpur, Uttar Pradesh, India
|Date of Submission||01-Feb-2021|
|Date of Acceptance||15-Apr-2021|
|Date of Web Publication||26-Oct-2021|
Department of Prosthodontics, Rajarajeswari Dental College and Hospital, Bengaluru - 560 074, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Dental undergraduate students and postgraduates do learn conventional denture making as their curriculum but previous studies have found that the final-year undergraduate students lack the confidence which is required in treating completely edentulous patients. This pilot questionnaire survey was done to evaluate patient awareness about dental implants and satisfaction with conventional complete dentures fabricated by undergraduate and postgraduate students in the department of prosthodontics. Materials and Methods: The study was carried out on thirty patients who received complete maxillary and mandibular denture. These 30 patients were divided into two groups, each group consisting of 15 patients on the basis if the denture was fabricated by a postgraduate or undergraduate student. After using the denture for a period of 3 months, the patients rated the functioning of the dentures using the questionnaire survey. The patient was also asked about the knowledge about the implant and their willingness to go for the implant treatment. Results: Patient satisfaction was significantly higher amongst the patients who received complete denture fabricated by postgraduate students as compared to undergraduate students, and the difference was statistically significant (P < 0.05) for six of the seven questions. Most of the patients were not aware of the dental implants, and the cost of the implant is a major factor for not going for implant treatment. Conclusion: The pilot study showed that the patients who received complete denture delivered by the undergraduates were not satisfied with the fit, masticatory efficiency and encountered falling of denture while talking and eating. In contrast, the patients who received complete denture delivered by the postgraduate students were happy with the fit and masticatory efficiency. The present survey found that there is a lack of awareness about implants in patients, and the cost factor is a major hurdle in patients for not taking implants as a treatment option.
Keywords: Complete denture, dental implant, patient satisfaction, retention
|How to cite this URL:|
Sunny G, Chowdhary R, Mishra SK. Patient awareness about dental implants and satisfaction with conventional complete dentures fabricated by undergraduate and postgraduate students. Adv Hum Biol [Epub ahead of print] [cited 2021 Dec 1]. Available from: https://www.aihbonline.com/preprintarticle.asp?id=329197
| Introduction|| |
Recently, the Fédération Dentaire Internationale World Dental Federation defined oral health as multifaceted and includes the ability to speak, smile, smell, taste, touch, chew and swallow, and conveys a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex. It reflects the physiological, social and psychological attributes that are essential to the quality of life. This new definition encompasses the multifaceted nature and attributes of oral health. Poor oral health has been shown to have a negative impact on the patients' overall health and quality of life.
The ultimate goal in any dental treatment is to achieve patient satisfaction. Patient satisfaction should be given utmost importance as Devan has appropriately stated that the dentist should meet the mind of the patient before he meets the mouth of the patient. In a patient receiving a complete denture prosthesis, many factors have a combined role in achieving his/her satisfaction. Efficient mastication, good aesthetics, comfortable speech and comfort in function are the factors in patient satisfaction. The ultimate goal for every patient should be maintainable health for the total masticatory system. Optimum oral health must be the goal of the complete dentist. When oral health is overlooked, the overall status of health and the quality of life is compromised.
The primary goal of a complete denture is to satisfy a normative need, felt need and expressed need from an edentulous patient. To achieve this goal, retention, stability and support are three key factors for a successful complete denture. Conventional complete dentures improve patients' satisfaction and quality of life, regardless of the technique used for denture fabrication. Females with fitted conventional complete dentures reported less satisfaction with aesthetics and ability to chew than males. This study denture satisfaction between the two groups was evaluated using a questionnaire.
Dental undergraduate students and postgraduates do learn conventional denture making as their curriculum, mainly under the guidance of the faculty. Despite the continued need to provide patients with complete dentures, previous studies have found that the final-year undergraduate students lack the confidence which is required in treating completely edentulous patients.,
Further, a paper outlined how differences in teaching methods could influence confidence, with students who experience clinical demonstrations exhibiting higher levels of confidence as opposed to students who only received theoretical teaching. It is essential that students receive sufficient clinical exposure to prosthetic treatments, else they are unlikely to develop either competence or confidence. Irrespective of the amount of student clinical experience, students need to develop insight and an accurate self-assessment of their own competence levels and associated confidence, such that further training and clinical experience can be sought after graduation where necessary.
Thus, the present pilot survey was done to evaluate the knowledge of patients about dental implants and their satisfaction with conventional complete dentures fabricated by undergraduate and postgraduate students.
| Materials and Methods|| |
A cross-sectional pilot survey was conducted on thirty patients who received complete denture in a maxillary and mandibular arch from the department of prosthodontics in a dental college in India. Only those patients were included who were wearing the denture for 3–4 months and were willing to participate in the survey. The pilot survey was approved by the institutional ethical committee board. Based on convenience sampling, these 30 patients were further divided into two groups, each group consisting of 15 patients on the basis if the denture was fabricated by a postgraduate or undergraduate student. These samples were chosen based on the inclusion and exclusion criteria. The inclusion criteria were (1) patients who received complete denture prosthesis from the department recently (within 3 months), (2) patients of both the sexes, (3) patients of ages between 40 and 70 years and (4) patients who were able to understand and respond to the questionnaire used in the study. The exclusion criteria were (1) patients with implant-supported complete denture prosthesis, (2) patients with complete denture prosthesis made elsewhere, (3) patients wearing complete denture prosthesis for more than 3 months, (4) medically compromised patients, (5) patients suffering from psychological and neurological disorders and (6) patients suffering from acute or chronic symptoms of temporomandibular disorders.
Informed consent was taken from all these patients. All the procedures performed in the study were conducted in accordance with the ethical standards of medical investigation involving human subjects given in the 1964 Declaration of Helsinki, as revised in 2013. After the complete dentures were delivered by the undergraduate and postgraduate students, these patients were recalled to the department of prosthodontics after 3–4 months. Patients were then evaluated for ulcerations, denture base fracture, loss of retention, loss or fracture of artificial teeth, masticatory efficiency, phonetics, appearance and overall comfort in the form of questions in their local languages. The questionnaire consisted of eight closed-ended questions [Table 1]. The results obtained were then statistically analysed.
The collected data were analysed with SPSS statistics software 22.0 version (Armonk, NY, USA: IBM Corp). In order to describe the data, descriptive statistics were done using frequency and proportions analysis for categorical variables and the mean and standard deviation were used for continuous variables. Chi-square test was used to compare the responses towards the questions evaluating the patient satisfaction on functioning of a complete denture, and also the patient perspective on implant-supported denture between two groups. Mann–Whitney test was used to compare the mean sum total scores of patient satisfaction on functioning of complete denture between two groups. In all the above statistical tools, the probability value of 0.05 is considered as a statistically significant level.
| Results|| |
Out of the 15 patients who received complete denture by the undergraduate students, only 33.3% (2/15) were very happy with the fit of the denture, 26.7% (4/25) were happy, 26.7% (4/15) were satisfied and 13.3% (5/15) were not satisfied. Amongst the patients who received their denture from postgraduate students, a significant difference (P = 0.04) was observed. 26.7% (4/15) were very happy, 60% (9/15) were happy and 13.3% (2/15) were satisfied [Table 2]. When asked if they could speak properly with the denture? For the complete denture given by undergraduate students, 13.3% of patients (2/15) gave a response as very happy, 40% (6/15) were happy, 13.3% (2/15) were satisfied and 33.3% (5/15) not satisfied. Forty per cent (6/15) of patients who received denture by postgraduates were very happy, 53% (8/15) were happy and 6.7% (1/15) were satisfied. The difference was significant (P = 0.04) [Figure 1].
|Figure 1: Graphical representation of responses for questions evaluating the patient satisfaction on functioning of complete denture between two groups (Q1–Q3). UG: Undergraduate students, PG: Postgraduate students.|
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|Table 2: Comparison of the responses towards the questions evaluating the patient satisfaction on functioning of complete denture between two groups using Chi-square test|
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When asked if patients are happy with the appearance of denture on face? 33.3% (5/15) of patients who received complete denture from undergraduate students responded as very happy, 20% (3/15) were happy, 33.3% (5/15) were satisfied and 13.3% (2/15) were not satisfied. A significant difference (P = 0.04) was seen in the responses by the patients who received denture from postgraduate students as 33.3% (5/15) were very happy, 60% (9/15) were happy and 6.7% (1/15) were satisfied [Figure 2].
|Figure 2: Graphical representation of responses for questions evaluating the patient satisfaction on functioning of complete denture between two groups (Q4–Q7). UG: Undergraduate students, PG: Postgraduate students.|
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When the question how comfortable do you feel with the denture in the mouth? Was asked, 6.7% (1/15) of patients who received complete denture by undergraduate students were happy, 13.3% (2/15) were happy, 46.7% (7/15) were satisfied and 33.3% (5/15) were not satisfied. A significant difference (P = 0.001) was seen in the response given by the patients who were given denture by postgraduate students as 33.3% (5/15) were very happy, 60% (9/15) were happy and only 6.7% (1/15) were satisfied [Figure 2].
Only 6.7% (1/15) of patients who received complete denture by undergraduates were very happy when asked if the denture met their expectation. 6.7% (1/15) were happy, 46.7% (7/15) were satisfied and 40% (6/15) were not satisfied. However, 26.7% (4/15) of patients who were given denture by postgraduate students were very happy, 53.3% (8/15) were happy and 20% (3/15) were satisfied, and the difference was statistically significant (P = 0.002) [Figure 2].
Only 3 out of 15 (20%) from the undergraduate group and 6 out of 15 (40%) in the postgraduate group had heard about implants. When asked if they are willing to go for implant treatment if given an opportunity, only 1 patient (6.66%) in the undergraduate group and 5 patients (33.33%) in the postgraduate group were ready. 93.33% of patients in the undergraduate group and 80% of patients in the postgraduate group were afraid of the surgical procedure involved in the treatment. On further questioning, 13.33% of patients in the undergraduate group and 46.66% of patients in the postgraduate group showed their apprehension towards dental implant treatment due to the cost involved [Table 3].
|Table 3: Comparison of the responses towards the questions on patients perceptive on implants between two groups using Chi-square test|
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| Discussion|| |
The goal of any dental treatment should be to achieve patient satisfaction at the end of the treatment. Although a dentist may have their own means to evaluate the quality of the denture, the success of the treatment should be evaluated in terms of patient satisfaction. The literature shows the use of patient questionnaires as a tool for assessing variables such as, comfort, aesthetics, speech, denture retention, and overall satisfaction related to complete denture.
Seven significant factors, i.e., chewing, speech, pain, aesthetics, fit (upper), retention (lower) and comfort, were included in the questionnaire to quantify the overall satisfaction with complete dentures.,
The present survey has shown that dissatisfaction is seen regarding the fit of the denture, comfort, difficulty in speaking, eating and reduced masticatory efficiency. For the treatment to be successful, not only the clinician's objectives have to be met, but also the patient has to be satisfied. The patient–dentist relationship for the attitude and expectation from the new denture also needs to evaluate.
In the present survey, 5 out of 15 patients (33%) who received complete denture by undergraduates were not satisfied with the fit of the denture. Most of the patients complained of the loose mandibular denture. This could be because of the poorly recorded impressions made by the undergraduate students, mainly due to lack of more clinical and laboratory experience. As there needs to be a definitive programme wherein some specific number of complete denture fabrication needs to be fixed for the undergraduate's students to complete during their undergraduate curriculum, as appears in United Kingdom dental schools, a regional variation in spending more time on the teaching of complete dentures.
Clark et al. found that there is no mechanism in place to ensure that the undergraduate dental schools in the UK teach complete denture construction to the level expected by the General Dental Council. This could be a similar reason in Indian dental school, which lacks proper training at the undergraduate level in complete dentures.
However, amongst the complete dentures delivered by the postgraduates, 9 out of 15 (60%) were happy with the retention of a lower mandibular denture. The improvement in the retention of the denture could be due to the more expertise of the postgraduate students in denture fabrication. This could be explained that several clinicians and patients believe that the success of dental treatment is also affected by the experience of a dentist. A randomised controlled trial revealed that the number of complete denture adjustments required after denture delivery is more in the case of junior clinicians than in the case of senior clinicians. These reports suggest that certain dental treatments are affected by the dentist's experience. The results of this study are very similar to the one by Kimoto et al., where the general satisfaction and satisfaction of speaking, stability and retention were significantly higher amongst patients who received complete dentures from the prosthodontists as compared to inexperienced clinicians.
So what could have caused the difference in satisfaction ratings between the denture delivered by the postgraduate and undergraduate students? It could be attributed to the fact that postgraduate students are better trained in their clinical skills and technical skills with regard to denture procedures such as impression making, recording maxillomandibular relationship and adjusting complete dentures. They are also skilled at evaluating post-insertion complaints of edentulous patients based on their knowledge about the occlusion, patients' oral anatomy and physiology, which is lacking in the undergraduate students. Another important factor in patient satisfaction is communication skills. A postgraduate student is capable of communicating better and establishing a good relationship with the patients, which helps them to understand the need and expectations of the patients. Langer et al. and Seifert et al. suggested that patients' personalities and their relationship with clinicians play an important role in overall adaptation to complete denture. Thus, this study helps to validate that clinical experience and skills are crucial factors for meeting the expectation of the patients.
Only 20% of patients from the undergraduate group and 40% in the postgraduate group had heard about implants. Only 6.66% of patients in the undergraduate group and 33.33% in the postgraduate group were ready to undergo implant treatment. 13.33% of patients in the undergraduate group and 46.66% of patients in the postgraduate group showed their apprehension towards dental implant treatment due to the cost involved. The present survey found that there is a lack of awareness about implants in patients, and the cost factor is a major hurdle in patients for not taking implants as a treatment option. It is advised that more focus should be given at the undergraduate level to educate patients about dental implant, and cost should be reduced so that more patients would be benefited from this treatment modality.
The present study had its own limitations. The sample size was thirty edentulous patients as it was done as a pilot survey. Further studies should be followed up with a larger sample size to obtain more significant results that would be clinically acceptable.
| Conclusion|| |
Within the limitations of this study, it can be concluded that
- Patients who received complete denture delivered by the undergraduates were not satisfied with the fit, masticatory efficiency and encountered falling of denture while talking and eating
- Patients who received complete denture delivered by the postgraduate students were happy with the fit and masticatory efficiency. Patients did not encounter falling of denture while eating or talking, and the complete denture met their expectation
- The present survey found that there is a lack of awareness about implants in patients, and cost factor is a major hurdle in patients for not taking implants as a treatment option.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]