Objectives:
The aim of this study is to investigate the impact of multiple factors in the Oral Health Related Quality of Life of patients being treated with Conventional Complete Dentures, including: a) Level of expertise of the dental provider (third year dental student vs. fourth year dental student); b) Length of time edentulous; c) Number of previous prostheses; d) Race; e) Sex; f) Age; g) Systemic conditions; h) Condition of the bone ridge; i) Economic factor and insurance coverage, in patients at the University of Iowa College of Dentistry (D3 and D4 Clinics).
Materials and methods:
Eighty-one subjects who had been completely edentulous (49 men and 32 women; age range from 23 to 93 years old, mean of 58.9+13) for a minimum of 3 months were recruited. Out of the eighty-one, eleven subjects were not included in the final analysis because their prostheses were not delivered due to various reasons (time, death, discontinued treatment). Subjects were asked to complete the OHIP-EDENT (Oral Health Impact Profile for Edentulous Patients) and the patient satisfaction questionnaire to record data at baseline, at 1-week post-delivery and at 1-month post-delivery of the new prostheses. Additional to these two instruments, the PDI Classification instrument (to assess bone/tissue condition) and the Kapur Index (to assess retention/stability of the new prostheses) were also used.
Baseline comparisons of subjects seen at the D3 vs. the D4 clinic were carried out using chi-square tests of association for nominal ordinal variables, and the Wilcoxon-Mann-Whitney test for ordinal and quantitative outcomes. Bivariate analyses were conducted to assess potential relationships between covariates and the primary outcomes (total OHIP-EDENT and total Patient Satisfaction Questionnaire scores at one-week and one-month follow-ups). The Spearman rank correlation was used to identify increasing or decreasing relationships between primary outcomes and quantitative and ordinal variables; the Wilcoxon-Mann-Whitney test was used to assess relationships between primary outcomes and categorical covariates.
Results:
Overall, there was not enough statistical evidence to conclude that patient satisfaction and quality of life were significantly affected by most of the factors being studied. However, there was suggestive evidence of the presence of higher level of quality of life for patients seen in the D4 clinic (students with higher level of expertise). At the one-month follow-up, the comparison of the total OHIP-EDENT score between the D3 and D4 clinics was significant at the 0.05 level (p=0.018, exact Wilcoxon-Mann-Whitney test). The total OHIP-EDENT scores tended to be lower (indicating greater satisfaction) in the subjects seen in the D4 clinic. Two of the nineteen items from the patient satisfaction questionnaires also suggested a greater level of patient satisfaction for patients seen in the D4 clinic (students with higher level of expertise).
Conclusion:
1) Oral health related quality of life at 1-week follow-up was not significantly different between patients treated by D3 and D4 students.
2) Oral health related quality of life at 1-week follow up was significantly better for patients who had been edentulous for a longer period of time than those who were recently edentulous. However, this result can only be considered suggestive due to the need for adjustment for multiple comparisons.
3) Oral health related quality of life at 1-month follow up was significantly better for patients treated by D4 students in comparison to D3 students. However, this result can only be considered suggestive due to the need for adjustment for multiple comparisons.
4) Overall, patient satisfaction at 1-week follow-up was not significantly different between patients treated by D3 and D4 students. However, patients treated in the D4 clinic reported significantly better outcomes in regard to speaking with their new prostheses.
5) Overall, patient satisfaction at 1-month follow-up was not significantly different between patients treated by D3 and D4 students. However, patients treated in the D4 clinic reported that they could chew better with their new prostheses compared to those treated by D3 students.