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ORIGINAL ARTICLE
Year : 2017  |  Volume : 15  |  Issue : 2  |  Page : 145-150

Comparison of chewing ability, oral health-related quality of life, and nutritional status before and after the insertion of complete denture among edentulous patients in Lucknow


Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Web Publication13-Jun-2017

Correspondence Address:
Punit Karmacharya
Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaphd.jiaphd_121_16

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  Abstract 

Introduction: Reduction in chewing ability is one of the most impactful sequels resulting from oral disorders and is a common problem reported among elderly adults. This tends to make them more irritable and to lose interest in life. One of the major problems among the old age people is loss of teeth, affecting their chewing ability, dietary intake, and overall general health. Aim: To assess and compare the chewing ability, oral health-related quality of life (OHRQoL), and nutritional status before and after insertion of complete denture among elderly edentulous patients attending the Dental Hospital, Lucknow. Materials and Methods: An intervention study design was used and nonprobability convenience sampling method was used. The population under the study consisted of edentulous patients, both males and females aged 50 years and above. A predesigned questionnaire was used to collect the data that include sociodemographic information and oral hygiene practices. Clinical examination was done using Geriatric Oral Health Assessment Index (GOHAI), Mini Nutritional Assessment, and body mass index. Comparisons between pre- and post-insertion of denture were evaluated at three levels, at baseline and 1st and 3rd month. Results: Chewing ability, GOHAI, and data from food intake questionnaire showed statistically significant improvement from baseline to 3rd month, but calf circumference had no statistically significant improvement. Conclusion: The denture insertion was effective in increasing the chewing ability, food intake, and OHRQoL in the elderly.

Keywords: Edentulousness, Geriatric Oral Health Assessment Index, mini nutritional status, oral health-related quality of life


How to cite this article:
Karmacharya P, Saha S, Kumari M. Comparison of chewing ability, oral health-related quality of life, and nutritional status before and after the insertion of complete denture among edentulous patients in Lucknow. J Indian Assoc Public Health Dent 2017;15:145-50

How to cite this URL:
Karmacharya P, Saha S, Kumari M. Comparison of chewing ability, oral health-related quality of life, and nutritional status before and after the insertion of complete denture among edentulous patients in Lucknow. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2019 Jul 22];15:145-50. Available from: http://www.jiaphd.org/text.asp?2017/15/2/145/207909


  Introduction Top


Oral health is important to such an extent that it can hinder a person's ability to work and concentrate on his routine. Dental problems can devastate a person's physical as well as psychological well-being. Especially in the aged, oral problems are more chronic and severe as they have been always neglected in preference to other health problems. This tends to make them more irritable and to lose interest in life.[1]

It is important to know the measures for improving their quality of life and bringing solace and comfort in their lives. The general health of the elderly gives an insight into their quality of life while the dental health also plays a very important role as the dental problems interfere with the primary needs of life such as mastication of food, esthetics, and speech, leading to irritability and loss of mental stability.[1]

Loss of teeth can substantially affect oral and general health, enjoyment with food, and overall nutrition, thereby affecting the quality of life. Oral health-related quality of life (OHRQoL) is a subset of health-related quality of life. The Geriatric Oral Health Assessment Index (GOHAI) has been recommended for use as an outcome measure in the evaluation of dental treatment.[2]

One of the major handicaps among the elderly is loss of teeth, affecting their mastication, dietary intake, and nutritional status. Very few epidemiological studies have been conducted in India to see the effect of complete dentures on chewing ability, OHRQoL, and nutritional status, i.e., there is need of adequate data in this regard.[2]

In India, the size of the elderly population is fast growing and life expectancy of Indian population is increased to 62.36 years for males and 63.39 years for females. Although the elderly population in India constituted only 7.4% of the total population at the turn of new millennium, its share is expected to increase up to 19% by the year 2025.[3]

Therefore, the aim of the present study was to compare the chewing ability, OHRQoL, and nutritional status before and after insertion of complete denture among edentulous patients visiting the Dental College in Lucknow.


  Materials and Methods Top


A cross-sectional study design was used. The study period was for 3 months (April 29, 2015, to July 1, 2015) and comparisons between pre- and post-insertion of denture were evaluated at three levels, at baseline and 1st and 3rd month. Examination was conducted in the Outpatient Department of Prosthodontics. This proposed study was reviewed by the Institutional Ethical Committee and the clearance was obtained. Informed consent was obtained from patients.

The sample size was calculated based on mean and standard deviation of a previous study,[4] in which nutrition status was assessed. The sample size was calculated using this information in nMaster1.0 (Biostatistics Resource and Training Centre, Christian Medical College, Vellore, India) with a power of 80% and an alpha error of 5% (two-sided). The minimum sample size was calculated to be 115. The sample size was increased to account for lost to follow-up to 138. The total of 23 patients did not respond at the follow-up visits; hence, they were excluded and the remaining 115 patients were finally assessed.

Individuals aged 50 years and above and patients coming to the hospital with the chief complaints of complete edentulousness were included in the study while medically compromised and psychologically compromised individuals were excluded from the study. A pilot study on 20 patients following the inclusion and exclusion criteria was conducted. For test-retest reliability, the patients were given the questionnaire at two different occasions to check the reproducibility of the questionnaire. Internal consistency (Cronbach's alpha) for questionnaire was excellent (1.0).

A nonprobability convenience sampling method was used. A predesigned questionnaire was used to collect the data that include sociodemographic information and oral hygiene practices. Data collection was done using GOHAI (Atchison, 1990)[5] and Mini Nutritional Assessment (Nestle, 2009).[6]

Data collection was carried out in two phases. Phase 1 included collection of data before insertion (baseline) of complete denture followed by insertion of complete denture, and Phase 2 included collection of data after insertion and use of complete denture at 1st and 3rd months. Comparisons between pre- and post-insertion of dentures were done in three levels, at baseline and 1st and 3rd month follow-up.

Data were analyzed using Statistical Package for Social Sciences (SPSS) for Windows version 16.0 (SPSS Inc. 233 South Wacker Drive, 11th Floor Chicago, IL). Changes in chewing ability, OHRQoL, and nutritional status before and after insertion of complete denture were analyzed using repeated measures analysis of variance (ANOVA) followed by post hoc test. The frequency of responses was calculated and presented from baseline to 1 month after prosthesis and 3 months after prosthesis insertion, and Chi-square test was applied to know the statistical significance (Level of significance, P< 0.05).


  Results Top


The GOHAI questionnaire was administered to participants at baseline and 1 and 3 months after prosthesis was given. The frequency of responses was calculated, and Chi-square test was applied to know the statistical significance (Level of significance, P< 0.05). The results showed that 100% of the participants often or always faced difficulties in biting or chewing food before treatment and after 1 month of prosthesis placement which decreased to 74% after 3 months. This decrease was found to be statistically significant (P = 0.00). In total, 92% of the participants were never uncomfortable to swallow which increased to 98.4% at the end of 1 month and 100% at the end of 3 months. This increase was found to be statistically significant (P = 0.00).

About 79.7% of the participants were often or always prevented from speaking due to their oral health, and this percentage decreased to 77.2% at the end of 1st month and 62% at the end of 3rd month. The results were statistically significant, where P = 0.00. In total, 98.6% of the participants often or always faced discomfort when eating at the start of the study, and at the end of 3 months, the percentage of participants was reduced to 88%. This difference was found to be statistically significant, where P = 0.00.

Medication to relieve pain was often or always used by 15.95% of participants at the baseline while no participant who is 0% used medication at the end of 1st and 3rd month. This difference was found to be statistically significant, where P = 0.00.

At baseline, 23.2% of the participants had often or always experienced sensitivity to heat or cold, while after 1 month and 3 months postinsertion, the percentage of participants was reduced to 0. This change was also found to be statistically significant where P = 0.00. In total, 97.1% of the participants were unhappy with their appearance and this percentage reduced to 82.5% at the end of 1 month and 78% at the end of 3 months. This difference was found to be statistically significant, where P = 0.00. In total, 91.3% of the participants reported that they were worried or concerned about their appearance which reduced to 72.9% at the end of 1st month after prosthesis and 72% at the end of 3 months after prosthesis insertion. This difference was found to be statistically significant, where P = 0.00.

In total, 62.4% of the participants were often or always nervous or self-conscious at the beginning of the study while this percentage decreased to 28% at the end of 1st month and 24.6% at the end of 3 months postinsertion. This difference was found to be statistically significant, where P = 0.00. In total, 45% of participants were often or always uncomfortable in eating in front of people at the beginning of the study and the percentage decreased to 10.6% at the end of 1st month and 2% at the end of 3 months postinsertion. This difference was also found to be statistically significant, where P = 0.00.

In total, 92.9% of participants reported having limit on kinds or amounts of food at baseline, and at the end of 3 months, the percentage was 92%. This difference was not statistically significant, where P = 0.11. In total, 33.3% of participants has often or always limit on contact with others due to oral health while the percentage of participants reduced to 5.2% at the end of 1 month and 2% at the end of 3 months postinsertion. This difference was found to be statistically significant, where P = 0.00 [Table 1].
Table 1: Frequency distribution of responses of the study subjects according to Geriatric Oral Health Assessment Index

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The results using repeated measures ANOVA show a decrease in overall GOHAI score among participants from baseline to 3 months of insertion of prosthesis [Table 2] and [Figure 1]. Overall, there was an increase in OHRQoL of participants at the end of 3 months postinsertion of prosthesis. The chewing ability questionnaire was found useful in evaluating the chewing ability of patients after wearing the denture.
Table 2: Overall change in Geriatric Oral Health Assessment Index among participants between the baseline, 1st month, and 3rd month

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Figure 1: Geriatric Oral Health Assessment Index scores from baseline to 1 month and 3 months

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Results show improved nutritional parameters (Mini Nutritional Assessment) among participants from baseline to 3 months of insertion of prosthesis and this difference is statistically significant [Figure 2].
Figure 2: Percentage distribution of effect of prosthesis on food intake over the study period

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Results show an improved parameter with 40.6% with a psychological stress episode (Mini Nutritional Assessment) at the beginning of the study period to 18% at the end of 3 months [Figure 3]. Chi-square test was used to compare effect of prosthesis on neuropsychological problems (Mini Nutritional Assessment) during the study period. Results show an improved parameter with 47.8% participants without dementia at the beginning of the study period to 82% at the end of 3 months and this difference is statistically significant [Figure 4].
Figure 3: Percentage distribution of effect of prosthesis on psychological stress or acute disease over the study period

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Figure 4: Percentage distribution of effect of prosthesis on neuropsychological problems over the study period

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The results using repeated measures ANOVA showed an increase in overall screening score among participants from baseline to 3 months of insertion of prosthesis and this increase was statistically significant [Table 3].
Table 3: Overall change in nutritional screening among participants between the baseline, 1st month, and 3rd month

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  Discussion Top


The present study was carried out to compare the chewing ability, OHRQoL, and nutritional status before and after insertion of complete denture among edentulous patients visiting a Dental Hospital, Lucknow, India.

The chewing ability questionnaire was found useful in evaluating the chewing ability of patients after wearing the denture. Hirai et al.[7] also suggested that food intake questionnaire was useful in evaluating masticatory functions in complete denture wearer.

In the present study, improvement in the chewing ability was observed during a period of 3 months after denture insertion which was statistically significant. This may be due to the fact that patients developed a pattern of functioning and adapting their diet to complete dentures over a period and probably good denture fit and stability of complete denture might have also played a role in improving the chewing ability. These findings were consistent with the similar studies conducted by Muller et al.,[8] which reported that edentulous patients receiving complete denture 1 year back had difficulty in chewing hard food when compared with the edentulous patients receiving implant-supported overdenture during the same period.

GOHAI is an example of a patient-based assessment of oral health problems commonly affecting older adults. As GOHAI is able to detect oral health changes over time and to measure the effect of oral treatment, GOHAI was used in the present study to evaluate quality of life. In the present study, GOHAI was found to be a simple and effective method of evaluating the OHRQoL of the edentulous patients receiving complete denture. The present study indicated an improvement in quality of life among edentulous patients after complete denture insertion. It has also been demonstrated by Veyrune et al.[9] that oral health quality of life of edentulous persons is less than that of dentate persons.

Complete denture improves the quality of life of edentulous persons as it contributes to better appearance and improves social and functional comfort. Thus, it was confirmed by the study that edentulous patients with less initial GOHAI score benefitted after placement of new dentures which increased their quality of life over a period of 3 months. The results of the present study are consistent with other studies conducted by Shigli and Hebbal,[10] which showed changes in GOHAI, 1 month after placement of denture in completely edentulous patients reporting to the in a private dental college in Madhya Pradesh. During the study period, highly statistically significant changes in GOHAI among patients were observed. Koshino et al.[11] showed in their study that insertion of denture enhances the degree of eating satisfaction which in turn contributes to psychological health and improves the quality of life. Similar results were found in this study among participants who showed improved OHRQoL.[11]

A study by Hung et al.[12] found significant associations between changes in dental status and dietary intake of specific nutrients suggesting change in dietary intake owing to tooth loss. No similar results were found among edentulous participants in this study. The results of the present study are not consistent with the study conducted by Wöstmann et al.[13]

However, the study had few limitations. As it was conducted in one dental college, the results cannot be generalized. Moreover, the edentulous patients belonged to low socioeconomic status.


  Conclusion Top


Thus, from the present study, it can be concluded that chewing ability and OHRQoL improved after insertion of complete denture among edentulous participants. These tools, designed to detect the outcomes of oral facial disorders in general, may also serve to identify individuals at risk of malnutrition caused by oral problems. A combination of poor oral health status and unfavorable results for chewing-related OHRQoL items should alert dental professionals to the possibility of nutritional problems, especially in a population as vulnerable as the elderly.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Madhuri S, Hegde SS, Ravi S, Deepti A, Simpy M. Comparison of chewing ability, oral health related quality of life and nutritional status before and after insertion of complete denture amongst edentulous patients in a dental college of Pune. Ethiop J Health Sci 2014;24:253-60.  Back to cited text no. 1
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2.
Dable RA, Nazirkar GS, Singh SB, Wasnik PB. Assessment of oral health related quality of life among completely edentulous patients in Western India by using GOHAI. J Clin Diagn Res 2013;7:2063-7.  Back to cited text no. 2
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3.
Chhabra A, Chhabra N, Kabi D, Jain A. Understanding dental status and treatment need of geriatric patients: Oral health trends in an Indian population. Oral Health Dent Manag 2013;12:213-6.  Back to cited text no. 3
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Paturu R, Thallam Veeravalli P, Vaidyanathan AK, Grover M. Evaluation of nutritional status and eating pattern in first and second-time denture wearers: A prospective 60 days (2 months) pilot study. J Indian Prosthodont Soc 2011;11:156-64.  Back to cited text no. 4
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5.
Atchison KA, Dolan TA. Development of the Geriatric Oral Health Assessment Index. J Dent Educ 1990;54:680-7.  Back to cited text no. 5
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6.
MNA, Mini Nutritional Assessment, Nestle Nutrition Institute; 2009. Available from: http://www.mna-elderly.com. [Last accessed on 2015 Apr 25].  Back to cited text no. 6
    
7.
Hirai T, Ishijima T, Koshino H, Anzai T. Age-related change of masticatory function in complete denture wearers: Evaluation by a sieving method with peanuts and a food intake questionnaire method. Int J Prosthodont 1994;7:454-60.  Back to cited text no. 7
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8.
Muller K, Morais J, Feine J. Nutritional and anthropometric analysis of edentulous patients wearing implant overdentures or conventional dentures. Braz Dent J 2008;19:145-50.  Back to cited text no. 8
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9.
Veyrune JL, Tubert-Jeannin S, Dutheil C, Riordan PJ. Impact of new prostheses on the oral health related quality of life of edentulous patients. Gerodontology 2005;22:3-9.  Back to cited text no. 9
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10.
Shigli K, Hebbal M. Assessment of changes in oral health-related quality of life among patients with complete denture before and 1 month post-insertion using Geriatric Oral Health Assessment Index. Gerodontology 2010;27:167-73.  Back to cited text no. 10
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Koshino H, Hirai T, Ishijima T, Tsukagoshi H, Ishigami T, Tanaka Y. Quality of life and masticatory function in denture wearers. J Oral Rehabil 2006;33:323-9.  Back to cited text no. 11
    
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Hung HC, Willett W, Ascherio A, Rosner BA, Rimm E, Joshipura KJ. Tooth loss and dietary intake. J Am Dent Assoc 2003;134:1185-92.  Back to cited text no. 12
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Wöstmann B, Michel K, Brinkert B, Melchheier-Weskott A, Rehmann P, Balkenhol M. Influence of denture improvement on the nutritional status and quality of life of geriatric patients. J Dent 2008;36:816-21.  Back to cited text no. 13
    


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