JCDA - Canadian Dental Association

Dramatic improvements in tooth retention by
adults have been reported in a number of adult
dental health surveys in industrialized countries.
The prevalence of edentulousness has decreased, but many
older adults remain edentulous. This article reviews recent
literature on the outcomes of edentulousness and complete
denture therapy.
One well-documented consequence of tooth loss is
resorption of the residual alveolar ridge. Despite extensive
research, reasons for inter-patient variation in the rate and
extent of bone loss remain unclear. This variation is likely
related to both local and systemic factors. Loss of alveolar
ridge, particularly in the mandible, can lead to instability of
complete replacement dentures, poor appearance and
discomfort. Loss of teeth also compromises ability to chew
food and thus may impair food choice. Objective assessment
of masticatory performance indicates that chewing is
substantially compromised by tooth loss. In studies evaluating
the effects of new, optimal dentures, masticatory
performance and masticatory ability were not significantly
improved. Results of objective and subjective assessments
were only moderately correlated. These results have implications
for treatment planning and indicate a need for a
standardized index of chewing efficiency. However, it
should not be assumed that poor diet is simply a direct
result of tooth loss. Factors such as socio-economic status,
education and food preference also play a major role in diet.
Nonetheless, research has shown that edentulous adults
have a poor-quality diet that is low in fibre. This has longterm
health implications.
662 November 2003, Vol. 69, No. 10
C L I N I C A L P R A C T I C E
A Review of the Functional and Psychosocial
Outcomes of Edentulousness Treated with
Complete Replacement Dentures
• Patrick Finbarr Allen, BDS, PhD, MSc, FDS RCPS •
• Anne Sinclair McMillan, BDS, PhD, FDS RCPS, FDS RCS(Ed) •
A b r i d g e d V e r s i o n
The complete article can be viewed on the eJCDA Web site at: http://www.cda-adc.ca/jcda/vol-69/issue-10/662.html
© J Can Dent Assoc 2003; 69(10):662
This article has been peer reviewed.
Many adults develop the skills required to overcome and
eventually accept limitations of dentures. However, some
patients do not cope well with the loss of natural teeth and
are classed as “maladaptive.” The broader issue of handicap
associated with edentulousness has not received as much
attention in the literature. This domain of health is difficult
to measure, and requires expertise beyond the dental
disciplines. Some studies have used psychological assessment
measures to assess patient acceptance of complete
dentures, but no convincing association was described.
These measures are not developed for use as oral health
status measures and are unlikely to have fully captured the
impact of tooth loss and denture-wearing problems.
Qualitative studies have probed into the impact of tooth
loss on quality of life. Common themes that emerged from
these interviews were feelings of bereavement, lowered selfconfidence,
altered self-image, dislike of appearance,
inability to discuss this taboo subject, concern about
dignity, behaving in a way that keeps tooth loss secret,
altered behaviour in socializing and forming close relationships,
and premature aging.
Research into the outcomes of total tooth loss and
complete denture therapy has been hampered by lack of
randomized clinical trials, questionable use of statistical
tests and failure to include comparable control groups. The
current evidence base needs to be supplemented with
stronger evidence from a more rigorous study design, which
will lead to a better understanding of the outcomes of tooth
loss and complete denture therapy. C
Journal of the Canadian Dental Association