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Predictive Prosthodontics: I. General Health Status and Edentulousness
Published in Journal of Prosthetic Dentistry, Vol. 21, No. 5, May 1969.
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The observation that denture design plays a cardinal role in denture tolerance is attested to by the facts that many people successfully tolerate physiologically designed dentures and that significant numbers of patients fare poorly with ill-fitting dentures. However, the common paradox that many patients cannot adapt to seemingly physiologic appliances and others adjust to ill-fitting prostheses makes the doctrine of specific etiology (denture design as the single cause) untenable.
Swenson and Stout1 introduced another variable into the perplexing problem of denture tolerance: “Any general systemic disability will make denture success uncertain. Most people of the complete denture age are likely to have contributing health causes to denture difficulties.”
The purpose of this report is to attempt to cast additional light upon two questions:
- What is the general health status of complete denture patients as opposed to dentulous patients?
- Can one predict the development of denture patients through all analysis of their general health states?
Method of Investigation
Eighty-nine presumably healthy female patients participated in this study. The age distribution is summarized in Table I. The number of teeth in each patient was counted, and the findings are outlined in Table II. Fifteen patients (17 per cent) were edentulous, and 9 (10 per cent) had a full complement of natural teeth (28).
Each patient completed the Cornell Medical Index Health Questionnaire (CM]).2This self-administered form includes 195 questions to be answered in the affirmative or negative. The scores ranged from a low of 5 affirmative responses to a high of 100 positive replies (Table III). It is reasonable to presume that the smaller the number of affirmative replies (symptoms and signs), the healthier the patient.
Results
The 32 subjects in the oldest age category (55 to 66 years) were separated into dentulous and edentulous groups (23 and 9 patients respectively). The CMI positive responses are summarized in Table IV and are plotted in Fig. 1. It is noted that the CMI scores ranged from 4 to 100 positive replies (mean and standard deviation = 29.5±20.1) in the dentulous group. The range extends from a minimum of 16 to a high of 8+ replies (mean and standard deviation = 54.7±20.4) for the edentulous group. The means are statistically and significantly different for the two groups (P<0.005). It is fair to conclude, within the limits of these observations and in answer to our first question, that elderly edentulous patients report more systemic pathoses than do dentulous patients in the same age group.
The question arises as to whether the.systemic complaints are the result of, the cause of, or simply related to edentulousness. Accordingly, the entire group has been re-analyzed in terms of tooth loss and CMI responses in relation to age. The Cornell Medical Index Health Questionnaire Manual notes that a serious disorder is to be expected when more than 25 items are marked yes.2 Table V summarizes the results. It is clear that there [are] statistically significant differences in the means in the oldest age group. Fig. 2 locates the four age groups on the abscissa. Pictured on the ordinate are the mean numbers of teeth. The stippled columns represent those with the fewer complaints (less than 30); the black bars represent the greater numbers (more than 30) of positive CMI responses. Fig. 2 shows that with time (advancing age) tooth losses increase. However, it is also clear that the mean for tooth loss is greater in those with more systemic symptoms and signs.
Discussion
The evidence presented here suggests that edentulous subjects report more systemic symptoms than do dentulous patients. Thus, even though this study does not demonstrate “cause and effect,” it does point out a relationship between general and oral health. Moreover, the data suggest that patients with the greatest number of complaints are the ones who experience progressively greater tooth loss with time (age). If the systemic factors are in any way related to the genesis of tooth loss, then the host problems in denture patients commence long before total tooth loss has occurred.3 It would prove interesting to eliminate the remediable systemic complaints and to note whether this in any way slows tooth loss and diminishes the possibility of one becoming a full-denture patient.
Summary
A study of 89 presumably healthy women (40 to to 60 years of age) brings two points into focus. First, edentulous patients are characterized by more systemic complaints indicative of poor health than are dentulous patients. Second, patients with more systemic symptoms and signs lose more teeth with time (age) than do individuals with fewer systemic findings. Thus, there appears to be a relationship between general health and the development of edentulousness.
References Cited:
- Swenson, M. G., and Stout, C. J.: Complete Dentures. ed. 4, St. Louis, 1959, The C. V. Mosby Company, p. 20.
- Brodman, K., Erdmann. A. J., Jr., and Wolff, H. G.: Cornell Medical Health Questionnaire: Manual. New York, 1949, Cornell University Medical College.
- Manhold. J. H., and Izard, C. E.: “Relationship of Dental Caries to General Health.” Science 120: 892-893, 1954.