Edentulism, dentures and psychological wellbeing – Phillip Silver

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  Posted by: The Probe      13th May 2019

Dentures have unfortunately been a source of comedy for decades, with countless gags in cartoons, films, television shows and stand up routines using them for cheap laughs. Usually associated with the elderly, cultural stereotyping like this can make younger wearers in particular anxious to avoid their dentures being revealed. This is despite the fact that wearing either partial or complete dentures is comparatively common, with nearly a fifth of the United Kingdom’s adult population doing so.[1]

Significant risk factors for edentulism include being over 50 years of age, smoking, disabilities, various chronic conditions (arthritis, asthma, uncontrolled diabetes), and socioeconomic background. Sex and education level may be associated, but the effect of these is contested in literature and may be more of a cultural variable.[2],[3]Some risk factors carry a level of social stigma in themselves, with society generally looking more favourably on young, healthy people and being more prone to discriminate against older, poorer people and those perceived to have health problems. Studies report that around a third of older people in the UK experience some level of age discrimination.[4]Edentulism is generally regarded as contributing to an ageing appearance, not just the lack of the teeth themselves, but from the effect this can have on the individual’s facial features. Any form of discrimination can have acute effects on a person’s physical, mental and material wellbeing.

While most edentulous individuals are older, among those under fifty, depression is strongly associated.2,3This can impair oral health in a number of ways. Behaviourally, those with depression are less likely to utilise dental services and maintain an adequate oral hygiene regimen (such as being less likely to brush twice daily). Biologically, depression can cause and contribute to immune system dysregulation and increase inflammation in the body, which can increase the risk of periodontal disease. Furthermore, some antidepressants can cause hyposalivation, which by itself can have a substantial impact on oral health, increasing the risk of caries, demineralisation, mucositis, ulcers, tooth sensitivity and oral candidiasis.[5],[6]

Figures suggest that around 18% of the population experience some level of depression or anxiety, with a general pattern that younger people report noticeably higher levels of mental health issues than those over 55.[7]It is understood that depression (as with other mental health issues) is widely under-reported and under-diagnosed and it is thought that only around a quarter of adults with the condition in the UK are receiving treatment.[8]

The relationship between depression and tooth loss may be bidirectional – with depression increasing the likelihood of poor oral health and the results of this further deepening the patient’s depression. Beyond basic function the measure of a person’s satisfaction with their teeth or oral prosthetics is their willingness to show them when smiling.[9]When we consider how important the smile is in interpersonal communication, self-image, confidence and identity – dissatisfaction or psychological stress over one’s smile may have significant effects on one’s quality of life.

Edentulism and denture use can also have affects on diet. Most notably, individuals that have difficulty chewing may avoid certain foods, including many fruits and vegetables, which in turn may adversely affect their nutrition and long-term health. Research has shown that patients’ self-perception of their own chewing ability plays a greater role than their dentist’s assessment.[10]This would indicate that the patient’s psychology is a greater factor in this behaviour, than the perhaps more objective assessment from a professional.

Whether by choice or necessity, many patients are precluded from having dental implants. But this shouldn’t prevent them from a subtle, aesthetically pleasing solution. Quality dentures can restore function and aesthetics, but unfortunately many patients still receive poorly fitting appliances. Where the fit is poor function can be inhibited and further oral health complications can occur, such as sores or abrasion caused by movement of the device. This is an all too common problem and frequent consequence of this is that the patient removes the denture in order to eat. Obviously this is a suboptimal outcome and one that can result in a worsening of their oral condition along with the potential for social ramifications.[11]

For a discreet, highly retentive and comfortable removable partial denture (RPD), Ultaire®AKP provides a biocompatible, lightweight alternative to traditional metal and flexible dentures. Ultaire®AKP is metal free and RPDs created with this advanced polymer are aesthetically pleasing and have a natural bone-like feel. In addition, Solvay Dental 360®are happy to visit dental practices to explain the digital manufacture of RPDs and the benefits of using polymer based frameworks.

A well-fitting prosthetic helps to maintain the structure of the face and a more youthful appearance; it aids function and in the best cases, becomes a natural part of the patient’s life. With careful material selection, manufacture and fitting, patients no longer need to fear the social embarrassment associated with dentures.


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[1]Campbell S., Cooper L., Craddock H., Hyde T., Nattress B., Pavitt S., Seymour D. Removable partial dentures: the clinical need for innovation. The Journal of Prosthetic Dentistry. 2017; 118(3): 273-280. https://www.thejpd.org/article/S0022-3913(17)30073-2/fulltextJanuary 31, 2019.

[2]Tyrovolas S., Koyanagi A., Panagiotakos D., Haro J., Kassebaum N., Chrepa V., Kotsakis. Population prevalence of edentulism and its association with depression and self-rated health. Scientific Reports. 2016; 6: 37083. https://www.nature.com/articles/srep37083January 31, 2019.

[3]Latif T., Vieira A. Risk factors and comorbidities associated with complete edentulism in individuals younger than fifty years of age. Journal of Dentistry and Oral Health.2017; 4: 1-6. http://www.jscholaronline.org/articles/JDOH/Risk-Factors-and-Comorbidities.pdfJanuary 31, 2019.

[4]Rippon I., Kneale D., de Oliveira C., Demakakos P., Steptoe A. Perceived age discrimination in older adults. Age and Aging.2014; 43(3): 379-386. https://academic.oup.com/ageing/article/43/3/379/16639January 31, 2019.

[5]Plemons J., Al-Hashimi I., Marek C. Managing xerostomia and salivary gland hypofunction: executive summary of a report from the American Dental Association Council on Scientific Affairs. The Journal of the American Dental Association.2014; 145(8): 867-873. https://www.sciencedirect.com/science/article/pii/S0002817714602002January 24, 2019.

[6]Hybels C., Bennett J., Landerman L., Liang J., Plassman B., Wu B. Trajectories of depressive symptoms and oral health outcomes in community sample of older adults. International Journal of Geriatric Psychiatry. 2016; 31(1): 83-91. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4641817/  January 31, 2019.

[7]Office for National Statistics. Measuring national well-being: domains and measures (September 2018 release). ONS. 2018. https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/datasets/measuringnationalwellbeingdomainsandmeasuresJanuary 31, 2019.

[8]Mental Health Foundation. Fundamental facts about mental health 2016. Mental Health Foundation. 2016. https://www.mentalhealth.org.uk/publications/fundamental-facts-about-mental-health-2016January 31, 2019.

[9]Afroz S., Rathi S., Rajput G., Rahman S. Dental esthetics and its impact on psycho-social well-being and dental self confidence: a campus based survey of North Indian university students. The Journal of the Indian Prosthodontic Society. 2013; 13(4): 455-460. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792334/January 31, 2019.

[10]Bradbury J., Thomason J., Jepson N., Walls A., Mulvaney C., Allen P., Moynihan P. Perceived chewing ability and intake of fruit and vegetables.  Journal of Dental Research. 2008; 87(8): 720-725. https://journals.sagepub.com/doi/abs/10.1177/154405910808700815January 31, 2019.

[11]Gellar M., Alter D. The impact of dentures on the nutritional health of the elderly. The Journal of Aging Research & Clinical Practice. 2015; 4(1): 50-53. http://www.jarcp.com/872-the-impact-of-dentures-on-the-nutritional-health-of-the-elderly.htmlJanuary 31, 2019.

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