A study on patients’ quality of life before and after implants

Dr. Neil Patel outlines his findings after carrying out a study on patients’ well-being before and after they had implants placed

Oral health changes, such as tooth loss, can have a profound effect on a patient’s quality of life (McGrath and Bedi, 2002). Many patients find it difficult to come to terms with tooth loss, being less confident about themselves and more inhibited in daily activities (Davis, et al., 2000).

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The partial and fully edentulous condition has negative impacts on ability to chew, speech, and appearance (Walton and MacEntee, 2005).

Population-based studies have commonly shown that satisfactory oral health is achieved with the presence of a minimum of 20 teeth, or a particular number of contacting posterior pairs of teeth (Sheiham, et al., 2001;
Shimazaki, et al., 2001). However, this is only on a functional level with the patient’s psychological well-being not taken into account.

Furthermore, the wider availability of prosthetics and advances in dental materials have made well-aligned, esthetically pleasing teeth more attainable and are now widely promoted in the media as to what society considers to be an acceptable standard for dental appearance (Sheiham, et al., 2001). Consequently, there may be increasing pressure for patients to replace lost teeth and obtain an appearance that is closer to celebrities in the media.

Compared to other dental disciplines, implant dentistry has enjoyed far more progressive development in recent years. Patients too are becoming more aware of dental implants and the benefits they can offer.

The study

The paucity of information reporting the influence of implant therapy, especially carried out in primary care, promoted the basis for this study. The aim of this study was to assess changes in oral health quality of life following dental implant treatment.

A total of 150 consecutive patients had implants placed at the Evodental Implant Center (a primary care dental practice specializing in implant therapy). They were asked to complete an Oral Health Impact Profile (OHIP) questionnaire reprinted from Gary Slade’s (1997) Measuring Oral Health and Quality of Life. This questionnaire is designed to measure patient perceptions of the impact of oral health issues on their lives. It is a scaled index consisting of 49 statements.

The OHIP was given to patients at their initial consultation and at a 6-month follow-up after restoration of the implants. In order to determine whether statistically significant improvements had occurred in oral health quality of life following treatment, the paired sample t-test was employed.

Results

From the 150 patients recruited, 107 returned for a 6-month follow-up and successfully completed the OHIP for a second time. Therefore, data can only be used from this group’s first and second OHIP answers. This sample of 107 patients included 48 male and 59 female patients, with an age range of 24 to 82 years. Thirty-nine patients were totally edentulous. Multiple implants were placed in 70 patients, and the remaining 37 each had a single implant placed.

At the preoperative assessment, areas that scored the lowest on the OHIP, and therefore signified the greatest effect on quality of life, were dissatisfaction with appearance, food catching under dentures, and negative feelings of self-consciousness.

Six months after restoration of the implants, there was a significant improvement in every component of the OHIP (p < 0.001). Categories where patients benefited the most after implant therapy included improvement in appearance, improvement in feelings of self-consciousness, and improved fit of dentures. Edentulous patients showed the greatest increase in OHIP scores, thus benefiting the most from implant therapy.

Discussion

This study has shown that quality of life is affected by oral health. Dental implant therapy has a positive affect on oral health quality of life as determined by the participants’ answers for the OHIP. Long-term follow-up is, however, required to provide an understanding of continuing benefits from dental implant therapy.

The study has also highlighted the benefits of using surveys to monitor patient outcomes. Patient-targeted questionnaire use is encouraged as part of the compliance framework of the Care Quality Commission in England (Busby, et al., 2012).

Furthermore, patient-reported outcome measures are gaining increasing popularity. Reliable patient surveys have the potential to improve the performance of any organization if results are acted upon. Patient responses to these oral health-related questionnaires provide clinicians with valuable information about the effectiveness of their therapies on functional capacity and well-being, areas in which patients are most interested and familiar.

A copy of the Oral Health Impact Profile used for this survey is available upon request.

References

1.Busby M, Burke FJ, Matthews R, Cyrta J, Mullins A. Measuring oral health self perceptions as part of a concise patient survey. BrDentJ. 2012;213(12):611-615.

2.Davis DM, Fiske J, Scott B, Radford DR. The emotional effects of tooth loss: a preliminary quantitative study. BrDentJ.2000;188(9):503-506.

3.McGrath C, Bedi R. Measuring the impact of oral health on life quality in two national surveys — functionalist versus hermeneutic approachesCommunityDentOralEpidemiol. 2002;30(4):254-259.

4.Meadows LM, Verdi AJ, Crabtree BF. Keeping up appearances: using qualitative research to enhanceknowledge of dental practice. JDentEduc. 2003;67(9):981-990.

5.Sheiham A, Steele JG, Marcenes W, Lowe C, Finch S, Bates CJ, Prentice A, Walls AW. The relationship between dental status, nutrient intake, and nutritional status in older people. JDentRes. 2001;80:408-413.

6.Shimazaki Y, Soh I, Saito T, Yamashita Y, Koga T, Miyazaki H, Takehara T. Influence of dentition status on physical disability, mental impairment, and mortality in institutionalized elderly people. JDentRes. 2001; 80(1):340-345.

7.Walton JN, MacEntee MI. Choosing or refusing oral implants: a prospective study of edentulous volunteers for a clinical trial. IntJProsthodont. 2005;18(6):483-488.

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