Study examines tooth loss and removable denture use

Franziska Beier, Dental Tribune International

Thu. 13 June 2024

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SHEFFIELD, UK: In a first-of-its-kind study, researchers from the University of Sheffield have investigated patients’ emotional challenges in being treated with and living with removable dentures. They found that careful management of patients’ experiences and empathy by the dental team can have a positive effect on the clinical results. It is hoped that these new insights can help dental professionals develop improved treatment plans and aftercare for the growing number of patients who are in need of dentures.

Improvements in oral healthcare, a shift towards preventive dentistry and the retention of natural teeth, together with increasing longevity, have resulted in a growing number of patients retaining more of their teeth and who need restorative dental treatment. However, solutions such as bridges and implants are not affordable for many people, and removable dentures are often the only viable option for patients with tooth loss. Despite this, relatively little is known about the path to their successful use, and many patients do not feel prepared for the struggle to adapt to living with removable dentures.

The research team worked with two partially dentate patient sample groups from the UK. The first group consisted of patients who had received dentures in the last five years and the second group consisted of patients receiving new or replacement dentures. Their methodology included participant observation of the denture-fitting process, debriefing interviews and a follow-up focus group which explored the patient experience.

The four phases of the tooth loss and replacement journey

The study participants expressed their experience of receiving dentures as involving four phases: tooth loss, the emotional tunnel, prosthetic hope and prosthetic compromise. Tooth loss was a strongly emotional experience, leading to significant personal trauma. As a consequence of this trauma, participants reported an incapacity to engage with their denture-fitting process and being unable to understand properly what the dental team was telling them. This phase was referred to as an emotional tunnel, and the patients conveyed feeling self-conscious, depressed, ashamed or fearful. This phase usually ended at the try-in stage, when patients could actually experience what the new denture would feel and look like and they started to develop prosthetic hope, including feeling excited about new possibilities such as regaining their smile and eating normally.

In the final phrase—prosthetic compromise—patients acknowledged that it would take time to adjust to living with new dentures. The phase involved managing expectations and practising how to eat and speak. It became clear to patients that their dentures, no matter how well fitting, would require ongoing daily adjustments, which could be challenging for some patients.

The overall goal of removable denture treatment for patients is to avoid the disclosure of having lost teeth in the first place, as this loss is still associated with stigma. Therefore, ill-fitting, loose or painful dentures were regarded as a threat to disclosure.

“Understanding the emotional difficulties identified in the study will help dentists to improve the care given to denture patients.”—Prof. Barry Gibson, University of Sheffield

Takeaway message for dental teams

The research team found that repeated cycles of denture fittings helped participants to have confidence in their dentist, and this was regarded as a significant contributor to successful treatment. For patients to develop trust, it is crucial for the entire dental team to demonstrate support, grant enough time, help patients relax and thoroughly explain the treatment process. The try-in stage was determined to be the best possible time to provide patients with information about denture use and plans for continued care. Patients described that, in forming a treatment alliance with their dental team, many of the negative aspects of receiving removable dentures could be overcome.

“Tooth loss can be hugely traumatic, and this study has uncovered just how challenging it is for people needing partial dentures. Feelings such as embarrassment or shame can significantly affect the process of having dentures made and fitted. On top of this, if they don’t fit properly, this can make everyday activities such as speaking, eating and drinking very difficult, which affects a person’s quality of life. The impact can be so dramatic that it can impact their confidence to leave the house. This can have a devastating and lasting impact,” said lead author Prof. Barry Gibson from the university’s School of Clinical Dentistry in a press release.

“Understanding the emotional difficulties identified in the study will help dentists to improve the care given to denture patients and lead to a more successful and better experience for everyone,” he added.

Co-author Dr Bilal el-Dhuwaib, clinical teacher in restorative dentistry at the university, commented: “This study is important because it goes beyond the typical numbers-driven approach to dentistry by looking at crucial aspects of patients’ emotions and lived experiences. By understanding the psychological and social impact of tooth loss and replacement, the research provides a valuable toolkit for myself and fellow dentists to better understand and address the emotional rollercoaster patients navigate during this process. By equipping dentists with the tools to understand these challenges, we can create a more compassionate and effective approach to tooth replacement.”

Artwork of local artist Gina Allen showing the emotional journey of patients receiving removable dentures. (Image: Gina Allen)

New patient questionnaire for enhanced treatment outcomes

The research team collaborated with a local artist to create an artwork that reflects the emotional journey of patients receiving removable dentures. This partnership influenced the development of a new patient questionnaire that is designed to help in providing more individualised care based on specific patient experiences. The questionnaire is also aimed at improving communication to encourage dental teams and patients to have open conversations about dentures. Another important aim is to allow dentists to identify and follow up with patients who may need additional support.

For this purpose, the research team is seeking further funding to validate the questionnaire and develop a comprehensive clinical pathway for denture care.

The study, titled “‘It’s like being in a tunnel’: Understanding the patient journey from tooth loss to life with removable dentures”, was published in the June 2024 issue of the Journal of Dentistry.