Evaluation of Patient Satisfaction of Removable Complete Dentures ()
1. Introduction
The degree of satisfaction is a subjective indicator of the quality of life of a population. It corresponds to the feeling of pleasure experienced or not (with all the nuances of appreciation) arising from the comparison between expectations and the perception of lived experience; it calls upon the notion of judgment [1].
Every patient expects to be treated in accordance with current scientific knowledge and in the most humane conditions of reception and care possible. Not long ago, the patient did not participate in decisions concerning their care. Currently, patients have become more demanding regarding the quality of service; they expect an overall quality in terms of reception, listening, information, and comfort, and they consider access to healthcare as a right.
Total edentulism is a handicap that predominantly affects elderly individuals in our population, who are often already confronted with numerous pathologies. Fortunately, the total prosthesis compensates for these disadvantages by restoring aesthetic appearance and oral functions [2].
The use of total dentures is becoming increasingly common in dental practice due to the increasing number of edentulous patients. It should not be regarded as a simple technical procedure by either the patient or the practitioner, but rather recognized and understood as a genuine therapeutic act. Its success often remains uncertain and depends primarily on its acceptance by the patient.
The completely edentulous patient seeking consultation presents functional impairment, aesthetic deficiencies, and psychological impact. For the majority of patients, tooth loss is a major physical and psychological problem. For many of them, this signifies a loss of self-esteem, a reminder that the body is aging, which can lead to voluntary isolation. Additionally, the edentulous patient feels like they are losing their true personality and often struggle with social integration. It’s for these reasons that it’s crucial to take into account the patient’s personality and their sufferings, and establish a trusting and understanding relationship between caregiver and patient to meet all of their expectations.
The fabrication of complete removable dentures thus requires a significant portion of psychology and time, as well as therapeutic adaptation based on each individual’s remaining abilities, always with the aim of comfort, hygiene, and aesthetics.
Patient satisfaction with total removable prostheses is a useful indicator for evaluating therapeutic success. This assessment of prosthetic satisfaction is measured using questionnaires covering three aspects.
The patient’s overall satisfaction with their prosthesis.
The level of satisfaction regarding various specific characteristics of this prosthesis such as retention, stability, comfort, hygiene, chewing, and speech.
The degree of satisfaction related to the appearance of the prosthesis and the perception of aesthetic result [1].
Our epidemiological survey aimed primarily to assess the level of satisfaction of fully edentulous patients fitted with prostheses in the adjunct prosthesis service of the Center for Dental Consultations and Treatments (CCTD) in Casablanca, in order to explore the needs and expectations of edentulous patients and to enhance their management.
2. Material and Methods
This descriptive cross-sectional survey involved 80 Patients recently fitted with a total prosthesis in the removable prosthodontics department. The study was conducted over a 6-month period.
The following patients were excluded from the study: Patients with psychological disorders.
- Patients unable to move around.
- Patients with maxillary defects.
- Patients who have undergone maxillofacial radiotherapy.
- Patients unable to communicate.
- Patients rehabilitated with complete supra-root and supra-implant prostheses.
Information relating to the variables studied was collected by means of a questionnaire consisting of several parts.
- Patients’ personal information (age, sex, background, level of education, general condition, harmful habits)
- Access to the hospital
The prosthetic phase (patient-practitioner relationship, duration of total edentulism, questions for former prosthesis wearers)
The post-prosthetic phase (patient expectations, satisfaction with the prosthesis, post-prosthetic advice, complaints)
Overall satisfaction with care
In all, the questionnaire contained 40 items, and the patients in the sample were asked to answer the questions on a 3 to 4 level scale.
- Excellent, good, poor, very poor.
- Very satisfied, satisfied, not very satisfied, not satisfied.
The Patients were fully and fairly informed, in comprehensible terms, of the objectives of the study and of their right to refuse to participate. Our study was carried out with respect for anonymity and confidentiality.
The analysis of the results was conducted using the software (Statistical Package for the Social Sciences) SPSS 10.0 at the epidemiology-biostatistics laboratory of the Faculty of Dentistry, Casablanca.
3. Results
The average age of patients was 61.44, with a minimum age of 29 and a maximum age of 87. The sample studied consisted of 80 patients, 50% of whom were 50% male and 50% female.
Out of the total, 46 patients, accounting for 57.5%, exhibit a favorable apparent general health status. Conversely, 34 patients, comprising 42.5%, present with pathology.
43 patients, representing 53.8%, experienced total edentulism for more than 5 years.
30% of patients surveyed were wearing a total denture, and 57.5% had never been fitted.
After the completion of the prosthesis, 87.5% of the patients were satisfied and indicated that the practitioner met their expectations, 82.5% of the patient were very satisfied with the aesthetic result, 58.8% with chewing, 50% with the comfort of their prosthesis, and 41.3% with the stability of their prosthesis, 37.5% were satisfied with the retention of their prosthesis. (Table 1)
Table 1. Degree of patient satisfaction with their prosthesis Concerning overall satisfaction with care.
|
Very satisfied |
Satisfied |
Not very satisfied |
Total |
Aesthetic result |
82% (n = 66) |
17.5% (n = 14) |
0 |
100% (n = 80) |
Chewing efficiency |
58.75% (n = 47) |
26.25% (n = 21) |
15% (n = 12) |
100% (n = 80) |
Comfort |
50% (n = 40) |
33.75% (n = 27) |
16.25% (n = 13) |
100% (n = 80) |
Retention |
33.75% (n = 27) |
37.5% (n = 30) |
28.75% (n = 23) |
100% (n = 80) |
Stability |
41.25% (n = 66) |
38.75% (n = 32) |
18.75% (n = 15) |
100% (n = 80) |
61.3% of patients were very satisfied with the duration of clinical sessions. 37.5% were satisfied with the time required to fit the prosthesis. (Table 2)
Table 2. Overall satisfaction with the care.
|
Very satisfied |
Satisfied |
Not very satisfied |
Total |
Duration of sessions |
61% (n = 49) |
37.5% (n = 30) |
1.3% (n = 1) |
100% (n = 80) |
Completion time |
10% (n = 8) |
37.5% (n = 30) |
52.5% (n = 42) |
100% (n = 80) |
Concerning the appraisal of the state of oral health 64 patients, or 80%, felt that their oral health had improved. (Table 3) As a result, 54 patients, or 67.5%, will strongly recommend the service to a friend or family member.
Table 3. Assessment of oral health status (OHS) perceived by the patient.
|
Headcount |
Percentage |
OHS Improved |
64 |
80 |
OHS Little improved |
16 |
20 |
TOTAL |
80 |
100 |
4. Discussion
Assessing patient satisfaction is not only a complement to the study of quality of care, but also an obligation. Given that patient/practitioner interaction is a major component of patient satisfaction, it is essential to have a specific questionnaire for evaluating patient satisfaction.
We divided the patients in our population by age group, ranging from a minimum of 29 years to a maximum of 87 years, with an average age of 61.44 years. This is nearly the same average age obtained in a study conducted in Türkiye in 2008 (61.62 years) [3] and in Brazil in 2006 (61 years) [4].
Currently, patients who are fully edentulous and concerned about their appearance are becoming increasingly demanding. They not only request the restoration of various functions related to the masticatory apparatus but also an enhancement of the existing aesthetics of their face, which they consider paramount [5]-[7]. According to a French study (Nantes, 2010), aesthetics, function, and comfort are the main requirements for both genders [8].
It is essential to know the reason for patients’ consultation in order to meet the patient’s demand and obtain acceptance of the complete prosthesis.
In the studied population, among the reasons for consultation expressed by the patients were: (pain, aesthetics, functionality, and instability). We found that aesthetics and functionality are the main reasons that lead patients to consult the adjunct prosthesis service (100% aesthetics, 88.9% functionality, 12.6% pain, and 15.1% instability of old prostheses).
In terms of patient satisfaction with the new prostheses, practitioners fulfilled the expectations of 87.5% of patients.
If we rank the percentage of patient satisfaction according to reported expectations, we find that aesthetics comes first in our study and similar studies conducted [9]-[12]. While retention, stability, and chewing come last [13].
This can be explained by the fact that the patient newly rehabilitated with complete prostheses will have to relearn how to chew, dealing with stability, balance, and prosthetic bulk. However, the chewing force developed will remain lower than in dentate patients, not to mention that certain types of food will need to be avoided [14] [15].
Furthermore, the results of our study show that the inconveniences and difficulties arising from the condition of fully edentulous patients rehabilitated with removable dentures have very little impact on their social relationships: this treatment, albeit palliative, nonetheless offers undeniable benefits (especially aesthetic ones), promoting self-esteem and relationships with their social circle [16] [17].
Regarding post-prosthetic advice, a prosthesis, just like teeth, must be properly cleaned. Indeed, it is a place where food debris and bacteria accumulate. These can not only be responsible for potentially serious infections but also for bad odors [18].
In addition to cleaning the prosthesis, it is important for completely edentulous individuals to brush their gums with a soft or medium toothbrush. Brushing helps remove food debris or adhesive residues from the prosthesis that may have been used, and especially tones the tissues weakened by the continuous coverage of the prosthetic base. As for wearing the prosthesis, one must make an effort to keep it in place to get used to it and wear it as regularly as possible [17] [19].
In our study, all patients expressed having been advised by their practitioner regarding the wearing of the prosthesis and prosthetic hygiene, and 73.8% of patients also received advice on oral hygiene.
Concerning post prosthetic complaints, 65% of patients had prosthetic complaints, with 51.3% experiencing injuries and 25% experiencing prosthetic instability. This shows that the majority of patients complained of pain due to injuries caused by their prostheses. Additionally, a survey by Smith and Hughes showed that pain is the most commonly reported complaint by total prosthesis wearers [20].
5. Conclusion
More and more healthcare facilities are incorporating satisfaction surveys into their quality improvement processes. This has indeed become a necessity to target and address patient expectations. This groundbreaking study at the adjunct prosthesis service of the Ibn Rochd University Hospital in Casablanca aims to enhance its quality improvement approach. Our survey has allowed us to uncover the various human, technical, and logistical components involved in caring for patients consulting the Adjunct Prosthesis Service of the CCTD.
Conflicts of Interest
The authors declare no conflicts of interest.