SHEFFIELD, UK: In a first-of-its-kind study, researchers from the University of Sheffield explored patients’ emotional challenges during treatment and living with removable dentures. They found that careful management of patient experiences and empathy by the dental team can have a positive effect on clinical outcomes. It is hoped that these new insights can help dental professionals develop improved treatment plans and aftercare for the growing number of patients requiring dentures.
Improvements in oral health care, the shift toward preventive dentistry, and the preservation of natural teeth, combined with increasing longevity, have resulted in an increasing number of patients retaining more than their teeth and requiring 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. However, relatively little is known about the path to their successful use, and many patients feel unprepared for the struggle of adjusting to life with removable dentures.
The research team worked with two sample groups of partially edentulous patients from the United Kingdom. The first group consisted of patients who had received dentures within the past five years, and the second group consisted of patients who received new or replacement dentures. Their methodology included participant observation of the denture fitting process, debriefing interviews, and a follow-up focus group that explored the patient experience.
The four phases of the tooth loss and replacement journey
Study participants expressed their experience of receiving dentures as comprising four phases: tooth loss, emotional tunnel, prosthetic hope, and prosthetic compromise. Tooth loss was an intensely emotional experience, leading to significant personal trauma. As a consequence of this trauma, the participants reported an inability to participate in the denture placement process and were unable to properly understand what the dental team was telling them. This phase was referred to as an emotional tunnel, and patients reported feelings of self-consciousness, depression, shame, or fear. This phase usually ended at the trial stage, when patients could actually experience the feel and look of the new denture and began to develop prosthetic hope, including excitement about new possibilities, such as regaining their smile and eating normally.
In the last phrase – compromise with prosthetics – patients acknowledged that it would take time to adjust to life with new dentures. The phase involved managing expectations and practicing how to eat and talk. It was made clear to patients that their dentures, no matter how well they fit, would require constant daily adjustments, which could be difficult for some patients.
The overall goal of removable denture treatment for patients is to avoid revealing tooth loss in the first place, as this loss is still associated with stigma. Therefore, ill-fitting, loose or painful dentures were seen as a threat to disclosure.
“Understanding the emotional difficulties identified in the study will help dentists improve the care provided to patients with dentures.”—Prof. Barry Gibson, University of Sheffield
Takeaway message for dental groups
The research team found that repeated cycles of dentures helped the participants to trust their dentist and this was seen as an important factor in successful treatment. In order for patients to develop trust, it is vital for the entire dental team to show support, allow enough time, help patients relax and thoroughly explain the treatment process. The trial phase was identified as the best possible time to provide patients with information about denture wear and plans for ongoing care. Patients described that by creating a treatment alliance with their dental team, many of the negative aspects of receiving removable dentures could be overcome.
“Losing teeth can be extremely traumatic and this study has revealed just how difficult it is for people who need partial dentures. Feelings such as embarrassment or shame can significantly affect the process of making and fitting dentures. In addition, if they do not fit properly, this can make everyday activities such as talking, eating and drinking very difficult, which affects a person’s quality of life. The impact can be so dramatic that it can affect their confidence to leave home. This can have a devastating and lasting impact,” lead author Professor Barry Gibson from the university’s School of Clinical Dentistry said in a press release.
“Understanding the emotional difficulties identified in the study will help dentists improve the care provided to patients with dentures and lead to a more successful and better experience for everyone,” he added.
Co-author Dr Bilal el-Dhuwaib, clinical lecturer in restorative dentistry at the university, commented: “This study is important because it goes beyond the typical numbers-based approach to dentistry by looking at critical 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 me and fellow dentists to better understand and address patients’ emotional rollercoaster ride 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 by local artist Gina Allen showing the emotional journey of patients receiving removable dentures. (Image: Gina Allen)
New patient questionnaire for improved 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 collaboration has influenced the development of a new patient questionnaire designed to help provide more personalized care based on specific patient experiences. The questionnaire also aims to improve communication to encourage dental teams and patients to have open discussions about dentures. Another important goal is to allow dentists to identify and monitor patients who may need additional support.
To this end, the research team is seeking further funding to validate the questionnaire and develop a comprehensive clinical pathway for denture care.
The study entitled “‘It’s like being in a tunnel’: Understanding the patient’s journey from tooth loss to life with removable dentures“, published in the June 2024 issue of Journal of Dentistry.
