Article Type : Research Article
Authors : Nand M
Keywords : Prosthodontic; Denture; Teeth; Knowledge; Attitudes; Practices
Introduction: Tooth loss significantly impairs oral
functions and reduces masticatory efficiency. Prosthodontic rehabilitation
maintains the aesthetics, functional support, and masticatory function of the
oral cavity. The study aims to assess the knowledge, attitude(s), and
practice(s) (KAP) towards prosthodontic rehabilitation and utilization of
prosthodontic services among patients visiting the Tuisuva Dental Teaching
Clinic (TDTC) between the months of February to April 2022 at the School of
Dentistry and Oral Health (SDOH), Fiji National University (FNU) in Suva, Fiji
Islands.
Methods: A cross-sectional, self-designed
questionnaire-based interview was conducted at TDTC among 83 patients visiting
the clinic for teeth replacement using removable complete and partial dentures
using a simple random sampling method. A questionnaire containing a total of 32
questions, of which 5 are demographic details, 11 knowledge-based, 8
attitude-based, and 8 practice-based questions, was developed to collect data.
Participant responses were entered in Microsoft Excel and analyzed using Epi
Info 7.2 Software.
Results: This study showed that participants'
knowledge was inadequate and lacked in prime areas of oral health information,
whereby 43.37% knew about removable partial dentures (RPDs), 34.94% knew about
removable complete dentures while 13.25% did not know about both. The
participants demonstrated a positive attitude towards treatment, whereby 72.29%
were satisfied, while 16.87% weren’t satisfied with their prosthesis. On the
other hand, practice was shown to be insufficient, whereby participants stated
that 65.06%wore their prosthesis, while 34.94% stated that they did not.
Conclusion: The findings demonstrated that knowledge
might vary among participants based on demographic factors like income,
education, gender, and age. Attitude varied from availability and
socio-economic status; practice had factors such as cleanliness, duration of
appliance, and hygiene practices. The study showed under-utilization of
prosthodontic services resulting in patients not demonstrating the need to
replace missing teeth in the oral cavity.
The American Dental Association (ADA) defines
"prosthodontics," as the branch of dentistry concerned with the
diagnosis, treatment, planning, rehabilitation, and upkeep of patients' oral
function, comfort, appearance, and health when those patients have clinical
conditions linked to missing or inadequate teeth or oral and maxillofacial
tissues. The oral prostheses replacing teeth may be removable complete dentures
or partial dentures or permanently fixed tooth prostheses, connected to
remaining teeth or implanted in the alveolar bone [1]. Prosthodontics also
provides oral prostheses to correct deformities, such as cleft palate, and to
replace alveolar bone to provide underlying support for dentures [1].
Prosthetic treatment varies widely from replacement of missing teeth in a
healthy incomplete dentition to complete rehabilitation of badly damaged teeth
to functional form. Edentulous individuals are also at greater risk for
different systemic diseases and an increase in mortality rate [2]. Multiple
prosthetic options are available for the patient to restore lost teeth,
including removable or fixed partial dentures, complete dentures,
implant-supported processes and over-dentures [3]. Although complete dentures
cannot be considered a substitute for natural dentition, they remain to be a
staple treatment option for edentulous patients [2]. The percentage of
edentulism has dropped in most Western countries over the past 20 years in each
age group as more individuals are living longer with their natural teeth [4]. On
the other hand, in less developed nations, where sore teeth are frequently
pulled rather than treated conservatively, the rate of edentulism is still
rising [3]. There is a case to be made that edentulism rates in emerging
nations are unnaturally low because of shorter life expectancies and a
correspondingly lower proportion of the elderly and extremely elderly [4]. In a
study by Brown D. W. the percentage of edentulism among people 65 and older
ranged from 1.3% to 78.0% among the 42 countries cited globally [5].
The cost of prosthodontic treatment depends on the
type of treatment requested [6]. Therefore, understanding the patient's
knowledge and attitude regarding prosthetic replacement prior to receiving
therapy is essential, given the emphasis on patient-mediated concerns in
prosthetic treatment planning [1,7]. This could be a useful technique for
forecasting whether or not a new prosthesis will be satisfactory [8]. Moreover,
due to financial constraints, many Fijians may opt to live with edentulousness
rather than treat it. University teaching clinics such as the Tuisuva Dental
Teaching Clinic (TDTC) in the School of Dentistry and Oral Health (SDOH) at the
Fiji National University (FNU) and other primary dental health centres at the
Ministry of Health and Medical Services (MoHMS) provide such services at a low
cost. The changing perceptions associated with advancing age, such as the
feeling of being too old to adapt to removable dentures and a lack of interest
in aesthetics, can be a contributing factor to the unwillingness to restore
lost teeth at an advanced age [9]. There has been no previous study conducted
in Fiji that assessed the knowledge, attitude(s), and practice(s) (KAP) towards
prosthodontic rehabilitation and utilization of prosthodontic services among
its patients. In Fiji, financial issues and lack of knowledge among patients
may lead to an ignorant attitude towards edentulism and its consequences.
Another possible reason contributing to the non-uptake of prosthodontic
services may be the absence of dental insurance in Fiji. However, there is a
paucity of published data on the prevalence of edentulism and associated
factors in the Fijian population, which gave an opportunity to conduct further
research in this area, which plays a vital role in the lives of the edentulous
people in receiving appropriate prosthodontic treatment.
Study design and sample
This was a qualitative cross-sectional study with a focus on assessing the KAP towards prosthodontics rehabilitation and the utilization of prosthodontic services among patients receiving and who have received removable prosthodontic denture treatment at SDOH Clinic. Demographic factors such as age, sex, educational status, and ethnicity affecting edentulism were assessed in patients receiving prosthodontic treatment services in Suva at the TDTC at SDOH, FNU. All patients that presented to the FNU TDTC and were seen by Bachelor of Dental Surgery (BDS) students in years 3, 4 and 5 for prosthodontic treatment from February to June 2022 as shown in Table 1 with the inclusion criteria for this study are the patients receiving removable prosthodontic treatment, removable prosthodontic appliance or fixed prosthodontic treatment, who are partially edentulous or completely edentulous, both male and female patients, ranging from 18-80+ in age and, patients with a history of wearing prosthesis. The exclusion criteria for this study are the patients with previous prosthodontic treatment and with temporomandibular joint disorders (Table 1).
Data collection tool
A questionnaire was developed, and patient interviews
and, in some cases, phone calls were used to collect data. The principal
investigator conducted in-person interviews with the patients while the
patients waited for their dental visits. The interview guide was constructed
based on the literature review and the research questions of the study. There
were 4 sections of the questionnaire with a total of 33 questions, of which
section 1 of the questionnaire had demographic information of the patient,
including age, gender, location, ethnicity, and education level information on
teeth comprising 5 questions. Section 2 had 11 questions centred on the
knowledge of patients towards prosthodontic rehabilitation and utilization of
prosthodontic services. Section 3 had 8 questions centred on the attitude of
patients towards prosthodontic rehabilitation and utilization of prosthodontic
services, and section 4 had 8 questions centred on the practice of patients
towards prosthodontic rehabilitation and utilization of prosthodontic services
having the medium of translation in English.
Study procedure
Prior to the start of the study, the College Human
Health Research and Ethics Committee (CHHREC), FNU, and facility approval from
the Head of SDOH was sought. Patients were given a participation information
sheet that outlined the details of the study. For patients phoned, the
questions were asked after verbal consent was taken where there was a phone
script prepared which was read out to the patients over the phone call.
Subsequently, after reading the information sheet and understanding the
interviewing process, the patient provided their consent to participate by
signing the consent form prior to the start of the
interview. For patients who were called via telephone, questionnaires and information sheets were read to them, and verbal agreement was obtained. The duration of the interview was 20-25mins which began with an introduction by the primary investigator to the patient, explaining the purpose and conveying the relevance of contribution to this study where all contributions were valued and remained confidential.
Table 1: Number of dental student cases.
Students |
Cases |
Removable - Partial |
Removable - Full/Full |
BDS 3 |
30 |
15 units |
15 cases |
BDS 4 |
50 |
25 units |
25 cases |
BDS 5 |
75 |
25 units |
50 cases |
Table 2: Demographic details of study participants (n=83).
Demographic
Variables |
Number (n) |
Percent (%) |
|
Age |
18-20 |
0 |
0 |
21-30 |
1 |
1.20 |
|
31-40 |
4 |
4.82 |
|
41-50 |
10 |
12.05 |
|
51-60 |
14 |
16.87 |
|
61-70 |
51 |
61.45 |
|
80+ |
3 |
3.61 |
|
Gender |
Male |
34 |
40.96 |
Female |
42 |
50.60 |
|
Non-Specific |
7 |
8.43 |
|
Residential Area |
Urban |
32 |
38.55 |
Sub-urban |
34 |
40.96 |
|
Rural |
17 |
20.48 |
|
Ethnicity |
I-Taukei |
37 |
44.58 |
Fijian of Indian Descent |
39 |
46.99 |
|
Fijian of Chinese Descent |
2 |
2.41 |
|
Others |
5 |
6.02 |
|
Highest education level |
No education |
27 |
32.53 |
Primary School |
37 |
44.58 |
|
High School |
18 |
21.69 |
|
Technical and Vocational Education and Training
(TVET) |
1 |
1.20 |
|
Diploma or Degree |
0 |
0 |
Table 3: Frequency of responses on knowledge related questions (n=83).
Question |
Number
(n) |
Percent
(%) |
|
Is there a need for tooth replacement |
Yes |
73 |
87.95 |
No |
3 |
3.61 |
|
Don't know |
7 |
8.43 |
|
Importance for tooth replacement |
Eating |
34 |
40.96 |
Speaking |
13 |
15.66 |
|
Not important |
19 |
22.89 |
|
Appearance |
13 |
15.66 |
|
Do you have missing teeth |
Yes |
82 |
98.80 |
No |
1 |
1.20 |
|
Missing teeth replaced |
Yes |
45 |
54.22 |
No |
35 |
42.17 |
|
Cannot recall |
3 |
3.61 |
|
If yes, which type of prosthesis |
Complete denture |
33 |
39.76 |
Implant |
0 |
0 |
|
Partial denture No prosthesis |
14 33 |
16.87 39.76 |
|
If No, what’s the
reason |
Inadequate Knowledge |
8 |
9.64 |
No time |
12 |
14.46 |
|
Not motivated |
4 |
4.82 |
|
Financial constraints Have prosthesis |
8
33 |
9.64 39.76 |
|
How many missing teeth |
2--5 |
5 |
6.02 |
5--10 |
21 |
25.30 |
|
10--15 |
20 |
24.10 |
|
15+ |
37 |
44.58 |
|
Which type of prosthesis do you know |
Complete denture |
29 |
34.94 |
Removable partial |
36 |
43.37 |
|
Fixed partial |
7 |
8.43 |
|
None of the above |
11 |
13.25 |
|
How long should dentures last |
1-2 years |
11 |
13.25 |
2-3 years |
20 |
24.10 |
|
4-5 years |
15 |
18.07 |
|
5+ years |
29 |
34.94 |
|
Review for denture important |
Yes |
56 |
67.47 |
No |
14 |
16.87 |
|
Don't know |
13 |
15.66 |
|
Do you know about dental implants |
Yes |
8 |
9.64 |
No |
75 |
90.36 |
Table 4: Frequency of responses on attitude-related questions (n=83).
Questions |
|
Number (n) |
Percent (%) |
Is immediate replacement important |
Yes |
65 |
78.31 |
|
No |
2 |
2.41 |
|
Don't know |
16 |
19.28 |
Can you eat with the denture |
Yes |
54 |
65.06 |
|
No |
16 |
19.28 |
|
Don't know |
12 |
14.46 |
Are you satisfied with your speech |
Yes |
60 |
72.29 |
|
No |
14 |
16.87 |
|
Don't know |
8 |
9.64 |
Are you satisfied with your denture aesthetics |
Yes |
64 |
77.11 |
No |
12 |
14.46 |
|
Don't know |
6 |
7.23 |
|
Is there any discomfort with the denture |
Yes |
24 |
28.92 |
|
No |
50 |
60.24 |
|
Don't know |
8 |
9.64 |
How often is your dental visit |
Regularly |
8 |
9.64 |
|
Irregularly |
18 |
21.69 |
|
Only during pain |
57 |
68.67 |
Is regular visit to the dentist important |
Yes |
63 |
75.90 |
|
No |
13 |
15.66 |
|
Don't know |
7 |
8.43 |
Is visiting the dentist an easy process |
Yes |
47 |
56.63 |
|
No |
35 |
42.17 |
|
Don't know |
1 |
1.20 |
Table 5: Frequency of responses on practice-related questions (n=83).
Questions |
|
Numbers (n) |
Percent (%) |
Preferred mode of replacement |
Removable |
58 |
69.88 |
|
Fixed |
8 |
9.64 |
|
Don't know |
17 |
20.48 |
How do you clean your dentures |
Rinse only |
25 |
30.12 |
|
Brush only |
8 |
9.64 |
|
Brush and toothpaste |
46 |
55.42 |
Are you wearing a denture |
Yes |
54 |
65.06 |
|
No |
29 |
34.94 |
Which type of denture |
Removable |
52 |
62.65 |
|
Don't know |
4 |
4.82 |
What is the duration of wearing |
Less than 1 year |
15 |
18.07 |
|
1-5 years |
24 |
28.92 |
|
5-10 years |
12 |
14.46 |
|
Don't know |
6 |
7.23 |
How often do you clean your denture |
Once |
15 |
18.07 |
|
Twice |
31 |
37.35 |
|
More then twice Don’t
know |
22 15 |
26.51 18.07 |
Which part do you clean |
Front only |
2 |
2.41 |
|
Back only |
19 |
22.89 |
|
Front and back |
49 |
59.04 |
Is cleaning like natural tooth |
Yes |
51 |
61.45 |
|
No |
23 |
27.71 |
|
Don't know |
9 |
10.84 |
Table 6: Percentage distribution of utilization of prosthodontic services at SDOH dental teaching clinic, FNU.
Variables |
Frequency (n) |
Percentage (%) |
|
Missing teeth |
Yes |
45 |
54.22 |
No |
35 |
42.17 |
|
Don't know |
3 |
3.61 |
|
Is immediate replacement important |
Yes |
65 |
78.31 |
No |
2 |
2.41 |
|
Don't know |
16 |
19.28 |
|
How often is your dental visit |
Regularly |
8 |
9.64 |
Irregularly |
18 |
21.69 |
|
Only during pain |
57 |
68.67 |
|
Is regular visit to the dentist
important |
Yes |
63 |
75.90 |
No |
13 |
15.66 |
|
Don't know |
7 |
8.43 |
|
Preferred mode of replacement |
Removable |
57 |
69.88 |
Fixed |
8 |
9.64 |
|
Don't know |
17 |
20.48 |
|
How often do you clean your dentures |
Once |
15 |
18.07 |
Twice |
31 |
37.35 |
|
More than twice |
22 |
26.51 |
|
Don't know |
15 |
18.07 |
Table 7: Percentage distribution of barriers to utilization of Prosthodontic services at SDOH dental teaching clinic, FNU.
Variables |
Frequency
(n) |
Percentage (%) |
|
Is there a need for tooth replacement |
Yes |
73 |
87.95 |
No |
3 |
3.61 |
|
Don't know |
7 |
8.43 |
|
Importance of tooth replacement |
Appearance |
13 |
15.66 |
Eating |
34 |
40.96 |
|
Oral Health Speaking Prevent teeth drifting Not important |
2 13 2 19 |
2.41 15.66 2.41 22.89 |
|
What is the reason for not replacing teeth |
Inadequate knowledge |
8 |
9.64 |
Not Motivated |
4 |
4.82 |
|
No time Scared of treatment Financial constraints Others Have prosthesis |
12 0 8 3 48 |
14.46 0 9.64 3.61 57.83 |
|
What type of prosthesis do you know |
Complete denture |
29 |
34.94 |
Removable partial |
36 |
43.37 |
|
Fixed partial Don’t know |
7 11 |
8.43 13.25 |
|
Is review important |
Yes |
56 |
67.47 |
No Don’t know |
14 13 |
16.87 15.66 |
|
Do you know about fixed prosthesis |
Yes |
8 |
9.64 |
No |
75 |
90.36 |
|
Are you wearing a denture |
Yes |
54 |
65.06 |
|
No |
29 |
34.94 |
Data management and
analysis
Once data was collected, it was entered into MS Excel,
and a backup was made online, which the primary investigator and the research
supervisors could only access. The collected data was then entered into Epi
Info 7.2 software for backup and storage. Relevant codes were used to label the
data to increase efficiency. Participant responses were categorized from the
questionnaire, which was divided into the 3 main branches for this research:
knowledge, attitude, and practice. Furthermore, all answered questionnaires
were given a unique code/number to reduce biases.
Ethical considerations
CHHREC of the FNU approved the study (Reference:
019.22). Confidentiality of participants were strictly ensured by removing any
form of identifier such as name or student identification number. The purpose
and nature of the study were explained to the participants verbally via
telephone and face-to-face to patients, and voluntary informed consent was
obtained, respectively, prior to the commencement of the interview.
Participation in the study was voluntary and participants were informed of
their right to participate or withdraw their participation during the course of
the study. All consent forms
were kept in a sealed envelope and stored in a locked
file cabinet, and the information from the questionnaires was kept secured and
password protected. This study had a very low risk of harm. However, proper
management was taken of the data being collected, ensuring no participant
information was revealed. These documents of the study would be retained for 1
year after which it would be destroyed by shredding.
The sample as shown in Table 1 consisted of 40.97%
male, 50.60% female and 8.43% non-specific respondents. It was noted that
61.45% of the participants were between the ages of 61-70 years old while
16.87% were from 51-60 years old. Regarding educational background, 44.58% of
the participants stated that they had only attended primary school. In terms of
ethnicity, 46.99% of the participants were Fijian of Indian descent (FID) while
44.58% were I-Taukei. Furthermore, 40.96% of the participants were from
sub-urban residential areas, while 38.55% were from urban (Table 2).
Table 3, illustrated below, highlights the assessment
of knowledge in frequencies among patients who participated in the study. There
was 87.95% of participants who felt there was a need to replace missing teeth,
whereas 3.61% didn’t agree. 40.96% of the participants chose to eat as the main
reason for replacing missing teeth, while others chose appearance 15.66%,
speaking 15.66% together with 22.89% of participants who thought it was not
important to replace teeth. Of the 83 participants, 98.80% had missing teeth,
from which 54.22% had those missing teeth replaced and 42.17% did not.
Furthermore, 54.22% of participants who had replaced missing teeth were wearing
removable prostheses, with 39.76% removable complete dentures and 16.87%
removable partial dentures. From the 42.17% who did not replace the missing
teeth, the most common response was inadequate knowledge (9.64%), followed by
no time (14.46%). Of the participants who had missing teeth, most had more than
15 missing teeth (44.58%). In terms of being aware of prostheses, the majority
of participants chose to know about removable partial dentures (43.37%), while
34.94% knew about complete removable dentures, and 13.25% had no information.
In terms of denture longevity, participants were asked how long a denture
should last, whereby 34.94% stated more than 5 years, while 24.10% stated 2-3
years and 18.07% for 4-5 years. When asked about the relevance of denture
review, 67.47% of the participants stated yes. Furthermore, 90.36% of
respondents were not aware of dental implants, while 9.64% knew (Table 3).
Table 4, illustrated below, reveals the participant's
attitudes towards prosthetic treatment. Most participants (78.31%) highlighted
the need for immediate replacement while 2.41% disagreed, and 19.28% were not
sure what to say. Additionally, participants were also asked multiple questions
regarding their existing dentures, whereby 65.06% of the participants stated
they could eat with their present dentures, while 19.28% disagreed. Moreover,
in terms of speech, 72.29% of the participants said they were satisfied, while
16.87% said they were not satisfied. Additionally, based on the aesthetic of
the dentures, 77.11% of participants mentioned yes while 14.46% stated no.
Furthermore, when asked about discomfort with dentures, 60.24% of the
participants stated no while 28.92% said yes. To add on, 68.67% of the
participants stated they only made dental visits for pain, while only 9.64%
mentioned making dental-related visits regularly. Based on visitations to a
dentist being an easy process, 56.63% responded in favour, while 42.17% stated
it was not. When it came to knowing if regular visits to the dentist were
important, 75.90% of the participants agreed, while 15.66% disagreed (Table 4).
Table 5 illustrates the frequency of the participants
on practice-related questions where they were asked about their preferred mode
of replacement for missing teeth. 69.88% of the participants preferred
removable dentures while 20.48% did not know the options. When looking at the
mode of cleaning prostheses, 55.42% used a brush and toothpaste, whereas 30.12%
preferred the rinse method. Moreover, when asked about wearing a denture,
65.06% wore one, while 34.94% stated they did not. Based on the type of
prosthesis, 62.65% of the participants mentioned about removable dentures,
while 4.82% did not know. 28.92% of the participants wore their dentures from a
year to 5 years, whereas 18.07% wore less than a year and 14.46% from 5-10
years. In relation to cleaning of dentures, 37.35% said they cleaned it twice a
day. Not only were they asked how often they clean their denture, but also
which part they clean it which highlighted that 59.04% of the participants
cleaned from front and back. When asked if cleaning their denture is the same
as natural teeth, 61.45% stated yes, while 27.71% mentioned no, with 10.84%
stating they did not know (Table 5).
Table 6, presented below, shows the distribution of
the utilisation of prosthodontic services at the dental teaching clinic. From
the questionnaire, several questions were picked to determine the utilisation
of services. It has been highlighted that 54.22% of the participants had
missing teeth, from which only 78.31% agreed that the immediate need for
replacement is important, while 19.28% did not know whether to replace or not.
Moreover, 68.67% of patients visit the dentist when they have pain, and 75.90%
feel that regular visitations to the dentist are important. From this, we can
deduce that even though patients have missing teeth and feel like replacement
is important, they visit the dentist when they have pain. Therefore,
under-utilization of the services provided to prevent dental pain. In addition,
the participants were also asked their preferred mode for tooth replacement;
69.88% had chosen removable, while 20.48% didn’t even know the options. When
participants were asked how often denture hygiene is performed, 37.35% stated
twice a day while 26.51% of the participants mentioned more than twice. This
shows us that participants didn’t know the options for tooth replacement which
led to under-utilization of prosthodontic services (Table 6).
Barriers prevent utilisation of prosthodontic services which is demonstrated in Table 7. Participants were asked if there was a need for tooth replacement; 87.95% said there was, while 8.43% did not know. When considering the importance of tooth replacement, 40.96% were for eating while 22.89% stated it was not important. Furthermore, the main reason for not replacing teeth with 14.46% was no time. Therefore, while the majority of the participants agreed that there is a need for replacement, the majority were replaced due to eating, while the other participants thought it was not important, with the main reason being having no time. This becomes a barrier to utilize services for prosthodontic rehabilitation. When asked which prosthesis they are aware of, 43.37% of the responses were removable partial dentures. Furthermore, when asked if review was important, 67.47% said it was while 16.87% of the participants stated no. Asking about fixed prostheses, 90.36% of participants did not know about them. It was also noted that 65.06% of the study group was wearing dentures while 35.94% did not. This inadequate knowledge of the type of prosthesis is a major contributor to a barrier to the under-utilization of services. It was also seen that 34.94% of participants were not wearing a denture, and it was also generally seen that 16.87% did not agree that review was important. This is the majority contributor to barriers affecting the proper utilisation of prosthodontic services (Table 7).
This study assessed the knowledge, attitude, and
practice of patients towards prosthodontic rehabilitation. It revealed that the
majority of the patients knew about their missing teeth, but only a certain
percentage (39.76%) had replaced them. This was mainly due to financial reasons
(9.64%) or lack of time (14.46%). It also showed that the majority only knew
about removable prostheses, whilst only a few knew about fixed prostheses.
Furthermore, this study also focused on the utilisation of prosthodontic
services among patients. This study showed that the majority did not fully
utilise the services provided. The outcomes of this research showed the
knowledge profile of the study population was insufficient with respect to the
placement of lost teeth. The probable reason could be that 44.58% parts of the
population just received primary education. This was similar to a study by
Marcus et al, whereby it was found that lack of education is correlated to a
lack of awareness about the importance of oral health, and the consequences of
neglect appear to constitute a barrier to using dental health care services
[10]. The study revealed that 99% of participants had missing teeth, with 45%
having more than 15 teeth missing. It was also seen that 54.22% of them had
favourable attitudes toward replacing missing teeth. This conclusion was
comparable to that of Nirmala et al, who found that the survey respondents were
aware of the need for tooth replacement [11]. Mostly because of inadequate
knowledge, no time and economic reasons, the majority did not receive therapy
[12]. In a study by Shetty et al, the main reason for not replacing the missing
teeth was no felt need for the participants to replace missing teeth [13].
Contrasting results were reported in an earlier study conducted by Reddy, in
which financial constraints were the least common reason to replace missing
teeth and inadequate knowledge was the most common reason for non-replacement
[14]. The results showed that individuals' attitude profiles revealed that 69%
of participants visit the dentist when they experience pain, while 10% have
regular dental visitations. They were also asked if regular dental visits were
important; 76% said it was important, while 16% didn’t. This was due to coming
to the dentist being an easy process, thus advancing caries progress and
eventually leading to tooth loss. In another study, Pallegdara & Ekanayake
came to the conclusion that altered perceptions brought on by advancing age,
such as the belief that one is too old to adapt to dentures and artificial
teeth and a lack of interest in appearance, maybe a factor in people's
reluctance to replace missing teeth as they age [9].
According to responses on denture cleanliness care,
81.93% of respondents had a positive outlook and believed that maintaining
prosthesis hygiene was crucial. In comparison to Amjad & Aziz (2014),
reported similar outcomes from the study undertaken in Pakistan. When the
question of prosthesis maintenance was posed, the authors reported receiving a
97.5% positive response [15]. The participants were asked how often they
perform denture hygiene, the majority answered they clean twice a day (37%)
while some said they cleaned more than two times a day (27%). Utilization is
conceived as the received amount of care; the most common measure is the annual
number of dental visits per person. Usually, there is a presumption that a high
level of utilization in a population has a positive correlation with oral
health. Other studies suggested that dental treatments may be performed as a
result of iatrogenic injuries and are also related to the so-called
supplier-induced demand [16,17]. Oral health is also likely to affect
utilization in a reverse relationship, meaning that good oral health is closely
related to a high level of utilization of dental services. Several studies
indicate that edentulism per se is related to a low level of utilization
[16-18]. Extensive prosthodontic treatments will require maintenance. The need
for maintenance is usually higher for removable prostheses than for fixed
prostheses, and several studies indicate excellent long-term survival rates
following treatment with fixed prostheses [18]. The process, from the
recognition of a need to its utilization, can be influenced by social and
economic factors. Evidence suggests that the use of dental services may be
adversely affected by the current national economic downturn. Even in systems
that offer financial assistance, people with low incomes use dental services
less frequently and spend less on them than people with higher incomes [19].
The most common reason given for not getting dental care is the cost. However,
research shows that offering free or greatly reduced services has little impact
on uptake. On the other hand, attitudes regarding expenditures may be
associated with the use of dental treatment [20]. Moreover, it can be seen when
comparing to this study, it was seen that participants only visited the dentist
when they had pain, this could relate to their financial status. Regular visits
often take time from a person's day, which is spent at work. Therefore, a fast
solution to a toothache is a route taken; this is evident from the majority of
the participants having missing teeth. The most common barriers to receiving
dental care, according to the caregivers in this study by Alfaraj et al. were
lack of time on their part, poor design, and environment of the dental clinic,
transportation issues, the special healthcare needs person's medical health
status, which prevents him/her from receiving immediate dental care, and the
dental clinic's location is too far from the intended special healthcare needs
person. Obstacles included unfriendly and inexperienced dental staff, cost and
financial difficulty, fear of the dentist, communication problems between the
dentist and the person with a special need, difficulty getting dental
appointments, and a lack of dental care facilities to accommodate people with
special needs [21]. These barriers are congruent with those reported by,
Al-Shehri and Alumran which can be grouped into those relating to special
healthcare needs individuals’ ability to physically access dental facilities,
inability to afford dental services due to high costs of treatment and
insufficient financing for dental treatment, and the preparedness and
willingness of dentists and dental nurses to treat special healthcare needs
individuals [22,23]. Patients were unable to take advantage of treatment
because they were unaware of the several prosthodontic treatment alternatives
available. According to studies by Menezes M, Van Twillert and Zitzmann dental
camps and prosthodontic outreach programs are a potential strategy to alter
attitudes, raise awareness, and impart knowledge about the various options for
replacing missing teeth [24-26].
Limitations of the study
Some limitations that were identified while
undertaking the study were: participation level was limited despite the sample
size of the study; the findings of this study cannot be applied to the entire
Fijian population because it was a cross-sectional study carried out in one of
the country's dental teaching clinics; this study was likewise a survey that
relied significantly on participants' recollection and the responses they
supplied when filling out the questionnaire; post Covid-19, patients were
reluctant for a face-to-face interview; seeking consent over the phone when
unable to meet the patients face-to-face; due to the nature of the study data
collections method, it was done based on participants’ availability.
Knowledge, attitude, and practice regarding prosthodontic rehabilitation were poor among the study participants. Financial constraints and lack of time were the main factors for not undergoing prosthodontic rehabilitation. This study showed participants had inadequate knowledge based on oral health and the various prosthetic treatment options available, many of which had more than 15 missing teeth. Moving on, attitude showed to be partially known and practised. Many of them knew why they had gotten a prosthesis and that replacement was important. In terms of practice, this was seen as insufficient as participants didn’t know how to perform denture hygiene as well as the frequency of it. In conclusion, the findings show that the majority of patients were between the ages of 60 and 70, and nearly all of them had missing teeth. Based on these findings, we can conclude that patients can have their teeth replaced if they have the proper mindset and knowledge to comprehend the various treatment options available. Since many participants had little knowledge about the types of prostheses available, their choice was confined to the ones they had heard about or seen previously. It was also observed that patients' main concern for prostheses was eating rather than oral health or speech, as they only visit the dentist when there is pain.
I would like to express my deep gratitude to Meenal
Nand and Suneil Nath my research supervisors and co-authors, for their
guidance, encouragement, and useful critiques of this research. I would also
like to pay my tribute to the Late Dr. Temalesi King for her continuous support
as the Course Convener for this study. All authors declare no competing or
potential conflicts of interest.