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Depression as a risk factor for denture dissatisfaction
Howard E. Strassler, DMD
John MT, Micheelis W, Steele JG. J Dent Res. 2007;86(9):852-856.
Depression is associated with impaired health outcomes. This study investigated whether there is a significant association between depression and dissatisfaction with dentures in older adults. In a population-based study (1,180 adults ages 65 to 74 yrs), depression was measured by an abbreviated Geriatric Depression Scale. Denture dissatisfaction was assessed with a five-point Likert-type question (“very dissatisfied” to “very satisfied”). The depression-denture dissatisfaction association was analyzed with dimple (dissatisfied vs not dissatisfied outcome) and ordinal logistic regression (based on outcome’s full range). For each unit increase on the 15-point depression scale, the probability of denture dissatisfaction increased by 24% [95% confidence interval, 15% to 34%, P < .001 (simple logistic regression)] and the probability for higher levels on the five-point dissatisfaction scale increased by 16% [95% CI, 11% to 22%, P < .001 (ordinal logistic regression)], adjusted potential confounding variables. The likely causal association in older adults has major implications for the evaluation of treatment effects and the demand for prosthodontic therapy.
Depression is identified by the World Health Organization as the fourth-ranked contributor to the global burden of disease. This article assesses depression as a risk factor for denture dissatisfaction, but this research has implications for all of our older patients when we provide dental services where there are expectations for the results attained, especially for those patients receiving esthetic treatments and more complex prosthodontic care. Currently, there are more than 36 million adults ages 65 or older. By 2050 this number will grow to more than 80 million. Also, more than 70% of adults 65 and older currently have some or most of their natural teeth. It is expected that the number of edentulous patients will stay stable at 9 million adults until 2020. While there has been a steady decline in the number of patients needing complete dentures, there has been a trend in the increase of older patients that will be seen in dental practices. It is important to bear in mind that when a clinician reviews a patient’s medical history, the patient may not report a history of depression either because they are undiagnosed or because they are embarrassed and fear that a judgment will be made about them.
This study found that depression, while prevalent in dental practice, might be overlooked. In the sample of patients, 10% were depressed (8% moderately depressed and 2% severely depressed) according to the Geriatric Depression Scale. If a patient received two dentures (maxillary and mandibular) there was a consequent increase in probability of dissatisfaction with one or both dentures. The authors note that the reported association between depression and denture dissatisfaction was based on probabilities, and was not deterministic. Nevertheless, this study does point to the importance of understanding a patient’s mental state and possibly even screening for depression before complex or comprehensive prosthodontic treatment in older adults.
Howard E. Strassler, DMD
Professor and Director of Operative Dentistry
Department of Endodontics, Prosthodontics and Operative Dentistry
University of Maryland Dental School, Baltimore, Maryland