Hidden challenges of tooth loss and dentures revealed in new study

The hidden challenges faced by people with tooth loss and dentures have been identified by new research from the University of Sheffield.

Improvements in dental care, more people living longer, and the social value placed on having a healthy smile has led to people keeping their own teeth longer, but it has also led to an increasing number of people needing some kind of restoration work, including crowns, bridges and implants.

Many of these treatments remain unobtainable for most people due to the availability of NHS dentists and the high cost of private dental work. Removable dentures are often the only viable option for anyone experiencing tooth loss, with an estimated 10–15% of the population wearing them.

A new study by researchers at the University of Sheffield's Healthy Life Span Institute and the School of Clinical Dentistry has highlighted the emotional struggles and hidden challenges patients experience when having dentures fitted. This is the first study to map out the patient journey and how this experience can affect the overall success of the treatment. The paper is published in the Journal of Dentistry.

The study found that patients think about their denture journey in four stages:

• Tooth loss: This is the initial stage where patients experience the physical loss of teeth.

• The emotional tunnel: This stage focuses on the emotional rollercoaster of tooth loss. Patients experience self-consciousness, depression, and struggle with dentures. They may feel shame, anger, or fear, but also hope.

• Prosthetic hope: This stage represents the hope and optimism patients feel when getting dentures. They might anticipate regaining their smile and ability to eat normally.

• Prosthetic compromise leading to managing disclosure: This final stage acknowledges that dentures take some getting used to. Patients might need to adjust their expectations and learn how to manage talking and eating with dentures. They might also develop strategies to feel comfortable disclosing their denture use to others.

These feelings and how dentists understand and manage them can influence patient outcomes. A dentist's empathy during this adjustment period is crucial for successful denture use and better patient outcomes.

The study also identified that wearing removable dentures can be a hidden disability for many. People with dentures feel they have to hide them due to feeling embarrassed or worrying they will fall out. Some patients also avoided social situations

Lead researcher Barry Gibson, Professor in Medical Sociology at the University of Sheffield, said, "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.

"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."

The research team partnered with local Sheffield artist Gina Allen to create an art piece reflecting the diverse emotional journeys of denture wearers.

The picture is a collage that illustrates the type of journeys patients go through from tooth loss to life with a denture. It uses color to depict the emotional nature of the journey and demonstrates that all patients have a unique journey and outcome from the experience. One patient, a young woman, has a successful outcome; a middle-aged man is okay but a bit "Meh." An older woman continues to struggle to cope with some aspects of adapting to her denture.

Allen said, "I'm a visual artist with a science background and a particular interest in how art can help to explore and interpret data, often around social and environmental themes. It seemed to me that there was such a depth and variety of individual experiences captured by the research team on this project, so it was a really interesting challenge to be involved in, trying to use the visual parameters of an artwork to convey some of that in an engaging and meaningful way."

This collaboration has influenced the development of a new patient questionnaire designed to:

• Identify individual needs: Tailor care based on specific patient experiences.
• Improve communication: Enable dentists and patients to have open conversations about dentures.
• Trigger follow-up: Identify patients who may need additional support.

In addition to identifying the emotional challenges faced by patients, the study also highlights the need for a clinical care pathway to improve patient support, focus on improving denture fit, educate patients about denture care, and combat the shame and stigma associated with wearing dentures.

Mr. Bilal El-Dhuwaib, Clinical Teacher in Restorative Dentistry at the University of Sheffield, said, "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."

The research team plans to validate the questionnaire and develop a comprehensive clinical pathway for denture care. This pathway aims to improve patient outcomes and address the hidden struggles faced by denture wearers.