Community Dental Health

cover art

Cover Date:
December 2011
Print ISSN:
0265 539X
Vol:
28
Issue:
4

Is the shortened dental arch an underused treatment strategy in the Republic of Ireland?

Objectives: To determine the proportion of Republic of Ireland 35-44 and 65+ year-olds currently satisfying the criteria for a classic shortened dental arch (SDA) of 20 anterior teeth. Research Design: Secondary analysis of data collected in the 2000/02 epidemiological survey of the oral health of Irish adults. Clinical setting: Participants underwent a clinical oral examination in health board dental clinics and completed a detailed interview pertaining to dental and general health. Participants: The analysis is based on a random sample of adults, aged 35 to 44 years (n=978), and 65 years and older (n=714). Main outcome measures: The SDA was measured as 20 teeth in the mouth in the positions normally described as from the left second premolar to the right second premolar in each arch. Results: Only one of the 35-44 year-olds and none of the 65+ year-olds had teeth in their mouths in positions normally described as a classic SDA. However, of the 35-44 year old age group only five patients who had at least a premolar dentition of 20 contiguous teeth had been provided with a removable denture compared to one patient from the 65+ years group. Conclusions: Very few older patients in the Republic of Ireland have a SDA based on the measure used. However, very few have been provided with removable dentures where they already possess at least a premolar dentition of 20 contiguous teeth. Suggested reasons for this may include limitations of the data recorded, patient preferences and economic factors.

Keywords: shortened dental arch, dentures, edentulous, older adults, partially dentate

Introduction
Oral health surveys indicate that dental health is improving, with a steady increase in the proportion of older adults retaining more of their natural teeth. The Republic of Ireland has seen a reduction in the proportion of edentate adults in the 35-44 year age group from 12% in 1979, 4% in 1989/90 to 0.9% in 2000/02. This pattern has been mirrored by adults 65 years and older, where the proportion edentate has decreased from 72% in 1979, 48% in 1989/90 to 40.9% in 2000/02 (Whelton et al., 2007). A reduction in the number of edentulous persons and an increase in the number of individuals with functional dentitions (21 or more teeth), at ages 35-44 and 65-74 years, were described as global goals for oral health by the Fédération Dentaire Internationale, the World Health Organisation and the International Association for Dental Research, in 2003 (Hobdell et al., 2003). When teeth are lost due to caries, periodontal disease, or trauma patients may seek tooth replacement to maintain function and an aesthetically-acceptable appearance. A variety of options exist for replacing teeth including the use of removable partial dentures. However, evidence suggests that many patients are unhappy with the prospect of wearing removable partial dentures and that these can have a negative impact on the remaining natural teeth. Conversely, many patients do not seek prosthodontic replacement of missing teeth and maintain function simply with a reduced number of natural teeth. It has not been possible to quantify the minimum number of teeth needed to satisfy functional demands as these vary between individuals (Armellini and von Fraunhofer, 2004), and

are related to the age of the patient (Käyser and Witter, 1985). According to Käyser and Witter (1985), factors which need to be considered in deciding how many teeth to save and restore are patient preference, the aim of dental services and the efficiency of treatment procedures. The shortened dental arch (SDA) concept has been proposed to provide satisfactory oral function without the use of removable partial dentures. Käyser (1981) first described the SDA as “a dentition where the most posterior teeth are missing”. The molar regions play important roles in mastication and stabilisation (de Sa e Frias et al., 2004), however they are high-risk teeth for caries and periodontal disease, and possibilities for restorative treatment are often limited (Witter et al., 1999). The concept of the SDA involves the direction of treatment efforts and resources towards preservation of the anterior and premolar teeth, which Käyser and Witter (1985) suggest are the ‘strategic’ part of the dental arch. In practical terms, however, it is impossible to maintain a natural shortened dental arch for all patients as some will have suffered trauma to anterior teeth, resulting in tooth loss and the need for prosthetic replacement. Others may be congenitally missing teeth and some teeth, particularly upper canines, do not erupt; potentially resulting in spacing (Gordon et al., 1994). The aim of this study is to determine the proportion of 35-44 year-olds and those aged 65 and over who satisfy the criteria for a shortened dental arch, or who could be successfully managed using the principles of the shortened dental arch concept. The study also aimed to survey patient attitudes towards wearing replacement dentures.

Correspondence to: Helena Guiney, Oral Health Services Research Centre, Cork Dental School and Hospital, Wilton, Cork, reland. Email: h.guiney@ucc.ie

Article Price
£15.00
Institution Article Price
£
Page Start
265
Page End
268
Authors
H. Guiney, G. McKenna, H. Whelton, D. O’Mullane

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