A study of the emotional reaction to tooth loss

Key Points

In Brief

• A significant proportion of people (45%) experienced difficulty in accepting the loss of their teeth despite coping apparently well with dentures.

• Whether people had difficulty in accepting their tooth loss or not, many of them felt unprepared for the effects of tooth loss and believed that the dentist could have given them more information.

• When breaking the news that teeth have to be lost provide the information at an appointment(s) prior to the extraction day.

• As well as giving verbal information about the effects of tooth loss, it is useful to provide written information in the form of a leaflet.

Abstract

Aim To establish how widespread the emotional effects of tooth loss are.

Method A questionnaire, distributed to 100 edentulous people undergoing routine prosthetic care in the Department of Prosthetic Dentistry at Guy's, King's and St Thomas' Dental Institute (GKT), was used to explore the emotional effects of tooth loss.

Results Ninety four people completed the questionnaire of whom 42 stated that they had experienced difficulties in accepting the loss of their teeth. In comparison with people who had no difficulties in accepting the situation, these people were: more likely to feel less confident about themselves; more likely to feel inhibited in carrying out everyday activities; and less able to accept the inevitable change in facial shape which occurs following the loss of teeth. Additionally, they took longer to come to terms with their tooth loss (All these differences were statistically significant). Just over three-quarters of the people who were unprepared for the loss of their teeth, felt that an explanation from the dentist prior to dental extractions would have helped.

Conclusion The impact that tooth loss can have on people and their lives should not be underestimated. In this study it affected 45% of the participants.

Main

The emotional effects of tooth loss: a preliminary quantitative study Davis D. M, Fiske J., Scott B., and Radford D. R. Br Dent J 2000; 188: 503–506

Comment

Dental health and its relationship to quality of life measures has captured the imagination of dental investigators. Davis and colleagues revisit the quality of life area, in their second paper, by examining the association between edentulousness with psychological health and the social well-being of patients attending a department of prosthetic dentistry. In their previous article the authors had shown, using qualitative methods, that people equated the loss of their teeth with changes in their lifestyles, feelings of bereavement, loss of self-confidence and concerns about their appearance.

In this second paper they present the quantitative findings. A questionnaire was developed which allowed an assessment of the prevalence of emotional reactions to tooth loss to be made. Nearly half of their sample stated that they had difficulties in accepting their edentulousness. Davis et al. show convincingly that the majority of patients who found it difficult to accept their tooth loss never accepted their edentulous state and remained low-spirited with little self-confidence. These patients restricted their food choice, avoided eating and/or laughing in public. About 80%, of them felt that their facial appearance had changed. They were hesitant about forming new relationships and refused to let friends or relatives see them without their dentures. Quality of life in terms of their psychological health and social well-being had been affected by the loss of their teeth.

In the final part of the paper Davis et al. return to examine the need for patients to be prepared for their tooth loss in order to prevent unrealistic expectations with regard to treatment outcome. Nearly half of the overall sample stated that they had been ill prepared for the loss of their teeth. Seventy-four per cent of the respondents, who had never accepted their edentulousness, felt unprepared and would have appreciated the 'opportunity to talk to someone who had experienced tooth loss'. The need to discuss the effects of tooth loss with patients is stressed by the authors as a means by which practitioners and specialists may assist their patients to accept their tooth loss and become more satisfied complete denture wearers.

Davis et al. have shown that nearly half of their sample had experienced difficulties in accepting the loss of their teeth. This had affected their quality of life. There remains a need for dentists to prepare their patients for tooth loss in order to prevent the unwanted emotional sequelae of edentulousness.