Dental science can be said to be a discipline that is closely related to the daily life of each of us. Prosthodontics is a very important part of it. I am a prosthodontist, and today I would like to take this opportunity to talk to you about how prosthodontics affects our quality of life.
I. Why do we need prosthodontics
Since the eruption of our teeth, they have been living in a very complex oral environment. Due to the influence of various physical, chemical, biological or congenital factors, teeth will have various kinds of defects or losses, such as broken teeth or even lost teeth due to external impact, chipped teeth or cavities due to acid, alkali and microbial corrosion, extracted teeth or lost teeth due to serious decay or periodontal disease, and some people are even congenitally missing teeth.
In addition, there are exposed tissues and organs of the jaw and face, due to trauma or post-operative tumor, etc., which can cause tissue loss, and congenital loss, such as being born without an auricle. In these cases, we need to use prosthodontic methods to restore and reconstruct various types of defects or abnormalities in the oral cavity and maxillofacial area with artificial materials, so as to restore their normal form and function and promote the physical and mental health of patients.
So what happens if these defects or abnormalities are not repaired?
First of all, if there is an individual missing back tooth, such as the most common missing first molar, also known as the sixth tooth. In addition to the direct impact of chewing on the missing side, it will also cause the adjacent teeth to tilt and move towards the missing gap, so that the gap between teeth will be easily blocked when eating fibrous food, and caries will easily occur after a long time.
If the food embedment causes periodontitis, the teeth will loosen or even fall off after losing the support of surrounding tissues; after the teeth move, the original good relationship between the upper and lower teeth of mutual embedding is destroyed, plus the teeth of the opposite jaw, that is, the teeth opposite to the gap between the missing teeth, will produce occlusal interference, affecting the normal occlusal movement, this abnormal occlusion not only to the local teeth, periodontal This abnormal occlusion may not only damage the local teeth and periodontium, but also lead to pathological changes in the muscles and joints of the whole occlusal system, such as soreness of the chewing muscles and pain and popping of the joints caused by TMJ disease.
If most teeth are missing, or even if all teeth are missing, the chewing efficiency can be seriously reduced. If most of the teeth are missing on one side, it often leads to lateral chewing, and long time lateral chewing will lead to excessive wear of the teeth on the healthy side, and the teeth on the jaw of the missing side will elongate until they bite into the tooth bed of the missing area, which makes the restoration difficult.
At the same time, the masticatory muscles on the healthy side will become compensatory hypertrophy, and the lateral chewing of children can also make the jaws develop asymmetrically, which will lead to facial asymmetry and the phenomenon of large face on one side and small face on the other, which will seriously affect the appearance.
In addition, in addition to the impact of missing front teeth, it affects the aesthetics and pronunciation of food. In addition to the impact of missing teeth, the color change of the front teeth is also getting more and more attention.
The loss and abnormality of the anterior teeth are the most concerned and most likely to affect people’s psychological activities. The damage to the maxillofacial tissues and organs is even more serious in terms of functional and cosmetic damage. For example, in patients who have their maxillae removed due to tumors, the oral cavity is directly connected to the nasal cavity, which directly leads to difficulties in eating and pronunciation; the loss of eyes, nose and ears directly affects the patient’s appearance.
In today’s society where the economy is growing, people’s life is rich and the level of material consumption is increasing, after the most basic needs are satisfied, the people’s demand for spiritual enjoyment is also gradually increasing. At the same time, the prosperity of economic life and the accelerated pace of life have caused increasing mental pressure and competition. People’s concern for themselves and others’ evaluation of them can affect our psychological health.
Patients with maxillofacial defects not only suffer the physical pain of impaired or lost functions, but also the psychological trauma. Seeing other people enjoying food, laughing, successful job hunting, and spending time in front of the moon, while their own physical defects due to congenital or acquired factors are often at a disadvantage in life and competition, living in the psychological gloom that they are inferior to others, and some even lose the courage to live.
Faced with these problems, as a prosthodontist, I feel a heavy heart and a great responsibility every time. So, what can restorative dentistry do for these patients?
II. What can restorative dentistry do for us
As we all know, when a tooth is missing, it needs to be filled, which is what we often call a cavity filling. The main purpose is to fill the cavity with materials that can be shaped, such as silver amalgam and resin, and for children, glass examples can be used to temporarily fill the cavity due to tooth replacement.
However, the strength of these materials is limited, and when the tooth is severely damaged and the defect is large, the plastic material is prone to fracture after the force is applied, and a restorative method is needed to repair the tooth. With restorative dentistry we can make metal or ceramic inlays to repair broken teeth.
If the defect is so large that the cavity formed in the defective part of the tooth no longer provides good retention for the inlay, the entire crown is needed to fix the restoration, which is called a full crown, commonly known as a brace. The materials used to make crowns are ceramic – porcelain and all-porcelain teeth, resin and metal, metal and can have ordinary metal, such as the commonly used cobalt-chromium alloy, which is a kind of stainless steel; can also have pure titanium and titanium alloy, which is a very good biocompatible metal, dental implants and artificial joints implanted in the human body is the use of titanium There are also cast crowns of precious metals, which contain more than 90% gold and have good casting and mechanical properties and can achieve the highest casting precision, and because the hardness of precious metals is close to that of the enamel on the surface of human teeth, the restoration is less abrasive to natural teeth.
When the majority of the tooth is missing and the remaining teeth do not provide better retention for a full crown, it is necessary to use the root of the tooth to anchor the restoration, which is called a pile crown restoration. As the name implies, a pile crown consists of two parts: a pile that is inserted into the root of the tooth to provide retention. The material used to make the pile can be resin, metal, or ceramic, and can be either a ready-made pile or a custom-made pile for the patient.
If there are individual teeth missing, we often make a fixed denture for the patient when there are less than 3 missing teeth in a row. This is commonly referred to as a dead tooth because the finished denture is glued to the tooth and cannot be removed by the patient. A fixed denture is an inlay, partial crown or full crown made on both sides of the missing tooth gap as a retainer, and a bridge attached to the middle part of the tooth to restore the missing natural tooth. Fixed dentures can be made of metal, resin, ceramic, or a combination of metal and resin or ceramic.
Many patients are apprehensive about grinding and cutting their teeth before a fixed denture is made, and do not want to grind their teeth or want to do so as little as possible. In fact, such concerns are unnecessary. First of all, grinding is necessary before a fixed prosthesis is made, because in order for the teeth with the prosthesis to maintain their original shape, the teeth must be ground to allow for the space that the prosthesis will occupy. Secondly, excessive grinding is also unnecessary and even harmful, because too much grinding will waste the doctor’s valuable treatment time and materials, and due to the limitations of the tooth anatomy, too much grinding and cutting of teeth may also damage the living pulp and affect the strength of the teeth themselves.
Individual missing teeth can be restored by movable denture, while full mouth tooth loss should be restored by full denture. This is commonly known as a live denture, which can be removed, cleaned and worn in the mouth by the patient after completion. A removable denture is usually composed of a wire retainer, a resin base and an artificial tooth, or a double crown and attachment can be used instead of a retainer to reduce the exposure of metal parts and enhance aesthetics. Although removable dentures are more widely available, cheaper, and easier to repair than fixed dentures, there is still a large gap in terms of restoration of masticatory function, aesthetics, durability, and convenience. The proportion of fixed prosthetics is the current development direction of dental prosthetics.
Since the 1970s, implant prostheses have been gradually used in prosthetic clinics and have now become popular worldwide. It is a titanium nail implanted into the bone of the missing tooth area, replacing the root of the natural tooth, and then the denture is restored on the exposed implant pile. It has the advantage of solving the problem of poor denture retention in patients with missing teeth, and is known as the “third set of human teeth”. However, dental implants require surgical implant placement and require a certain amount of bone quality in the missing tooth area.
For patients with maxillofacial tissue and organ defects, we can make prostheses to restore the jaws, eyes, nose and ears lost due to surgery or trauma, i.e., prosthetic jaws, eyes, nose and ears. At present, with the continuous development and improvement of simulated prosthetic materials and fixation technology, we can make fake prostheses to restore patients’ normal appearance, build up confidence and return to life and work.
Third, how to improve the quality of life of dental prosthetics
How can restorative dentistry improve the quality of life of patients? Does it naturally improve the quality of life of patients by restoring their defective tissues and organs? The answer is no.
The definition of the concept of quality of life varies depending on the discipline. For example, for urban planners, quality of life may include the extent to which green spaces and other amenities are available, but for clinical medicine, it refers primarily to the extent to which physical and mental health disorders are caused by disease. It may also involve the indirect effects of illness, such as unemployment and economic hardship.
Many researchers believe that quality of life should be a multidimensional concept that includes at least physical health, self-care, cognitive functioning, mental health, social interaction, family emotional support, life satisfaction, health service availability, economic status, leisure time, and well-being. Quality of life is like beauty in people’s eyes, which is understood and perceived differently by each person. Oral health-related quality of life is a comprehensive assessment that reflects the impact of oral diseases and their prevention and treatment on patients’ physical, psychological and social functions. The oral specificity scale is used to evaluate the current status of oral disease, its impact on mental psychological and daily life and patient satisfaction, which can better reflect the content of patients’ quality of life.
1.For the elderly population
With the continuous prosperity of the economy, the improvement of health care level and the gradual increase of the senior population, China has entered the elderly society. But just prolonging life without increasing the quality of life is meaningless. Longevity is not our ultimate goal, but a long and healthy life is the goal of human beings. This has become a consensus. Healthy longevity is actually a synonym for “successful aging” and “healthy aging”. Healthy longevity means to extend life span and health span at the same time, or to increase life span and increase health span accordingly or even increase health span more.
Unfortunately, the increase in human life expectancy has not been accompanied by an increase in dental life expectancy. Despite the introduction of the 8020 program, a large number of older adults still require prostheses to restore individual or total missing teeth. The increase in life expectancy of the elderly has been accompanied by an increase in the duration of denture wear.
A national survey in the United Kingdom in 2000 showed that people with fewer than 20 teeth in their mouths without dentures had a much lower quality of life than those with more than 20 teeth in their mouths or less than 20 teeth in their mouths with dentures after missing teeth. Missing teeth not only affect the chewing function and chewing ability, but also have social and psychological impact. Missing teeth or missing teeth without restoration can reduce people’s quality of life.
German scholars have investigated the oral health-related quality of life of patients with removable, complete and fixed prostheses within one year and found that the quality of life of patients with various prostheses improved significantly, and the quality of life of patients with fixed prostheses improved more significantly than that of patients with removable or complete prostheses, with statistically significant differences.
Different scholars also found that the quality of life of patients before and after oral prosthesis was more comfortable with metal prosthesis than with resin prosthesis, and there was no significant difference between implant prosthesis and removable prosthesis, but the oral health status score of the former was higher than that of the latter, suggesting that intraosseous implant prosthesis was better than removable prosthesis.
Studies have shown that the degree of satisfaction of patients with complete dentures is influenced by their economic conditions, the degree of improvement in chewing and pronunciation, and the concept of “beauty at different ages”.
It has also been shown that the comfort and function of the denture after restoration with a removable partial denture using a sleeve crown has a significant impact on the patient’s quality of life.
2. For the non-elderly population
As we have mentioned before, the task of prosthodontics is not just about dentures. Therefore, restorative dentistry is not only for the elderly, more and more young patients become the beneficiaries of restorative dentistry. The young age of tumor patients has led to a large number of young patients with postoperative maxillofacial tumors requiring restorative treatment to improve and enhance their postoperative quality of life. Studies have shown that the quality of life of head and neck tumor patients after surgery is significantly lower than that before surgery, mainly in terms of appearance, function, pain and other effects.
After restorative treatment, there was a statistically significant correlation between patients’ satisfaction with the restorations and their overall quality of life. This indicates that restorative treatment not only restores the oral function of maxillofacial tumor patients after surgery, but more importantly, it helps patients regain their self-confidence, re-establish their belief in life, and return to their normal social life and work as soon as possible.
In addition to the restoration of defects, the reshaping of tooth color and shape is also an important task of restorative dentistry. Bright eyes and white teeth have always been one of the criteria of beauty. With the development of dental materials, more and more materials similar to the color of human teeth are being used in restorative dentistry, such as realistic dental veneers, crowns and fixed dentures made of various bonded resins, hard resins and ceramics, which can almost make the teeth of the candidates reach the point of near perfection in color and appearance. The huge social demand for cosmetic dentistry has been the direct driving force behind the rise and development of cosmetic dentistry.
How many stars’ charming smile is the crystallization of dentists’ skills, how many beautiful marriages are the merits of dentists, and how many career successes are the result of dentists rebuilding their self-confidence. In the past, restorative dentistry focused more on the physiological and functional restoration of defects or flaws, but nowadays, psychosocial factors are being paid more and more attention to the improvement of function is not the only purpose of restorative dentistry, and the improvement of the patient’s quality of life should be a higher goal pursued by clinical prosthodontists.