Correlation Between Quality of Mitsuyoshi Yoshida, DDS, PhDa

Yuuji Sato, DDS, PhDb

Life and Denture Satisfaction in Yasumasa Akagawa, DDS, PhDc
Elderly Complete Denture Wearers Kyou Hiasa, DDSa

Purpose: This study was done to clarify the correlation between the quality of life (QOL),
defined as overall satisfaction with daily life, and denture satisfaction in elderly complete
denture wearers. Materials and Methods: A new method for quantifying overall satisfaction
with daily life (QOL) among 2,079 elderly people (age 65 years) was developed by
evaluating the contribution of 13 factors (eating, health problems, daily exercise, fatigue,
sleep quality, smooth communication, physical comfort, aging, loneliness, job and hobbies,
meaningfulness, social life, and economic problems) to overall daily life satisfaction by a
multiple regression analysis. Then, correlation between the QOL and denture satisfaction
was analyzed by the regression model in 84 randomly selected complete denture wearers
from the above population. Results: Quantification of the QOL was completed by converting
category scores to integers between 0 and 100 for eight highly correlated factors (eating,
smooth communication, physical comfort, loneliness, job and hobbies, meaningfulness,
social life, and economic problems) to overall satisfaction with daily life (P < 0.01).
Significant positive correlation was found between the QOL score and denture satisfaction
score (P < 0.05). Conclusion: Edentulous elderly people who are well satisfied with their
daily lives are also satisfied with their complete dentures. Int J Prosthodont 2001;14:7780.

T he impact of oral health on the quality of life (QOL)

of the elderly may have increased significantly over
the last decade because of the increase in the elderly
population and the longevity without their own teeth.1
Tooth loss affects oral healthrelated QOL measures
such as functional problems in eating and speech and
social discomfort when smiling.24 Locker and Slade5
and Leao and Sheiham6 reported impairment and dis-
ability of oral healthrelated QOL by evaluating the re-
a Research Fellow, Department of Removable Prosthodontics,
Faculty of Dentistry, Hiroshima University, Japan.
bAssociate Professor, Department of Removable Prosthodontics,
Faculty of Dentistry, Hiroshima University, Japan.
cP r o f e s s o r a n d C h a i r m a n , D e p a r t m e n t o f R e m o v a b l e
Prosthodontics, Faculty of Dentistry, Hiroshima University, Japan.
Reprint requests: Dr Mitsuyoshi Yoshida, Department of
Removable Prosthodontics, Faculty of Dentistry, Hiroshima
University, Kasumi 1-2-3, Minami-ku, Hiroshima 734-8553, Japan.
Fax: + 81-82-257-5679. e-mail: mitsu@hiroshima-u.ac.jp
lationship between oral health and QOL with their
original questionnaire. In contrast to their results, oral
healthrelated QOL has recently been recognized as
a separate and distinct facet of overall QOL.7 QOL has
been classified in three levels by Spilker8: (1) an over-
all level (an individuals total satisfaction with life and
ones general sense of personal well being); (2) a mid-
dle level (broad domain including the four categories
physical state and functional abilities, psychologic
state and well being, social interactions, and economic
status and factors); and (3) a lower level (indicating spe-
cific aspects for various diseases). A lower level of
QOL has been found to be oral health related in pre-
vious studies.26 However, the relationship between
oral health benefited by dental treatment and overall
QOL has not yet been fully clarified.
The purpose of this study was to evaluate the re-
lationship between satisfaction with daily life and
denture satisfaction among edentulous elderly peo-
ple by a method for quantifying overall satisfaction

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 Quality of Life and Denture Satisfaction in Elderly Denture Wearers Yoshida et al

Table 1 Questions Asked of the Subjects in the Study

Category
Question Grade 1 Grade 2 Grade 3

1. Are you satisfied with your diet? Well satisfied Satisfied Dissatisfied
2. Are you confident about your health? Very much Almost Little
3. Do you exercise daily? Every day Some days Few days
4. Do you feel tired most days? Few days Some days Most days
5. Is your sleep often disturbed? Never Sometimes Often
6. Are you satisfied with your communication? Well satisfied Satisfied Dissatisfied
7. Do you usually feel well? Very well Well Not well
8. Do you feel anxious about aging? Never Sometimes Often
9. Do you feel loneliness often? Never Sometimes Often
10. Are you satisfied with your job and hobbies? Well satisfied Satisfied Dissatisfied
11. Do you feel your life is meaningful? Very much Almost Little
12. Are you contributing to your community? Very much Almost Little
13. Are you satisfied with your economic status? Well satisfied Satisfied Dissatisfied
14. Are you satisfied with your overall daily life? Well satisfied Satisfied Dissatisfied
These questions relate to eating, health problems, daily exercise, fatigue, sleep quality, smooth communication, physical comfort, aging, loneliness, job
and hobbies, meaningfulness, social life, and economic problems (questions 1 to 13) for explanatory variables of overall satisfaction (question 14).
Subjects were given a forced choice among three categories.

with daily living.
Materials and Methods
Two thousand seventy-nine elderly persons (mean
age 74.2 years for 841 men and 74.8 years for 1,238
women) randomly selected from the Kure, Japan pop-
ulation of almost 200,000 participated in this study.
Almost 50 volunteer examiners visited the subjects
homes and interviewed them by means of an original
questionnaire (Table 1). Subjects were asked to re-
spond by giving one of three categorized answers to
each question concerning overall satisfaction with
13 daily life factors (eating, health problems, daily ex-
ercise, fatigue, sleep quality, smooth communication,
physical comfort, aging, loneliness, job and hobbies,
meaningfulness, social life, and economic problems).
A multivariate regression analysis was used to de-
termine the contributions of the 13 factors to overall
satisfaction with daily life. Because these explanatory
variables (13 factors) were a part of an ordinal rather
than an interval scale, the following multiple regres-
sion model with dummy variables9 was used to sim-
ulate the relation of overall satisfaction (Y) and these
13 factors:
Y = a11x11 + a12x12 + a13x13 +...+ an1xn1 + an2xn2 + an3xn3
The variable xij, called a dummy variable, is 1 when
the examination of factor number i is graded number
j and is 0 in another case. The coefficient aij is called
the category score. From the 13 factors, those sig-
nificantly contributing to overall satisfaction were
selected by backward elimination and forward se-
lection methods to avoid the problem of multicolin-
earity,10 which decreases the reliability of analysis be-
cause of excess factors. Backward elimination and
forward selection were performed from 13 to 1, and
from 1 to 13 step by step, at the probability level of
99%.
After selecting the contributing factors, category
scores for each factor were calculated and converted
into integers such that the sum of category scores for
the remaining contributing factors was distributed
from 0 to 100.11,12 Category scores for grade 3 were
converted to 0, and the sum for grade 1 was con-
verted to 100. This converted sum determined the
QOL score in this study. An analysis of variance
(ANOVA) and post hoc tests were done to evaluate
the validity of comparing QOL scores for three grades
of overall satisfaction with daily life.
Eighty-four totally edentulous elderly people (41
men and 43 women) were selected from among the
subjects who had worn maxillary and mandibular
complete dentures. The mean duration of wearing
dentures was 9.1 8.4 years. These subjects were
asked to respond to questions concerning overall
satisfaction with their dentures, and this satisfaction
was calculated by the method of Sato et al.12 The lin-
ear relation between denture satisfaction scores and
QOL scores was evaluated by a regression analysis.
Results
All 13 explanatory variables were significantly related
to satisfaction with daily life and to each other by Chi-
squared test (P < 0.0001). The value of r2 (indicator of
appropriateness of multiple regression models) was
highest (r2 = 0.666) when eight factors (eating, smooth
communication, physical comfort, loneliness, job and

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 Yoshida et al Quality of Life and Denture Satisfaction in Elderly Denture Wearers

Table 2 Eight Selected Factors and Their Category Scores

Partial correlation Category scores Integers converted from category scores

Factor coefficient Grade 1 Grade 2 Grade 3 Grade 1 Grade 2 Grade 3

Eating 0.18* 0.19 0.26 0.42 13 4 0

Smooth communication 0.18* 0.23 0.21 0.52 16 7 0
Physical comfort 0.11* 0.15 0.07 0.48 14 9 0
Loneliness 0.11* 0.15 0.09 0.24 8 3 0
Job and hobbies 0.07* 0.12 0.05 0.12 5 2 0
Meaningfulness 0.13* 0.21 0.10 0.46 15 8 0
Social life 0.07* 0.08 0.13 0.13 5 0 0
Economic problems 0.29* 0.38 0.16 0.72 24 12 0

Sum of category scores for yes 1.51 100

*P < 0.01.
These eight factors were selected by a multiple regression analysis. A category score for each factor was calculated and converted into integers such
that the sum of category scores was distributed from 0 to 100. Category scores for grade 3 were converted to 0, and the sum for grade 1 was converted
to 100. Consequently, the converted sum determined the QOL score.

100
30 Satisfied
Well satisfied
80
Frequency (%)

20
Dissatisfied

QOL score
60

10 40

20
0
0 20 40 60 80 100
QOL score 00 20 40 60 80 100
Denture satisfaction score

Fig 1 Distribution of QOL scores for each grade of overall sat- Fig 2 Relationship between QOL scores and satisfaction
isfaction with daily life. The distribution of QOL scores for three scores for complete dentures (r = 0.27, P < 0.05).
grades of overall satisfaction is shown as well satisfied (82 15),
satisfied (57 16), and dissatisfied (38 20), with a significant
difference (P < 0.01).

hobbies, meaningfulness, social life, and economic
problems) were selected using both the backward
elimination and forward selection methods. Then, cat-
egory scores for these eight factors were converted into
integers (Table 2). The distribution of mean QOL scores
for three grades of overall satisfaction were shown as
well satisfied, satisfied, and dissatisfied with a signifi-
cant difference (P < 0.01; Fig 1). Moreover, a signifi-
cant positive relationship was detected between QOL
scores and satisfaction scores regarding complete den-
tures (P < 0.05; Fig 2).
Discussion
In this study, we attempted to assess the overall level
of QOL in elderly complete denture wearers. Con-
ceptually, major QOL domains include the following
four categories: (1) physical state and function abilities,
(2) psychologic state and feeling of well being, (3) so-
cial interactions, and (4) somatic sensation.13,14 How-
ever, these domains appear to have some variations
associated with impairment of daily life. Somatic sen-
sation and/or physical state categories, such as pain
control, may be more essential for serious diseases like
cancer, while social interaction categories such as
leisure and hobbies may be more important for chronic
diseases like hypertension. Tooth loss is considered to
be a slow, progressive, and chronic disease and may
mainly affect the social aspects of QOL. Therefore, in
this study we tried to weight these four categories. An
original questionnaire in this study referred to the QOL
questionnaires for cardiovascular patients.15 After sta-
tistical analysis of evaluating QOL, eight factors were
selected in this study, and these factors corresponded
to four categories of major QOL domains: (1) eating;
(2) loneliness, meaningfulness; (3) smooth communi-
cation, job and hobbies, social life, economic prob-
lems; and (4) physical comfort.

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Quality of Life and Denture Satisfaction in Elderly Denture Wearers
Weighted satisfaction was made by a multivariate
analysis quantification method.9 This method is often
used to analyze the complicated contributions of
primary factors to outcomes by transforming quali-
tative data into quantitative data. Category scores and
partial correlation coefficients indicate the degree of
contribution of each satisfaction factor and grade to
overall satisfaction. To offer an easier intuitive un-
derstanding of the degree of overall satisfaction with
daily life, decimal category scores were converted to
integers distributed from 0 (completely dissatisfied)
to 100 (perfectly satisfied).
This method, developed in this study, focused on
overall level of QOL and is regarded as useful for
evaluations of oral disease impairment and for out-
come assessments in prosthetic rehabilitation.
Prosthetic treatment for edentulous patients often
improves their chewing, appearance, and social func-
tioning.16,17 Yet, denture patients often experience
problems in home tasks, social work, and leisure ac-
tivities.18 Poorly fitting dentures affect the patients
ability to eat satisfactorily, talk clearly, and smile
freely.19 However, it was not demonstrated that den-
ture treatment enhances patients QOL in previous
studies.6,7,20 This study has shown that subjects who
have a greater QOL are also satisfied with their com-
plete dentures. However, it is still not clear that im-
proving the quality of complete dentures improves
QOL. To determine this possibility, further study
should be done to explore the relationship between
complete denture quality and QOL with the use of
this new method.
Conclusion
Under the limited conditions of this study, it may be
concluded that eight factors (eating, smooth com-
munication, physical comfort, loneliness, job and
hobbies, meaningfulness, social life, and economic
problems) are highly correlated with overall satis-
faction with daily life of elderly people. Based on the
weights of contribution of these eight factors to QOL,
edentulous elderly people who are well satisfied
with their daily lives are also well satisfied with their
complete dentures.
The International Journal of Prosthodontics
Yoshida et al
Acknowledgment
The authors are very grateful to Kure City Dental Association for
generous assistance with this study.
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