Experimental studies of adaptation tocomplete dentures related to ageing

Frauke Muller and Inge Hasse-SanderU c p a n n i c n l o i P r o s t h e t i c O c i U i s t i v , U n i v c i s i l v o f H o t i n , I - R G

The assessment of a patient's capability to adapt to new dentures is still a challenge in theprosthetic treatment of geriatric patients. The aim of this study was to assess the relation-ship of age to manual motor ability as well as the mental concentration capacity in com-parison lo the oral motor ability and the capability to adapt to new dentures. Sixty completedenture wearers volunteered for the experiment. The results indicate, that the manual motorability and the mental concentration capacity deteriorate with age, whereas the relationshipof age to adaptation to new dentures and oral motor ability is less obvious. This may be dueto the patient's denture experience.

Key words: adaptation, complete dentures, ageing

Gerodontology 1993; 10(1): 23-27

Introduction

In the prosthetic treatment of geriatric patients theassessment of the patient's capability of adaptationto new dentures is still a challenge' -. Clinical expe-rience shows that ageing of the stomatognathic sys-tem does not strongly correlate with the chronologi-cal age"*. Previous studies have dealt with the oralmuscular coordination^ " or adaptation to new com-plete dentures'-"''*. The aim of this study was to as-sess the relationship of a subject's age to manualmotor ability and menta! concentration capability incomparison to the oral motor ability and the capabil-ity to adapt to new dentures and thus evaluate the agedependence of effect of the loss of teeth on the oro-facial system.

Material and method

Sixty edentulous subjects - 39 women and 21 men -took part in the experiment. Their age ranged from39 to 85 with an average of 68 years. All subjectswere experienced denture wearers and had new com-plete dentures inserted during the tmal dental exams2 to 3 weeks previously. A full history and clinicalexamination were taken.

Digit - symbol test

A standardised psychological test to assess a patient'smental concentration ability and intelligence was ap-plied^. After a short instruction followed by 8 exam-ples, subjects were asked to assign symbols to digitsaccording to a given pattern (Fig, 1). After 90 sec-onds the experiment was stopped and the correctlyassigned symbols were counted to represent the'mental concentration ability'. Standardised tables,stratified by age, enabled the authors to assign an 'in-telligence quotient'.

Manual motor ability test

The manual motor ability was evaluated by the 'so-called' pinhole-board test. In this test the subject hasto pick up three tiny metal-pins and stick them intoas many holes of a pinhole-board as possible in thefirst row. After 90 seconds the test person had to con-

'^ NAl Nurnbcrgcr Aiicrsinvcntar, Oswald W D andFleischmann U M. WAIS - Wcchsier Adult Intelligence-Scale.

© The Gerodontology AssociationVolume 10, No.

24 Miilloi and Hassc-Sander

1V

2X

3T

4N

5C

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7 8U

9

Figure 1.e.xatnples.

- symbol test: The task L\ to assiiiti symbols to dif;its atcordini; to the

Example

2 1 2 3 1 3 4 5 4 1 2 7 9 5 6 8 3 8 6 5 2 4 3 7 1

_9j 5 9 8 3 7 2 6 4 1 9 4 7 6 5 2 8 1 3 7 9 8 6 1 3

6 2 5 1 9 2 8 3 7 4 6 5 9 4 8 3 7 2 6 1 5 4 6 3 7

tinue u ith the following row. The total number ofcorrecth' filled holes in all 5 rows - the "pinhole-board score' - depicts the tnanual motor ability. In-creasing numbers of correctly filled holes in subse-quent rows indicate the manual learning ability.

Oral motor ability test (MA-test)

To test tbe subject's oral motor ability we simplifiedthe test first described by BeiT>' and Mabood m 1966'which was later modified by Landt-. In this test thesubject was asked to assemble two halves of test-pieces in tbe mouth {Fig.2). Three different shapesof increasing difficulty were used. Eacb shape wasreplicated twice. If the subject did not succeed tbeexperiment was stopped after 180 seconds. When thesubject gave up prematurely we also notated 180 sec-onds. Tbe total assembly time of all 9 tests was addedand considered to represent the subject's oral motorability.

Figure 2. MA-test-pieces; Three different test-pieees were usedThe two halves are assemhled in the

Adaptatiou index

The degree of adaptation to the new dentures wasassessed by means of a new developed questionnaire.The following statements were read to the subject:

- I can chew well (with my neu dentures)

- My new dentures are comfortable to wear

- It is difficult to get used to the new dentures

- I am constantly aware of tbe new dentures in my

mouth

- I like the appearance of the new dentures

- ! ha\e difficulties in speaking with the newdentures

- 1 like my old dentures better

- When I am alone I remove the new denturesmore often than the old ones

- I always wear my dentures - even when I amalone

- Tbe old dentures looked better

The patient could agree or disagree with the state-ments on 3 different levels from 'applies completely"to 'does not apply at all". According!) an adaptationindex score was calculated ranging from 40 for per-fect adaptation - to /eto for complete failure.

Results

Tbe relation of the chronological age in years to themental concentration ability is depicted in Fig.3. Thelatter is quantified in total number of correctly filled

Gerodontology

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Figure 3. Age-relation of the digit - symbol test sc(ne. represent-inii the subject's coitcciitration iibilitx iii = 5..U.

2000n

1000-

r = 0.33psO.OI

30 40 50-T—60

- I —

70 80 90

Age

Figure 5. Aife-reUition oj the oral motor ability, assessed bymeans of the MA-test (n=60}.

boxes in the digit-symbol test. The relationship isdescribed by a correlation coefficient of v=0.5 withthe linear regression coefficient being significantlydifferent from zero {p<O.OUI).

No age relationship was found when convertingthe Digit-Symbol test score into the "'intelligencequotient".

The manual motor ability demonstrated a slightlystronger relationship to age (r=0.6I, p<0.0001) thanthe digit-symbol test (Fig.4). The increase or de-crease of correctly filled holes in the pinhote-boardin subsequent rows did not show any significant agerelation. Furthermore this remained unchanged whenexcluding the last two rows from analysis to accountfor fatigue which might have diluted any learningeffect.

Less clear age relationships were found for oralmotor ability (Fig.5) and capability of adaptation(Fig. 6). However, the regression straight lines weresignificantly different from zero (p<0.01 (Fig.5);p<0.05 (Fig.6), respectively).

No significant correlations were found betweenadaptation capability and the wearing period of theold set of dentures or the age when the patient be-came edentulous.

Likewise neither the muscular learning ability ex-pressed as percentage of increase or decrease in timeneeded for repeated muscular tasks nor the 'in-telligence quotient" showed a significant correlationto a subject's capability to adapt to new prostheses.

Discussion

Ageing is a biological process, not simply chrono-logical'\ which therefore leads to ronsiderable inter-individual variations. Furthermore the effect of ageon the investigated physiological features cannotclearly be separated from the person's medical his-tory or any drug effect. Low scores in the digit sym-bol test as well as the pinhole-board test might beinfluenced by an impaired vision. Although positive

ou -

60-

40-

20-

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^ ^ • •

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30 40 50 60 70 80 90Age

Figure 4. Age relation of the manual motor ability, as.sessed bymeans of the pinholeboard test score ln=5H)

50-1

T3c§40ao.•? 30H

20-

10

30 40 50 60 70 80 90Age

Figure 6. Ai;e relation of the eapability to adapt to new dentures.The "adaptatitm inde.x" ranges from 0 for no adaptation to 40for coinplete adaptation {n=60).

Volume lU, No.

Miillor luui 1 lassc-SuiKler

.IS well as iiogMliNc sUiluniciUs were used, il

bo cxeUkied. thai a patient would give positive an-swers in order nol lo appear ungralelul. Ineonelusionwe need lo be earelul w hen interpreting data o! ihistype.

In this stud) our interest focussed on ehronologi-eal age and iis relationship to physiologieal !une-tions. When analysing the relationship on manualmotor ability and the mental eoneenlration abilityboth showed elose eorrelatioiis to elironological age;as expeeted the performance m the pmhole-board testand ihc digit-symbol test deteriorate with age. In eon-trast. the oral motor ability seems to be less elearlyage-related, as was the eapability of adaptation toeomplcte dentuies. Every denture loses retention af-ter a period of wear, due to alveolar bone resoiptionand/or ehanges of the mueosal tissues. As a eonse-quence the oral muscles take over responsibility inholding the denture in place. This requires a goodmuseular coordination ability"'. Wearing dentures isa challenge, training and exercise for the oral mus-cles. This continuous muscular training might con-found the relationship between oral motor ability andchronological age and thus explain the low correla-tion seen' . Howe\er, to confirm a training effect by

denture wearing and lo separate it Irom age, eden-tulous subjects of the same age group but wilh vari-ous denture experiences would have to be studied.

The hypothesised correlation between a 'learningability' in repealed muscular tasks and the eapabilityol adaptation could not be confirmed. Especially inelderly people fatigue might counteract an improve-ment in museular performance. When extracting theage-component from the digit-symbol test score us-ing standardised tables and age-independent 'intelli-gence-quotient" could be estimated. However, theability to adapt seems to require skills other than thepatient's intellectual capacity.

Conclusions

These results indicate that the manual motor abilityand the mental concentration capacity deterioratewith age whereas the effect of ageing on the capabil-ity of adaptation to new dentures and on oral motorability is less obvious. Tbis eould result from a train-ing effect by denture experience, but further studiesare needed to confirm this hypothesis.

References

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6. Landt H, Ingervall B. Oral ability to reeogni/e formsand oral niulor ahilily in 1 1-year-old children. J OtulRehah 1975; 2:63-73

7. Landt H, Frans.son B. Oral ahilily to rceogni/c formsand oral tiiuseular eoordmalmn ability in Jcntulous youngand eldcriy adulls. J Otal Rrluth 197.S; 2:123-1 3S

8. Landt H, Alin L, Lindquist L. The experimental ef-feet on results with oral form recognition tests and withtesls measuring oral muscular ability. J Oral Rchah 1975;2:235-248

9. Landt H, Fransson B, Alin L. Oral recognition offorms and oral muscular coordination ability. A longitu-dinal study in young adults. J Oral Rehah 1979; 6:279-290

10. Landt H. Oral Stereognosis and Oral Museular Coor-dination Ability. In: Frontiers of Oral Physiology, Basel:Karger, Vol. 4, pp.55-79. 1983

11. Smink L. Tests /ur oralen Stereognosie (RF) und zuroralen iiuiskularLMi Koordination (MA) im Hinbliek aufeine moghehc Prognose bei der Behandlung zahnloseraltcrer Paticnten. Mod. Diss. Mtinster, 1985

12. Basker R M. Adaptation to dentures. Br Dent J 1966;120:573-576

1 3. Bell I) W Jr. Problems in eoiupleie denture treatment.J Pro.sih Dcni I96K; 19:550-560

14. Berry !> C, Mahood M. Oral Slereognosis and OralAbility in Kelation to Piosthelie Treatment. Br Dent J

). 120/4: 179- 185

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A(l;i[tl;iliun ID miiipk'lL" (Icnliiics 27

IS. StoixT R. The effect of llio Climacteric and of Ageing 17. Mii l lor I'", Ilasst'-Sander f. Comparative Studies onun Piosthelic Diagnosi.s and Tiv;ilincnl Planniiij:. Hr Dent iiral and inantial initlor abilily in cdenlalo snlijccls ./ OtidJ l%5; 119:344-3^ Rrluih Vm. I9:I77-I7S

16. Fish S F. Adaplalion .iiul hahitualion lu lull denliues.BrDcntJ \'-)W. 127; l')-2(i

Address for correspondence: Dr. Frauke Muller University of Main / , Dcpl. of Prosihelic Ocntistry.Augustusplatz 2, 551}} Main/ . Germany

Acknow ledgoment: The authors would like to thank Prof. Dr. L. Hupfauf for his helpful support during thestudy. Prof. Dr. K. Fuhr and Mr. P.M. Black lor critical comments on the manuscript.

Paper presented the lADR Satellite symposium and 3rd annual Conference of the European College ofGerodontology "appropriate dental care for older people" July 1992, Stirling, Scotland

Volume 10. No.