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Some personality determinants of denture preference
Some personality
determinants
of denture preference
Shmuel Tau, D. M.D. ,* and Uri Lowental, M.D. ** Hebrew
University-Hadassah
School of Dental
P
Medicine,
ersonality characteristics of dental patients influence their behavior and cooperation throughout treatment. Sensitivity over the treatment of their teeth increases ;IS the patients approach the edentulous stage, affecting both their satisfaction with their dentures and their functional accommodation to denture treatment.‘, ’ It is often an emotional factor rather than the prosthodontic technique, or patient physiology, which can lead to a therapeutic failure. The prevention of such a failure requires a comprehensive evaluation of the various emotional trends, with “personality” referring to the overall reactive trends expressed as “character,” that is, the habitual, typical mode of responding to various stimuli. Denture dissatisfaction can be conveniently divided into two categories, esthetic and functional.’ The nature of denture acceptance is highly subjective and causes many patients to express dissatisfaction with their well-fitting, adequately functional dentures. Such nonacceptance apparently relates to esthetic considerations and personality determinants. These determinants are sometimes the result of ethnocultural parameters which can be expressed by directly measurable factors (such as marital status and professional activityj and can lead to inference about hidden trends. Treatment dissatisfaction is usually related to the patient’s age, gender, ethnic background, level of education, and previous treatment experience. Each of these parameters can be seen in the light of the characteristic dissatisfaction coefficient of the individual. The predominantly immigrant population seeking treatment at Hebrew University-Hadassah School of Dental Medicine Clinic reflects extensive ethnic variations. The objective of this study was to investigate personality characteristics associated with ,esthetic denture preferences in this population. *Department of Oral Rehabilitation. **Clmical Lecturer in Psychiatry
10
JULY 1980
VOLUME
44
NUMBER
I
Jersualem,
Israel
Table I. The patients
Married Divorced Wldowed Total
Men
Women
Total
23 1 1 25
21 3 13 37
44 4 14 62
METHOD Sixty-two patients were involved in the study (Table I). Most of the patients were housewives or retired, semiskilled laborers. They had a moderate or less than moderate income, representing the average patient population of the clinic. Fifty-six of the patients had come to the clinic to exchange their old dentures for new ones, and six of the patients were being fitted with their first set of complete dentures. The latter group included some patients who had previously worn removable partial protheses. A complete history was taken for each patient, including the relevant data for the present investigation: age, sex, marital status, ethnic origin, level of education, and duration of previous prosthetic experience. Only three of the patients were born in Israel, and the ethnic origin of their parents was noted. All patients treated in this study were supervised by one of the authors (S. T.). A questionnaire prepared by the second author (U. L.) aimed at quantitative recording of the following: identification, demographic variables, general health history, level of education, denture history, satisfaction with prosthetic treatment, selfimage, and health assessment. Five direct questions were aimed at determining the patients general experience of well-being, health record since immigration, familial well-being, professional achievement record, and satisfaction with housing and economic level. These questions where combined to indicate an Index of Personal Satisfaction (IPS),
0022-3913/80/070010
+ 03$00.30/00
1980 The C. V. Mosby Co.
PERSONALITY
DETERMINANTS
OF DENTURE
PREFERENCE
with scores ranging from 5 (minimal score, 1 point for each question) to 25 (maximal score, indicating a high degree‘of personal satisfaction and little or no tendency to complain). Subsequently. each patient was asked whether he or she preferred beaut2fil or natural-looking teeth on the denture. Some patients could not reach a decision and were graded as “indifferent.”
RESULTS The effects of ethnocultural background, sex, and the IPS are shown in Tables II to IV. The difference between Western Jews preferring a natural appearance and the Oriental Jew with a preferred bt~azhjicl appearance, is statistically significant with p 5 0.001 a chance of one in a thousand to achieve these results randomly according to Pearson’s x’ test.’ The difference between patients of Western and Oriental origin was more pronounced in women with p 5 0.1 (Table III). The results shown in Table I\’ suggest that those individuals satisfied with themselves and with their achievements tended to ask for natural-looking dentures, while the dissatisfied patients preferred beautiful (impressively compensatory) artificial teeth. Statistical significance is in the p I 0.1 range. The results of the inquiry of the parameters of age, education, and length of denture history failed to demonstrate any effect upon denture preference beyond their correlation with the ethnocultural origin. It must be pointed out that the education level of our Ll’estern patients M.as twice as high as that of the Eastern patients. In fact, even where there M’as equal education, the Western-Oriental parameter prescribed the choice of dentures.
Table II. Effects of ethnocultural Ethnocultural origin Western* (29 patlents) Ortentalt (33 pdtlents) Total
background
Desired appearance Beautiful
Natural
Indifferent
3
20
6
21
10
2
24
30
8
*\Vestern patients were immigrants from America and Europe. JTOrienral pattents were immiqrants from Asia and North .\frlca.
true choice of denture appearance innermost through hypnosis. Those patients whose choices turned out to be’ virtually opposed to their conscious declarations were spared subsequent conflicting doubts and remorse by the dentist’s assessment of their true self-image. Personality dynamics and motivations are intensely interwoven, and their mutual influence is often quite obscure. Therefore, we focused only on the most obvious characteristics.
Ethnocultural
background
Ethnocultural background was the most influential determinant in this study. Patients of \4’estern origin preferred a natural appearance; Oriental patients asked for beautiful, shining white teeth. In Israel, a \Vestern origin often implies that the person is an old-timer, cultured and secure (m the category of most \‘IPs and national leaders), in contrast to the Oriental Jews. The differentiation coincides in some respects \l+th Ashkenazi versus Sefardi Jews or with high versus low socioeconomic conditions.
DISCUSSION
Gender
Esthetic factors play a very important part in denture satisfaction,’ and the dental literature contains several methods for achieving good esthetic results,’ as well as attempts to predict and understand the reasons for denture success.“.” We felt that the specific question allowing a choice between beautifully shining teeth versus naturallooking ones was a parameter which covered multiple emotional determinants. Several of these determinants were unconscious ones touching upon questions of artistic preferences, professional background, gender, and basic drives and individual motivations. Ament and Ament”’ attempted to uncover some of these hidden factors by searching for the patient’s
Women are assumed to place more significance on physical appearance than men. Our re.sults, however, indicated that the major determinant of a beautiful denture preference was the ethnocultural origin, rather than the gender (Tables II and III). Again, Oriental Jews were generally of a lower socioeconomic status.
THE JOURNAL
OF PROSTHETIC
DENTISTRY
IPS A correlation existed between the degree of general, biosocial and psychosocial subjective sense of well-being and the choice of natural-looking teeth, whereas dissatisfied individuals preferred beautiful. shining teeth. This suggests that personally and socially insecure people possess little personal satis-
11
TAL
AND
LOWENTAL
Table III. Effect of gender on desired appearance Natural
Beautiful Western Men (2.5 patients) Women (37 patients) Total
Oriental
3 1 4
Western
7 13
6 15
20
21
Indifferent Oriental
Oriental
Western
6
1
2
3 9
4 5
I 3
\V = Western (immigrants from America and Europe) 0 = Oriental (immyants from Asia and North Africa).
Table IV. Effect of Index of Personal
Satisfaction
(IPS) IPS score 5 14 (22 patients) 15 to 17 (19 patients) 2 18 (21 patients)
Beautiful 12 6 6
Natural 8 9 13
Indifferent 2 4 2
satisfaction who chose brilliant, beautiful teeth. In this study, the patient’s choice was motivated by compensatory strivings which were more pronounced in those with a low self-esteem rating. This is a consideration that should influence the prosthodontist’s approach. REFERENCES I.
faction; therefore, they feel more emotionally threatened by the loss of their teeth and look for compensation through impressive looking dentures. Self-assured people are more often content with a restoration of their former appearance by naturallooking teeth. Their own self-image is sufficiently satisfying that they need not strive for idealization.
CONCLUSIONS This investigation suggests the importance of ethnosocial and personality factors in the acceptance of dentures and the degree of functional restoration. The central motivating factor appears to be related to a patient’s self-esteem, and this concept is proposed as a guideline for prosthodontic treatment.
Pilling, L F. E:mouonal aspects of prosthodontic patients. J PROSTHET DENT 30:514, 1973 2. Koper, A.: Human factors in prosrhodontic treatment J PROSTHET DENT 30:678. 1973 3. LombardI, R E.. X method for the classihcatlon of errors in dental esthetics J PROSTHETDENT 32:501, 1971. 4 Siegal, S. Non-parametric Stanstics fol the Behavloural Sciences. New York, 1956, hIcCraw-Hill Book Co Inc. 5. Culpepper, W. D , Mitchell, P. S., and glass. M. S.: Estheuc factors in anterior tooth restoration J PROSTHET Dw30:576, 1973 6 Bliss, C H : Psychologic factors mvolved in presenting denture senwe. J PROSTHETDENT 1:-19, 1951 7 Langel, A, hllchmann, J , and Slefelt, I Factors influencmg satisfaction with complete dentures m gerlatrlc patients. J PROSTHET DENT 11:1019, 1961. 8 Levin, B., and Landesman, H. M : A pracl lcal questionnaire for predicting denture success or failure J PROSTHET DENT 35:124,
9
SUMMARY Sixty-two edentulous patients were treated with complete dentures. A correlation was evident between Oriental ethnocultural background (connected with socioeconomical shortcomings) and a preference for white, shining denture teeth rather than natural-looking ones. A similar trend was observed in individuals with a low score of personal
12
10
1976.
Silverman, S., SIlverman, S. I., Silverman, B., and Garfinkel, L: Self-image and its relation to denture acceptance J PROSTHET DENT 35:131. 1976 Ament, P , and Ament, A: Body Image m dentistrk J PR~STHETDENT 24:362, 1970
Repnn~ requds //I DR. S Tw P.0 Box 1li:! JERUSALEII, ISK-\LL
JULY 1980
VOLUME
44
NUMBER
1
determinants
of denture preference
Shmuel Tau, D. M.D. ,* and Uri Lowental, M.D. ** Hebrew
University-Hadassah
School of Dental
P
Medicine,
ersonality characteristics of dental patients influence their behavior and cooperation throughout treatment. Sensitivity over the treatment of their teeth increases ;IS the patients approach the edentulous stage, affecting both their satisfaction with their dentures and their functional accommodation to denture treatment.‘, ’ It is often an emotional factor rather than the prosthodontic technique, or patient physiology, which can lead to a therapeutic failure. The prevention of such a failure requires a comprehensive evaluation of the various emotional trends, with “personality” referring to the overall reactive trends expressed as “character,” that is, the habitual, typical mode of responding to various stimuli. Denture dissatisfaction can be conveniently divided into two categories, esthetic and functional.’ The nature of denture acceptance is highly subjective and causes many patients to express dissatisfaction with their well-fitting, adequately functional dentures. Such nonacceptance apparently relates to esthetic considerations and personality determinants. These determinants are sometimes the result of ethnocultural parameters which can be expressed by directly measurable factors (such as marital status and professional activityj and can lead to inference about hidden trends. Treatment dissatisfaction is usually related to the patient’s age, gender, ethnic background, level of education, and previous treatment experience. Each of these parameters can be seen in the light of the characteristic dissatisfaction coefficient of the individual. The predominantly immigrant population seeking treatment at Hebrew University-Hadassah School of Dental Medicine Clinic reflects extensive ethnic variations. The objective of this study was to investigate personality characteristics associated with ,esthetic denture preferences in this population. *Department of Oral Rehabilitation. **Clmical Lecturer in Psychiatry
10
JULY 1980
VOLUME
44
NUMBER
I
Jersualem,
Israel
Table I. The patients
Married Divorced Wldowed Total
Men
Women
Total
23 1 1 25
21 3 13 37
44 4 14 62
METHOD Sixty-two patients were involved in the study (Table I). Most of the patients were housewives or retired, semiskilled laborers. They had a moderate or less than moderate income, representing the average patient population of the clinic. Fifty-six of the patients had come to the clinic to exchange their old dentures for new ones, and six of the patients were being fitted with their first set of complete dentures. The latter group included some patients who had previously worn removable partial protheses. A complete history was taken for each patient, including the relevant data for the present investigation: age, sex, marital status, ethnic origin, level of education, and duration of previous prosthetic experience. Only three of the patients were born in Israel, and the ethnic origin of their parents was noted. All patients treated in this study were supervised by one of the authors (S. T.). A questionnaire prepared by the second author (U. L.) aimed at quantitative recording of the following: identification, demographic variables, general health history, level of education, denture history, satisfaction with prosthetic treatment, selfimage, and health assessment. Five direct questions were aimed at determining the patients general experience of well-being, health record since immigration, familial well-being, professional achievement record, and satisfaction with housing and economic level. These questions where combined to indicate an Index of Personal Satisfaction (IPS),
0022-3913/80/070010
+ 03$00.30/00
1980 The C. V. Mosby Co.
PERSONALITY
DETERMINANTS
OF DENTURE
PREFERENCE
with scores ranging from 5 (minimal score, 1 point for each question) to 25 (maximal score, indicating a high degree‘of personal satisfaction and little or no tendency to complain). Subsequently. each patient was asked whether he or she preferred beaut2fil or natural-looking teeth on the denture. Some patients could not reach a decision and were graded as “indifferent.”
RESULTS The effects of ethnocultural background, sex, and the IPS are shown in Tables II to IV. The difference between Western Jews preferring a natural appearance and the Oriental Jew with a preferred bt~azhjicl appearance, is statistically significant with p 5 0.001 a chance of one in a thousand to achieve these results randomly according to Pearson’s x’ test.’ The difference between patients of Western and Oriental origin was more pronounced in women with p 5 0.1 (Table III). The results shown in Table I\’ suggest that those individuals satisfied with themselves and with their achievements tended to ask for natural-looking dentures, while the dissatisfied patients preferred beautiful (impressively compensatory) artificial teeth. Statistical significance is in the p I 0.1 range. The results of the inquiry of the parameters of age, education, and length of denture history failed to demonstrate any effect upon denture preference beyond their correlation with the ethnocultural origin. It must be pointed out that the education level of our Ll’estern patients M.as twice as high as that of the Eastern patients. In fact, even where there M’as equal education, the Western-Oriental parameter prescribed the choice of dentures.
Table II. Effects of ethnocultural Ethnocultural origin Western* (29 patlents) Ortentalt (33 pdtlents) Total
background
Desired appearance Beautiful
Natural
Indifferent
3
20
6
21
10
2
24
30
8
*\Vestern patients were immigrants from America and Europe. JTOrienral pattents were immiqrants from Asia and North .\frlca.
true choice of denture appearance innermost through hypnosis. Those patients whose choices turned out to be’ virtually opposed to their conscious declarations were spared subsequent conflicting doubts and remorse by the dentist’s assessment of their true self-image. Personality dynamics and motivations are intensely interwoven, and their mutual influence is often quite obscure. Therefore, we focused only on the most obvious characteristics.
Ethnocultural
background
Ethnocultural background was the most influential determinant in this study. Patients of \4’estern origin preferred a natural appearance; Oriental patients asked for beautiful, shining white teeth. In Israel, a \Vestern origin often implies that the person is an old-timer, cultured and secure (m the category of most \‘IPs and national leaders), in contrast to the Oriental Jews. The differentiation coincides in some respects \l+th Ashkenazi versus Sefardi Jews or with high versus low socioeconomic conditions.
DISCUSSION
Gender
Esthetic factors play a very important part in denture satisfaction,’ and the dental literature contains several methods for achieving good esthetic results,’ as well as attempts to predict and understand the reasons for denture success.“.” We felt that the specific question allowing a choice between beautifully shining teeth versus naturallooking ones was a parameter which covered multiple emotional determinants. Several of these determinants were unconscious ones touching upon questions of artistic preferences, professional background, gender, and basic drives and individual motivations. Ament and Ament”’ attempted to uncover some of these hidden factors by searching for the patient’s
Women are assumed to place more significance on physical appearance than men. Our re.sults, however, indicated that the major determinant of a beautiful denture preference was the ethnocultural origin, rather than the gender (Tables II and III). Again, Oriental Jews were generally of a lower socioeconomic status.
THE JOURNAL
OF PROSTHETIC
DENTISTRY
IPS A correlation existed between the degree of general, biosocial and psychosocial subjective sense of well-being and the choice of natural-looking teeth, whereas dissatisfied individuals preferred beautiful. shining teeth. This suggests that personally and socially insecure people possess little personal satis-
11
TAL
AND
LOWENTAL
Table III. Effect of gender on desired appearance Natural
Beautiful Western Men (2.5 patients) Women (37 patients) Total
Oriental
3 1 4
Western
7 13
6 15
20
21
Indifferent Oriental
Oriental
Western
6
1
2
3 9
4 5
I 3
\V = Western (immigrants from America and Europe) 0 = Oriental (immyants from Asia and North Africa).
Table IV. Effect of Index of Personal
Satisfaction
(IPS) IPS score 5 14 (22 patients) 15 to 17 (19 patients) 2 18 (21 patients)
Beautiful 12 6 6
Natural 8 9 13
Indifferent 2 4 2
satisfaction who chose brilliant, beautiful teeth. In this study, the patient’s choice was motivated by compensatory strivings which were more pronounced in those with a low self-esteem rating. This is a consideration that should influence the prosthodontist’s approach. REFERENCES I.
faction; therefore, they feel more emotionally threatened by the loss of their teeth and look for compensation through impressive looking dentures. Self-assured people are more often content with a restoration of their former appearance by naturallooking teeth. Their own self-image is sufficiently satisfying that they need not strive for idealization.
CONCLUSIONS This investigation suggests the importance of ethnosocial and personality factors in the acceptance of dentures and the degree of functional restoration. The central motivating factor appears to be related to a patient’s self-esteem, and this concept is proposed as a guideline for prosthodontic treatment.
Pilling, L F. E:mouonal aspects of prosthodontic patients. J PROSTHET DENT 30:514, 1973 2. Koper, A.: Human factors in prosrhodontic treatment J PROSTHET DENT 30:678. 1973 3. LombardI, R E.. X method for the classihcatlon of errors in dental esthetics J PROSTHETDENT 32:501, 1971. 4 Siegal, S. Non-parametric Stanstics fol the Behavloural Sciences. New York, 1956, hIcCraw-Hill Book Co Inc. 5. Culpepper, W. D , Mitchell, P. S., and glass. M. S.: Estheuc factors in anterior tooth restoration J PROSTHET Dw30:576, 1973 6 Bliss, C H : Psychologic factors mvolved in presenting denture senwe. J PROSTHETDENT 1:-19, 1951 7 Langel, A, hllchmann, J , and Slefelt, I Factors influencmg satisfaction with complete dentures m gerlatrlc patients. J PROSTHET DENT 11:1019, 1961. 8 Levin, B., and Landesman, H. M : A pracl lcal questionnaire for predicting denture success or failure J PROSTHET DENT 35:124,
9
SUMMARY Sixty-two edentulous patients were treated with complete dentures. A correlation was evident between Oriental ethnocultural background (connected with socioeconomical shortcomings) and a preference for white, shining denture teeth rather than natural-looking ones. A similar trend was observed in individuals with a low score of personal
12
10
1976.
Silverman, S., SIlverman, S. I., Silverman, B., and Garfinkel, L: Self-image and its relation to denture acceptance J PROSTHET DENT 35:131. 1976 Ament, P , and Ament, A: Body Image m dentistrk J PR~STHETDENT 24:362, 1970
Repnn~ requds //I DR. S Tw P.0 Box 1li:! JERUSALEII, ISK-\LL
JULY 1980
VOLUME
44
NUMBER
1