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Reappraising prosthodontic treatment goals for older, partially dentate people: Part I. Traditional management strategy.

Identifieur interne : 007703 ( Main/Curation ); précédent : 007702; suivant : 007704

Reappraising prosthodontic treatment goals for older, partially dentate people: Part I. Traditional management strategy.

Auteurs : R. Omar [Arabie saoudite]

Source :

RBID : pubmed:15449440

Descripteurs français

English descriptors

Abstract

In conventional terms, prosthodontic treatment becomes necessary when a patient has missing and/or broken-down teeth. Part I of this two-part series of papers reviews the available evidence for a traditional therapeutic model that seeks purposefully to reconstitute lost morphology, with specific reference to older, partially dentate people, at the population level. Furthermore, because anterior and premolar teeth are indispensable to a number of prime oral functions in most societies, the question of need for replacement relates essentially to that of molar teeth. Research findings are presented which cast doubt on many of the assertions made for the mandatory replacement of all posterior teeth. Specifically, there appears to be a lack of compelling evidence that dental arch integrity is a prerequisite for optimal oral health and function, and favours the prognosis of the remaining dentition. Wide variability in the effects of posterior tooth loss on occlusal stability indicates a 'wait-and-see' management approach rather than immediate replacement, while reported chewing sufficiency in people with reduced but well-distributed dentitions, and a lack of association between the level of posterior support and temporomandibular disorders, further undermine the traditional premise for the mandatory replacement of posterior teeth, specifically molars. With the parallel recognition that the assessment of treatment need must take a broader view of peoples' functional concerns arising from their tooth loss, as well as weighing the cost/benefit ratio of treatment, Part II will compare the merits of the traditional model with the documented functional benefits that a more limited, less morphologically-driven approach may have for the growing, older sector of society.

PubMed: 15449440

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<term>Developing Countries</term>
<term>Health Planning</term>
<term>Health Policy</term>
<term>Health Services Accessibility</term>
<term>Health Transition</term>
<term>Humans</term>
<term>Needs Assessment</term>
<term>Socioeconomic Factors</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr">
<term>Accessibilité des services de santé</term>
<term>Adaptation physiologique</term>
<term>Facteurs socioéconomiques</term>
<term>Humains</term>
<term>Pays en voie de développement</term>
<term>Planification en santé</term>
<term>Politique de santé</term>
<term>République d'Afrique du Sud</term>
<term>Soins dentaires pour personnes âgées</term>
<term>Transition sanitaire</term>
<term>Évaluation des besoins</term>
</keywords>
<keywords scheme="Wicri" type="geographic" xml:lang="fr">
<term>Afrique du Sud</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">The second of this two-part series, on the theme of estimating prosthodontic treatment needs and goals for older, partially dentate people, examines the roles of patient-perceived functional impairment, treatment outcome and changing demographic profiles in influencing these goals. In contradistinction with the lack of compelling evidence for the basis of the traditional, morphologically-driven prosthodontic treatment strategy, the evidence that the assessment of treatment need should take greater account of individuals' felt oral functional concerns, and thereby assuming a more problem-oriented, outcomes-based approach to prosthodontic decision-making, is gaining strength. Furthermore, the current blueprint guiding prosthodontic planning and procedures cannot be exempt from the far-reaching changes in society brought about by new economic and social realities, and will need to transform itself in the light of new evidence. How these realities translate in a developing country context is not certain, but it is known that inequalities in access to, and the provision of healthcare are related to socio-economic factors, be they prevailing or of residual nature from past structural conditions. Such conditions adversely affect peoples' health status and add urgency to the pursuit of viable and appropriate management strategies. In the context of a reappraisal of current prosthodontic paradigms, the shortened dental arch concept is presented as a potentially compelling strategy for the appropriate management of the ageing, partially dentate patients in South Africa, whose access to healthcare is inequitable. Since dental and oral health status is variable, the management strategy highlighted here should be seen as one, albeit an important one, within a range of available options.</div>
</front>
</TEI>
</PubMed>
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