For example, some individual who undergo edentulism feel that "…final loss of teeth can represent the final loss of youth and virility "(Edentulousness and oral rehabilitation: experiences from the patients' perspective, 2002, p. 417).

Psycho-social Impact and Self-Image

One of the most commonly recorded and disturbing aspects of edentulousness is the loss of self-confidence and the reduction of a positive self-image that it engenders in many individuals. This loss of self-image is also linked to a number of concomitant emotional reactions. There is a feeling of "…having lost part of one's self" (Davis et al. 2000, p. 503). A study by Davis et al. ( 2000) also found that there was a surprising depth of feeling among those interviewed. This depth of feeling was linked to the perception of loss of self-identity and self-image and that was associated with negative societal perceptions of teeth loss (Davis et al. 2000, p. 503).

This finding is supported in a number of other studies; including a Review of the Functional and Psychosocial Outcomes of Edentulousness ( 2003). This study found that among the study sample of patients receiving conventional prosthodontic treatment various common themes emerged. These included; "…feelings of bereavement, lowered self-confidence, altered self-image, dislike of appearance, inability to discuss this taboo subject, concern about dignity, behaving in a way that keeps tooth loss secret, altered behavior in socializing and forming close relationships, and premature aging" (Allen and McMillan,2003, p. 662c). Furthermore, this study concluded that "… tooth loss may profoundly affect the psychosocial well-being of patients, even those who are apparently coping well with dentures" (Allen and McMillan, 2003, p. 662c).

A connection has also been made in the literature between Edentulousness and the perception of the socially "deviating person ." This term refers to someone who deviates or is perceived to deviate from the acceptable norms and standards of society. According to a study by Trulsson et al. (2002) many people who have total edentulism perceive themselves as becoming outsiders or deviating persons. As this study notes;

" Having a poor dental status is, according to the informants, a sign of unsocial behavior and deviating personality (i.e. being different)" (Trulsson et al. 2002. P. 418). This in turn can lead to various...

However, it is important to note that these physical factors are compounded by and associated with socio-psychological factors as discussed above.
Physical pain is often linked to the process of edentulism. Bone loss is also another inevitable consequence of edentulism. "Following total tooth loss, the height and width of the alveolar bone decrease markedly" and "…bone loss is an ongoing process following tooth loss (Allen and McMillan,2003, p. 662a). This may also lead to difficulty in chewing and eating, which may in turn exacerbates the psychos-social problems discussed above. This can also in some instances lead to a reduction in healthy nutrition. "The loss of natural teeth is related to diminished nutritional intake, especially in older adults. Studies of nutrition of adult populations34 -- 36 report that adults wearing partial or complete dentures have poor-quality diets" (Allen and McMillan, 2003, p. 662a).

Conclusion

While to be edentulous does not in every case lead to negative consequences for the individual what the above discussion shows is that it can very often lead to negative socio-psychological consequences. Many studies also find that the physical and biological consequences of tooth loss, such as bone reduction and poor nutrition, can be exacerbated by the socio-psychological dimension of this issue. These dimensions can include loss of self-image and identity, as well as a feeling of social and psychological isolation from others.