Edentulism Biopsychosocial Impacts of Complete

Edentulism

Biopsychosocial impacts of complete edentulism

Edentulism is often experienced as a life-changing event and in many cases has a negative and traumatic impact on the life of the individual. The literature points out that while many who experience total edentulism cope well with their changed situation there are also a high percentage of individuals who perceive the loss of one's teeth as being socially unacceptable. This can lead to problems in terms of self-worth and self-image; which can in turn lead to further psycho-social problems of isolation and depression. The literature also points out that these socio-psychological problems can exacerbate the physical and biological impact of tooth loss on the life of the individual who undergoes edentulism.

Introduction

In recent years there have been an increased number of studies that have focused on the various biological, social and psychological effects of total edentulism. This increase of interest and concern is also a result of the increasing elderly population in most developing countries and the propensity among this population towards edentulism and associated problems. As one research study found, "….45% of edentulous individuals feel that edentulousness has a major impact and leads to decreasing confidence, less ability to carry out everyday activities and difficulties in accepting facial changes caused by tooth loss…" (Trulsson et al. 2002. p. 423).

The above study also makes the cardinal point that the "…impact of edentulousness in individuals should not be underestimated "(Trulsson et al. 2002. p. 423). As the present paper will attempt to explore, edentulism has a number of social and psychosocial implications, as well as biological aspects that should be taken into account in the understanding of this condition. It is, for example, often a cause of feelings of guilt, shame and loss of self-esteem and has also been shown to have an impact of self-efficacy, as well as leading to depression.

The view that edentulism can have a profound effect on the individual is also supported by many other studies; for example, the emotional impact of extreme teeth loss is empathized in a study by Davis D.M., Fisk J. Scott B. And Radford D. ( 2000) in this study it was found that as many as forty-five percent of these interviewed with regard to the effects of teeth loss felt that this loss had a profound and dramatic effect on their lives.

It has also been found that facial disfigurement can have a deeply felt effect on the individual. In the above-mentioned study, the authors found that "Even minor facial abnormalities can result in social stigma…..Visible disfigurements are recognised as having a profound effect on individuals and… hidden impairments (such as total tooth loss) can cause an equal amount of stress" (Davis et al. 2000, p. 503). Therefore, the total loss of one's teeth is often perceived by the patient as "…a serious life event," which has certain implications and biopychosocial effects that will be explored below (Davis et al. 2000, p. 503).

Assessment

As has been referred to, there are a number of studies that point to the radical effects that edentulism can have on the individual. However at the same time it must also be pointed out that's this is not always the case and that in many instances the individual's adapt to the edentulism in various ways and through the use of implant prostheses and complete removable dentures

(Allen and McMillan,. 2003, p. 662). However, in general there is predominant focus on the often negative and problematic aspects of teeth loss in a socio-psychological sense.

In a study entitled Edentulousness and oral rehabilitation: experiences from the patients' perspective ( 2002), the author's state that, "The psychological effects of tooth loss in the permanent dentition are relatively unknown. Complete edentulousness is a serious life event in terms of readjustment" (Trulsson et al. 2002). In other words, while there is a relative paucity of knowledge in this area, there is sufficient research evidence to make some acceptable assessments and deductions. These assessments include the following.

In the first instance, experts tend to agree that, "… complete edentulousness is a serious life event in terms of readjustment, which can be perceived as more stressful than marriage or retirement" (Edentulousness and oral rehabilitation:

experiences from the patients' perspective, 2002, p. 417). This also refers to the social image and perception of the ideal or acceptable body image of the individual. In this context the loss of one's teeth can be perceived by the individual as not only a physical fact but also a social fact that has deep personal psychological implications. 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 psychological problems and issues, such as a loss of perceived self-worth in the eyes of society, isolation and possibly depression.