The present study investigated the reliability and the validity of the PDA-T, and then used this self-assessment form to evaluate Thai patients’ satisfaction toward their complete denture experience. The results indicated that the PDA-T can be used to evaluate patient satisfaction with their denture treatment and results.
There is no information about the clinical and oral characteristics of the participants. However, we focused to collect the data from chair-side check and interviewing, randomly. The study participants in each group had problems based on missing teeth, ill-fitting complete dentures and poor chewing ability in the Exper and NonExper group, respectively. These results indicate that the Exper group focused on how well their complete denture fit. In contrast, in the NonExper group, the primary concern was to gain chewing ability according to Table 3. Therefore, Exper group are capable of varying the denture satisfaction which may have more concern problems than the NonExper group that more focusing into their chief complaint. Using the PDA-T, not only we can classify the patient’s problem, but also can be used as a guideline to communicate to varied characteristic of the patients. Which also means that using the PDA-T is patient-centered. Furthermore, the data indicated that the Exper group sought treatment due to a poor fitting denture after a period of having their denture (less than five years, 18.5%; more than five years, 81.4%), which most of the Exper patient experienced no more than 3 set of dentures. After the Cronbach’s alpha were applied to the result of the PDA-T score at t0, as shown in Table 5, it proved that the score is reliable. Therefore, the minimum years of having a fitting complete denture in this group was five years. The chief complaint in each group indicates that in edentulous patients a well-fitting and functioning denture is more important compared with their psychological and physical needs. The educational level of the participants’ data illustrated that most patients in each group were at the Primary-secondary school educational level. These results suggest patients with a Primary-secondary school education might suffer from tooth loss at an earlier age.
Both groups' treatment, by dental students, procedures were supervised by their respective faculty members, which standardized the procedures between the groups. In this particular, the supervisors’ data are not included in this study, which may differ the quality of treatment result. However, there were no other factors that differentiated the groups in concurrent validity.
The Exper group demonstrated various denture treatment needs before treatment (t0). However, the lower denture topic demonstrated the worst satisfaction scores pretreatment. After treatment, the lower denture subtopic average scores were still the lowest score compared with other subtopics in both groups but significantly higher than their old denture, according to Table 4. Which means that experiences are one of the factors that indicate the improvement of overall treatment satisfaction treatment and new dentures. The lower score of the lower denture’s function may indicate the efficacy of the treatment methods, e.g., an error in tooth arrangement or clinical re-mount. To identify the most sensitive step in denture treatment that affects the denture’s functioning requires further studies that include occlusal schemes and ridge height. The results of the present study demonstrated a high degree of reliability and validity. In the present study, the average inter-item correlation and Cronbach's α was used to determine internal consistency. The Cronbach's α summary score of 0.95 (range 0.76‒0.95) indicated similarity between subtopics, which are acceptable for clinical usefulness. Our results were similar to that of another study using the PDA . However, the expectation topic, which comprised 3 subtopics, demonstrated the lowest score (0.76) between topics, which indicated that the number of questions affected the Cronbach's α score . The average inter-item correlation was significantly different between the summary score (0.47) and the beauty and speech subtopic (0.83, demonstrating that the participant’s psychological and physical needs concerns were lower compared with other subtopics. Furthermore, Q16‒Q19 were similar, which may account for the highest score of the average inter-item correlation coefficients in the beauty and speech subtopic.
The ICCs of the test–retest reliability are typically determined with a 2 to 8 weeks interval between tests [9, 36,37,38]. All of the subtopic ICCs in our study were all close to 1.00, indicating that the PDA-T is reliable.
There was a significant difference in the summary score and the six subtopics scores before and after replacing the old dentures for the assessment of validity. The PDA-T score was significantly higher at t1 compared with t0 (p < 0.05). The greatest improvement was seen in the lower denture topic (approximately two-fold increase), implying the value of lower denture function. The treatment effect might be related to the dentist’s skill in lower denture fabrication. Thus, future studies should include the lower jaw and alveolar ridge anatomical information to better understand the impact of these factors on denture fabrication and treatment results. These results indicate that the PDA-T can detect differences in patients’ self-assessment between previous and new dentures.
The size effect is the amount of change and the indicator illustrates the effectiveness of the treatment. With an effect size of 1.71, this study demonstrated a large significant difference in scores between after-insertion (t1) and before-treatment (t0), indicating that an edentulous patient’s value functional ability more than other factors. However, the interval between completing the questionnaire might have affected the amount of change detected. If the participants completed the questionnaire longer after completing denture treatment, there might be a larger difference between the negative and positive effects of the denture treatment.
Most of the NonExper patients faced similar problems according to Table 3, and from the improving score in PDA-T1 from Table 4 indicated higher satisfaction in all the NonExper patients. Which can also describe that there was no significant difference between the patient demographics (genders, ages, education, and dentist’s skill level) that might affect the quality of the treatment in any category, according to Table 8. There are studies demonstrating that genders affects oral health, suggesting that females might have better oral health compared with males [39,40,41,42,43]. However, our Pearson correlation analysis found no significant correlation between genders and denture function. It may be intuitive to believe that aging is negatively correlated with oral health and their physical condition [2, 17, 44], however, studies have found no relationship between these factors [45,46,47,48,49]. Therefore, our results indicate that we can improve a patient’s oral health while their physical condition declines, such as restoring tooth loss with a denture that leads to a better quality of life. Social and economic status may be another factor affecting the oral related quality of life.
An educational index is a tool that is often used to determine socioeconomic status, especially in the elderly who do not have income from work. Prior studies demonstrated that education level positively correlates with oral hygiene related quality of life [2, 45, 46, 50,51,52]. However, other studies have not demonstrated a significant association between with educational level patient satisfaction [23, 34]. In contrast, the present study found a weak association between educational level and denture function. These findings suggest that the satisfaction of edentulous patients receiving a complete denture is controlled by their denture’s function, rather than any demographic aspects. Another aspect is whether the dentist ‘s skill level affects the denture-wearing patients’ the quality of life, which should be further explored in future studies. The fact that the treatment given between groups was supervised by Faculty members may explain why the dentist’s skill level did not affect the PDA-T results.
The present study demonstrated the excellent reliability and validity of the PDA-T. The PDA-T would be useful in clinical practice for understanding the patients’ opinion on their denture’s function, which important for the dentist to understand to be able to provide the best denture treatment. However, this study has limitation due to the short time between denture delivery and the final follow-up; therefore, additional studies are needed. For instance, comparing with OIDP or any standard indexes for quality-of-life evaluation.