Structural equation modeling for factors influencing patients’ willingness to replace removable dentures

Abstract

Purpose: To investigate the factors influencing patients' willingness to replace removable dentures using structural equation modeling (SEM). Methods: A total of 153 patients who sought consultations for removable dentures self-evaluated denture quality using a visual analog scale (VAS); health-related quality of life using the 36-item Short-Form Health Survey; and oral health-related quality of life using the Oral Health Impact Profile. Dental clinicians evaluated denture quality using a VAS and by assessing the presence of defects. After being informed of various treatments, patients were asked whether they would prefer denture replacement. SEM was applied to analyze the relationships and interactive effects among the variables.Results: The final model showed high goodness-of-fit indices (chi-square/ degree of freedom = 1.009, comparative fit index = 1.000, Tucker-Lewis index = 0.999, standardized root mean square residual = 0.421, and root mean square error of approximation = 0.008). SEM demonstrated that two latent constructs indirectly predicted patients' willingness to replace dentures; the standardized total effects of good oral health and poor denture quality were −0.154 and 0.503, respectively. Conclusion: These findings provide a unified understanding of the shared decision-making process for denture replacement and highlight the pretreatment assessments that play a relevant role in patient treatment preferences.Keywords; clinical decision-making, oral health-related quality of life, patient preference, patient-reported outcomes, removable dental prostheses, structural equation modeling Materials and Methods Study populationThis cross-sectional study was conducted at a prosthodontic clinic in Showa University, Tokyo, Japan. A total of 171 patients with removable dentures were recruited from the study participants of a previous consecutive case series [5] who visited the clinic for consultation or treatment for their dentures in April 2009. All patients provided written informed consent prior to their enrollment in this study. The inclusion criteria were:(1) 20 years or older, (2) ability to understand and provide informed consent before starting the study, ( 3) ability to answer self-administrated questionnaires, and (4) use of removable dentures, including removable partial dentures and complete dentures, for more than one month. The exclusion criteria were: (1) presence of pain that did not originate from their denture, (2) presence of acute signs and symptoms in the oral and maxillofacial regions, (3) patients who had been seeking treatment with fixed implant prostheses, and (4) patients with a history of systemic disease that precludes standard dental treatment and alters daily activities to a level consistent with ASA (American Society of Anesthesiologists) III classification. In addition, patients were excluded from the analysis if they did not complete the required assessment and examination. Overall, data from 153 patients (mean age: 67.8 years ± 9.2 standard deviation [SD], female/male = 1.5) w...

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