Journal of Oral Rehabilitation 2006 33; 323–329
Quality of life and masticatory function in denture wearers
H. KOSHINO*, T. HIRAI*, T. ISHIJIMA*, H. TSUKAGOSHI*, T. ISHIGAMI† &
Y . T A N A K A ‡ *Department of Removable Prosthodontics, School of Dentistry, Health Sciences University of Hokkaido,
Tobetsu, Japan, †Department of Removable Partial Denture, School of Dentistry, Nihon University, Tokyo, Japan and ‡Department of
Removable Partial Denture, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan
SUMMARY Successful prosthodontic treatments for a
patient with removable partial dentures including
maxillofacial prostheses hopefully brings about psy-
chological wellbeing as well as improved health. The
purpose of this study was to investigate the rela-
tionship between quality of life (QOL) and the
various aspects of denture function. At first, a
questionnaire with a visual analog scale with 16
question items concerning denture and/or eating
problems, the present state of health, psychological
and physical wellbeing, life satisfaction, and QOL
was developed. To discuss the validity and reliabil-
ity of the questionnaire, 48 outpatients who wore a
denture were asked to fill it out. Next, to discuss the
difference in QOL of the patient with various kinds
of dentures and conditions, 103 outpatients were
Introduction
Epidemiological surveys in recent years have revealed
the close relationship between oral health status and
quality of life (QOL) (1–3). Osterberg et al. (4) reported
that dental impairment was associated significantly
with a lower capacity for cognition, sight, hearing, lung
volume, heart volume, muscle strength and bone
mineral content, as well as an overall self-assessment
of health. They also reported that the amount of
occlusal support in men was related to the survival
rate in those subjects who were between 70 and
79 years of age. Yamamoto (5) reported the close
relationship between QOL and exercise and/or sports.
We confirmed through our research that a close
relationship exists between teeth clenching and phys-
ical exercise, such as elbow flexion strength, knee
ª 2006 Blackwell Publishing Ltd
Ishikari-
asked to complete the newly developed question-
naire. The questionnaire which contained four fac-
tor areas with eight questions for denture patients
was developed by factor analysis with Varimax
rotation. The reliability of the QOL scale was con-
firmed by reliability analysis (Cronbach’s a = 0Æ784).
The QOL score of edentulous patients with a com-
plete denture having some trouble chewing was
significantly lower than that of other denture
patients. It was suggested that the wearing of a
denture significantly affected the QOL of elderly
persons.
KEYWORDS: QOL, denture wearers, prosthodontic
treatment, elderly person
Accepted for publication 19 March 2002
extension strength, back strength, maximal anaerobic
power activity, and reaction time in a vertical jump
(6–8). A previous study on rats also suggested that the
decrease of masticatory function caused by tooth loss
leads to a decrease in cerebral blood flow volume and
acetylcholine synthesis resulting in a learning memory
disorder similar to the symptom displayed in dementia
(9). Another investigation suggested that ageing, soft
diet, malnutrition and loss of occlusal support could
accelerate osteoporotic changes of the mandibular bone
and femur, and cause a decrease of bodily activities and
sensory deprivation (10). From the above results, we
have speculated that the recovery of occlusion and/or
dental arch by prosthodontic treatment are important
factors to secure QOL. The need to find accurate,
reliable indicators on which to base planning, provision
and evaluation of health services has given impetus
doi: 10.1111/j.1365-2842.2005.01152.x
324 H . K O S H I N O et al.

to the continued search for accurate information. The
development of simple standardized indicators of QOL
is thus important in the assessment of health services
and health care.
Successful prosthodontic treatments for a patient
with removable partial dentures including maxillofacial
prostheses are supposed to bring about psychological
wellbeing as well as improved health and/or a sense of
wellness. It is necessary to establish the objective
criteria for judging the contribution of prosthodontic
treatments for patients.
The purpose of this study was to investigate the
relationship between the QOL and denture function.
from these subjects participating in this study. The list
of questions had an analog scale with straight lines
(10 cm in length), a random question sequence and a
reversed polarity of questions, the so-called visual
analog scale (VAS). Filling out of the items was
performed by way of an interview. The evaluation
was carried out by points, each represented by 10 cm.
Statistical analysis
Statistical analysis of the validity and reliability of the
each item in the questionnaire were performed by the
factor and reliability analysis (SPSS for Windows 9.0,
SPSS Inc.).

Development of QOL scale for denture

wearers Results

Five factors were obtained by the factor analysis with

Method
Varimax rotation, and the results of Q4 and Q13 were
To measure QOL of denture wearers, an index the eliminated. After that, the factor analysis with Varimax
QOLD was developed by the authors. This was com- rotation was performed again. Four factors were
posed of 16 questions suggested by Padilla and Grant obtained, which could be classified as psychological
(11) concerning denture and/or eating problems, pre- health (Psy), physical health (Phy), eating satisfaction
sent state of health, psychological and physical wellbe- (Eat) and pain experienced with denture use (Den)
ing, life satisfaction, and QOL (Table 1). (Table 2). Two high-loading items for each factor were
Forty-eight outpatients with either maxillofacial selected (Table 3). In the questionnaire with four
prostheses (17 persons) and/or complete dentures (31 factors composed of eight questions, the reliability
persons) in our university hospitals were asked to fill coefficient (Cronbach’s a) was 0Æ784.
out a questionnaire. Informed consent was obtained
Table 2. Factor analysis with Varimax rotation matrix (second
rotated component)
Table 1. Sixteen items of QOLD for denture wearers
Component
Q1. How much physical strength do you feel you have?
1 2 3 4
Q2. Is the amount of time you sleep sufficient to meet your needs?
Q3. Do you tire easily? Q1 0Æ250 0Æ542* )0Æ028 0Æ149
Q4. Do you feel your present weight is a problem? Q2 0Æ016 0Æ691* 0Æ237 )0Æ096
Q5. How would you rate your present state of health? Q3 0Æ131 0Æ804* )0Æ368 )0Æ055
Q6. How much fun do you have (hobbies, recreation, social Q5 0Æ134 0Æ791* 0Æ006 0Æ064
activities)? Q6 0Æ835* 0Æ334 0Æ246 0Æ016
Q7. Do you find eating a pleasure? Q7 0Æ240 )0Æ005 0Æ842* 0Æ267
Q8. Is the amount you eat sufficient to meet your needs? Q8 0Æ168 0Æ091 0Æ900* 0Æ130
Q9. How useful do you feel? Q9 0Æ177 0Æ603* 0Æ296 0Æ350
Q10. How much happiness do you feel? Q10 0Æ856* 0Æ220 0Æ332 )0Æ039
Q11. How satisfying is your life? Q11 0Æ771* 0Æ101 0Æ436 0Æ221
Q12. How good is the quality of your life? Q12 0Æ784* 0Æ291 0Æ144 0Æ271
Q13. Do you worry (fearful or anxious) about your denture? Q14 0Æ243 0Æ028 0Æ105 0Æ921*
Q14. How much pain do you feel when wearing your denture? Q15 0Æ096 0Æ106 0Æ258 0Æ915*
Q15. How often do you feel pain when wearing your denture? Q16 0Æ762* )0Æ038 )0Æ200 0Æ209
Q16. Do you have any concern about bad odors being emitted
*Questions selected.
from your denture?
Text in bold; 2 high-loading items selected.

ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 323–329

 QUALITY OF LIFE AND MASTICATORY FUNCTION
Table 3. Components and questions
1. Psychological health (Psy)
Q6. How much fun do you have (hobbies, recreation, social
activities)?
Q10. How much happiness do you feel?
2. Physical health (Phy)
Q3. Do you tire easily?
Q5. How would you rate your present state of health?
3. Eating satisfaction (Eat)
Q7. Do you find eating a pleasure?
Q8. Is the amount you eat sufficient to meet your needs?
4. Pain by denture (Den)
Q14. How much pain do you feel when wearing your denture?
Q15. How often do you feel pain when wearing your denture?
QOLD in the patients with various kinds
of dentures
Method
One hundred and three outpatients in our university
hospitals with various kinds of dentures were asked to
fill out the QOLD questionnaire. Informed consent
was obtained from these subjects participating in this
study. They were divided into five groups. They were (i)
10 edentulous patients with complete denture having
some trouble chewing and diagnosed as requiring
prosthodontic treatment (TFD; mean age 77Æ0 
11Æ3 years), (ii) 23 fully edentulous patients with newly
fabricated complete dentures that had been adjusted
(NFD; mean age 77Æ5  6Æ7 years), (iii) 21 single
edentulous patients with newly fabricated upper or
lower complete dentures that had been adjusted (SFD;
mean age 73Æ7  8Æ3 years), (iv) 31 partially edentu-
lous patients with newly fabricated removable partial
dentures that had been adjusted (NPD; mean age
67Æ4  9Æ7 years), and (v) 18 patients with defective
jaws and newly fabricated maxillofacial prostheses that
had been adjusted (NMP; mean age 59Æ2  17Æ7 years).
The score of the QOLD in each patient was repre-
sented by showing the VAS on a 10-cm line. Each score
of four factors in the QOLD was represented by the
average point of two question items. The ‘QOLD score’
was represented by the average score of four factors.
‘Masticatory score’ (MS score) was also calculated by
using the food intake questionnaire method developed
by the authors for complete denture wearers (12). In
this study, the questionnaire on eating was answered
during a personal interview with the authors.
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 323–329
325
Statistical analysis
Statistical analysis of the difference in each group was
performed by one-way analysis of variance (ANOVA)
with multiple range test (Duncan) (SPSS for Windows
9.0, SPSS Inc.). A correlation among factors was
performed by simple linear regression analysis (SPSS
for Windows 9.0, SPSS Inc.).
Results
Regarding the average age of each group, there was no
statistical difference among the TFD group, NFD group,
SFD group and NPD group. However, the average age of
the NMP group was statistically lower than that of the
other four groups.
Figure 1 shows the score of four factors (Psy, Phy, Eat
and Den) of the QOLD, the ‘QOLD score’. The ‘MS
score’ in each group were 25Æ9  13Æ9, 55Æ7  23Æ6,
65Æ5  20Æ8, 69Æ8  21Æ7, 57Æ6  20Æ5%, respectively.
The ‘MS score’ in the TFD group was statistically lower
than that of the other four groups. As to the average of
Psy score, Eat score, Den score and MS score in each
group, the score of the TFD group was significantly
lower than that of other groups. Moreover, in this
group, the average of Phy score was the lowest among
all the groups, although it was not significant. As a
result, the QOLD score of the TFD group was signifi-
cantly lower than that of other groups. The Den score
was the lowest among the four factors in this group.
The correlation among the score of the four factors,
the QOLD score and the MS score were analysed. The
relationship between the four factors and the QOLD
score (Fig. 2), Phy score and Psy score, Psy score and
Eat score, Eat score and Den score (Fig. 3), the MS score
and the four factors (Fig. 4), and MS score and QOLD
score (Fig. 5) were statistically significant.
Discussion
Quality of life measurements are used to justify or
refute different forms of medical treatment (13). Pre-
sant et al. (14) and Padilla et al. (15) developed a
multidimensional instrument for measuring QOL, and
reported that initial testing of the model using data
from 135 colostomy patients showed how satisfaction
regarding nursing care and personal control act as
cognitive mediators of self-worth, which then impacts
the dimensions of QOL.
326 H . K O S H I N O et al.
It is necessary to find evidence that prosthodontic
treatments improve the QOL of denture patients. The
QOLD developed by the authors was judged to be
reliable, because the reliability coefficient was 0Æ784. As
to the procedure for developing QOLD, five factors
including 16 question items were obtained by the first-
factor analysis. In the factor analysis, the order of five
factors is based on factor loading levels. The fifth factor
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 323–329
Fig. 1. The score of four factors (Psy,
Phy, Eat and Den) of the QOLD, the
QOLD scores in each group.
Fig. 2. Relationships between QOLD
score and four factors.
had the lowest loading level and there was no common
context in questions Q4 and Q13. Then, Q4 and Q13
were eliminated. Next, four factors including 14 ques-
tion items were obtained by the second-factor analysis.
Four factors seemed to best represent question items. It
was possible to group the items under Psy, Phy, Eat and
Den. In the factor analysis, the factor loading level was
influenced by the number of question items. To
 QUALITY OF LIFE AND MASTICATORY FUNCTION 327

Fig. 3. Relationships between ‘Phy’

and ‘Psy’, ‘Psy’ and ’Eat’, ‘Eat’ and
’Den’.

Fig. 4. Relationships between MS

score and the four factors.

standardize each factor, two high-loading items in each questionnaire with four factors composed of eight
factor were selected for the QOLD questionnaire. question items. The reliability of this method was then
Finally, the reliability analysis was performed for the confirmed.

ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 323–329

328 H . K O S H I N O et al.
Fig. 5. Relationship between the MS score and QOLD score.
In order to discuss the difference in QOL of the
patient with various kinds of dentures and conditions,
103 outpatients were asked to fill out the questionnaire
newly developed by the authors.
In the five groups, the average age of the NMP group
was significantly younger than that of other groups.
The reason for this may have been that the defective
jaw with tooth loss is often caused by a surgical
operation and/or a traffic accident and not by ageing.
In the TFD group, Phy score and Psy score were
statistically low in comparison with other groups
(Fig. 1). These results suggest that recovery of the
masticatory function is essential to keep a sound mind
and body. Unexpectedly, the QOLD score of NMP group
was almost the same as the NFD, SFD and NPD group
(Fig. 1). This result suggests that the QOL of patients
with defective jaws could be improved by the appro-
priate maxillofacial prostheses.
As previously mentioned, the relationship between
the four factors (Psy, Phy, Eat and Den) and the QOLD
score, Phy score and Psy score, Psy score and Eat score,
Eat score and Den score, the MS score and the four
factors, and MS score and QOLD score were statistically
significant (Figs 2–5). The MS score representing the
masticatory ability of complete denture wearers had
already been verified to be effective and the relation-
ship between the food intake questionnaire method
and the sieving method suggested by Kapur and
Yurkstas (16) had been significantly correlated (12,
17, 18). Therefore, in this study, the food intake
questionnaire method was used to evaluate the
masticatory ability. It is speculated that the significant
correlation with Eat score and Den score suggests that
ª 2006 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 33; 323–329
proper denture insertion enhances the degree of eating
satisfaction, and the significant correlation with Psy
score and Eat score suggests that eating satisfaction
contributes to psychological health (Fig. 4). It is also
speculated that the significant correlation with Phy
score and Psy score suggests that there is a close
connection between the physical health factor and the
psychological health factor (Fig. 4). Because the MS
score was correlated statistically with the score of four
factors and the QOLD score, proper denture insertion is
speculated to be important to bring about overall
wellbeing (Fig. 5).
Conclusion
It has been suggested that eating satisfaction and the
feel of comfort when chewing with dentures has
influence on physiological and psychological health.
Moreover, it has been suggested that the wearing of a
denture significantly affected the QOL of elderly
persons.
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Correspondence: Hisashi Koshino, Department of Removable Pros-
thodontics, School of Dentistry, Health Sciences University of Hokka-
ido, 1757 Kanazawa, Ishikari-Tobetsu, Hokkaido, Japan 061-0293.
E-mail: koshino@hoku-iryo-u.ac.jp