Loss of teeth affects mastication, speech and esthetics, resulting in an adverse effect on the quality of life of an individual. This has even more impact in completely edentulous patients, esp. in the geriatric age group.
Hence, it becomes important to study the mental attitude and evaluate the psychological state of an edentulous patient before starting the denture treatment. This would help in determining the patient's acceptance for the treatment.
There are several classifications of mental attitude proposed for edentulous patients:
- House classification.
- Winkler classification.
- Gamer classification.
House Classification
MM House in 1950 classified patient's psychological response to being edentulous and denture into four types:
Philosophical mind
- Reasonable, calm and involved in every step of the treatment.
- Looking forward for denture and willing to listen to dentist's advice related to diagnosis and treatment.
- Willing to follow the instruction given by the dentist.
Exacting mind
- Disciplined, precise, strict and often make excessive demand, such as, may ask for a guarantee.
- Dentist need to have more patience and give more attention and effort, after which the patient listens and follows advice.
- Patient with history of dissatisfaction to past dental treatment, often doubts the present dentist's ability. However, once satisfied, the patient can be the clinician's greatest supporter.
- Prognosis is usually good.
Hysterical mind
- Emotionally unstable and anxious with a negative attitude.
- Poor oral health and lack of effort in maintaining oral health.
- Have unreasonable complaints and unrealistic expectation.
- Although they try to fit with denture, but, often fail to wear as they think the denture will appear and function as natural teeth.
- Poor prognosis.
Indifferent mind
- Lacks motivation and not interested in treatment.
- Not concerned to follow instructions or cooperate with the dentist.
- Not concerned about their appearance or motivated to enjoy their meal. They can survive without denture.
- More likely to blame the clinician regarding poor health of patient.
- Prognosis is doubtful or bad.
*Limitation: House classification helps clinician to anticipate patient's response to specific clinical procedure, however, it does not put much attention to how the patient response would be determined by treatment and dentist's attitude.
Winkler Classification
Hardy Elderly
- Physically and psychologically ready.
- Active in social and professional life.
- Easily adapt to age changes and accept them.
Senile Aged Syndrome
- Poor physical health, may be ill (chronic disease), disabled, or, aged.
- Psychologically and emotionally weak.
- Cannot cope with stress and prone to illness.
Satisfied Old Denture Wearer
- Happy with old dentures, even though they are faulty.
- Adapted well with old denture and not motivated for treatment.
- Poor prognosis.
Geriatric Patient who doesn't Want Denture
- Long-standing edentulism, without any denture.
- No motivation or desire for treatment.
- Poor prognosis.
Gamer Classification
Simon Gamer in 2003, classified patients based on two factors, i.e., patient's engagement level to dentist and treatment procedure in a continuum from totally engaged (++++) to disengaged (+).
It considered dentist's attitude as a defining factor of patient's attitude.
Ideal Patient
- Reasonably engaged (+++) and reasonably trusts the dentist (+++).
- Not scored ++++ as they are mature in balancing healthy life.
- May ask questions and need satisfying answers from the dentist.
- May not be over suspicious or over accepting of the dentist's advice.
- Similar to philosophical type (House classification).
Submitter Patient
- Highly engaged (++++) and completely trusts the dentist (++++).
- Do not discriminate and tend to idealise the dentist.
- Incapable of providing pure informed consent as they submit everything to dentist's skill.
Reluctant Patient
- Engagement level is ++ and trust in dentist/treatment is ++.
- Tend to doubt the dentist and skeptical of treatment plan.
Indifferent Patient
- Minimal level of engagement (+) and indifferent to dentist's opinion i.e., trust for treatment is +.
- Often forced to get treatment by their family and relatives.
- Similar to indifferent type (House classification).
Resistant Patient
- Engaged with treatment, but, with an adverse mindset.
- Have minimal or no trust and are skeptical of being helped by anyone under any circumstances.
- Tend to defy and challenge the dentist, instead of acknowledging or accepting.
- Similar to House's exacting mind.
References
- Jubhari EH, Rachellea K. 2020. Patient mental attitude: a systematic review. Journal of Dentomaxillofacial Science 5(2): 69-73.
- Mental Attitude in Complete Denture Patients: A Review, Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4.
- The image used is available in the public domain (Source: Wikimedia Commons).
*This article is an excerpt from above mentioned sources and Medical Sutras does not make any ownership or affiliation claims.