Table 22. Studies measuring OHQoL in conventional dentures No Study Sample N Mean age (SD/Range) Study design Measurement points OHQoL measure Other impacts measured Denture satisfaction 1 Abuzar, Kahwagi, Yamakawa(2012) Individuals seeking removable partial dentures 232 > 60 (77.9%) Cross sectional observational One measurement post denture insertion OHIP- 14 Perceived denture performance Denture material Denture frequency of use Yes 2 ALLEN, MCMILLAN, WALSHAW, LOCKER (1999) Individuals seeking implants, removable dentures, dentate patients 88 58,64,54 Cohort One measurement alone prior receiving dentures OHIP -49 Pain, general satisfaction with dentures, Chewing Yes 3 ALLEN, MCMILLAN, LOCKER (2001) 3 groups Implant supported dentures, Conventional dentures (sought implants), conventional dentures 83 57, 60.1, 64.9 Clinical Trial Baseline and 3 months follow-up OHIP -49 Denture satisfaction, SF-36 Yes 4 ALLEN AND MCMILLAN (2003) 4 groups (3 edentulous 1dentate) Implant supported Conventional dentures (requesting implants) Conventional dentures Routine treatment 103 58.7, 60.2, 65.1, 58.7 Clinical trial Pre-treatment and post treatment OHIP -49 SF-36, Denture satisfaction Yes 5 ALLEN, THOMASON, JEPSON, NOHL, SMITH AND ELLIS (2006) 2 groups (edentulous) Implant group Conventional denture group 118 64.5 (8.8) 68.5 (9.9) Randomised controlled trial* Pre-treatment and 3 months post treatment OHIP -49 Denture satisfaction Yes
6 ARMELLINI, HEYDECKE, HABIL/WITTER, AND CREUGERS (2008) 5 groups Short Dental Arches(SDA)- intact anteriors SDA -interrupted anteriors SDA -distal extension SDA - interrupted with RPD Complete dental arches 160 54 ± 18 (2 centre) observational One measurement alone prior receiving dentures OHIP -49 SF-36 No 7 ASSUNCAO, ZARDO,DELBEN AND BARAO (2007) 2 groups Complete dentures (CD) Upper CD opposed by implant supported dentures 34 68 Cohort One measurement 2 months after delivery of dentures Questionnaire based on OHIP Comfort, Aesthetics, ability to chew 8 foods types of varying textures, psychological limitations. Yes 8 AWAD,LOCKER, 2 groups of edentulous Conventional dentures Implant-supported dentures 102 33-65 Randomised controlled trial Pre-treatment and 2 months post insertion OHIP -49 Nil No 9 AND FEINE(2003) 2 groups (Maxillary conventional dentures) with Mandibular conventional dentures Mandibular over dentures 60 69.3 male (2.8) 69.1 female (3.2) Randomised controlled trial Pre-treatment and 2 months post insertion OHIP -49 , OHIP EDENT VAS scale on Comfort, Stability (denture), ability to chew (6 type of food), clean, speak Yes sectional
10 BAE,KIM,PAIK AND KIM (2006) 2 groups (denture wearers) Complete denture Partial denture 445 55-64 (29.7%) 65-74(46.5%) >75 (23.8%) telephone Survey One measurement OHIP- 49 (Korean version) Status of the removable denture No 11 BARAN AND NALCACI (2011) Patients seeking removable partial denture 136 62.47 (7.36) Longitudinal observational Baseline and 1 year follow-up OHIP- 49 (Turkish version) Denture status No 12 ELLIS, PELEKIS AND THOMASON (2007) 2 groups (edentulous) Conventional denture group Duplicate denture group 40 74.2 (7.29) 73.1 (8.61) Longitudinal observational Pre-treatment, post treatment, 12 months OHIP-49 Yes 13 EMAMI, ALLISON, GRANDMONT, ROMPRE AND FEINE (2010) 2 groups (complete edentulous) Mandibular conventional dentures; Over dentures retained by implants (ball attachments) 173 66-69 (30.1%) 70-79 (61.8%) 80-89 (8.1%) Cross observational One measurement after 12 months follow up OHIP- 20, Sense of coherence mediated effect of dentures on OHQoL No 14 FORGIE, SCOTT AND DAVIS (2005) 2 groups (edentulous) Requesting replacement dentures 58 (32, 26) 71 (9.6) 74 (10.3) Longitudinal observational Pre-treatment and 3 months post dentures OHIP-14 Change in satisfaction for replacement dentures Yes 15 FURUYAMA, TAKABA, INUKAI, MULLIGAN, IGARASHI AND BABA (2012) 2 groups (edentulous) Implant supported Removable partial dentures 188 (79, 109) 51.7 (12.4) Cross sectional observational One measurement at least 1 month post insertion of dentures OHIP-49 (Japanese version) - No 16 GECKILI, BILHAN AND BILGIN (2011) 1 group (edentulous conventional denture wearers seeking implant retained mandibular over dentures) 78 65-82 Within subject cross over trial Baseline before insertion of dentures and a 6 month follow-up OHIP-14 (Turkish version) - No 1-
22 HEYDECKE, THOMASON, LUND AND FEINE (2005b) 2 groups (edentulous) Mandibular implant retained dentures; Conventional dentures 102 50.8 (7.2) 51.2 (7.7) Longitudinal observational Baseline, 2 months follow-up OHIP-49 Influence of prostheses on Social, leisure and sexual activities Social Impact Questionnaire (SIQ) No 23 HWANG, PATTON, KIM AND KIM (2012) Socially active community living elders 634 74 (26.5) Cross sectional observational One measurement alone OIDP Whether chewing ability can influence OHQoL N0 24 JABBOUR, EMAMI, GRANDMONT, ROMPRE AND FEINE (2012) 2 groups (edentulous) Mandibular implant retained dentures; Conventional dentures 153 71 (4.5) Longitudinal observational Baseline. 1 year and 2 year OHIP -20 McGill questionnaire, Stability of improvement in OHQoL over time Yes 25 JOHN, SLADE, SZENTPETERY AND SETZ (2004) 3 groups Fixed partial dentures Removable partial dentures Completer dentures 107 43.8 (12.5) 60.5 (9.4) 68.1 (7.1) Longitudinal observational Baseline and at 1, 6 and 12 months follow-up OHIP-49 G German version Differences in OHQoL based on types of dentures No 26 KAMALAKIDIS, ANASTASSIADOU, SOFFOU, PISSIOTIS (2016) Individuals seeking replacement complete dentures 20 74.2 (7.4) 71.5 (5.3) Cross sectional One measurement only OHIP-20 To assess difference in OHQoL and complete denture satisfaction questionnaires (CDS) satisfaction levels between two construction methods Yes up
27 KUBOKI, ICHIKAWA, BABA,HIDESHIMA, SATO,WAKE, TSUGA, SAKURAI, SATO, ISHIBASHI, YATANI, OHYAMA, AKAGAWA, HIRAI, SASAKI AND KOYANO (2012) 3 groups Edentulous Partially edentulous Patients with teeth problems 151 66.3 (11.5) Multi-axis. Longitudinal assessment Measurement at baseline and 2 weeks after first visit OHIP – 49 Japanese version Evaluation of a multi-axis assessment scheme introduced for prosthodontic treatment No 28 LEE, YANG, HO AND LEE (2012) Elderly divided into 3 groups Edentulous and satisfied Edentulous and not satisfied with dentures Dentulous 1332 74.05 Cross sectional observational One measurement only OHIP -49 (Chinese version) Denture replacement Yes 29 LOCKER, MATEAR, STEPHENS, LAWRENCE AND PAYNE (2001) 1 group of elderly people 225 dentures) 83 Cross sectional observational Measured after a personal interview. Reference period of 1 year GOHAI, Activities of daily living (ADL), Perceived stress questionnaire (PSQ) Yes 30 LOCKER AND ALLEN (2002) Community dwelling older adults 541 (3 years follow up) <50 Longitudinal observational Baseline 1, 3 and 7 year follow-up OHIP -49 , OHIP -14 To determine a short of OHIP questionnaire, Discriminant validity was determined between denture wearers No 31 MICHAURD, GRANDMORT, FEINE AND EMAMI (2012) 2 groups of denture wearers Implant over dentures Conventional dentures 199 70 Range 64-85 Longitudinal observation Baseline and 6 month 1 year follow-up visits OHIP - 20 McGill Denture Satisfaction Instrument Yes 32 MONTERO, LOPEZ, GALINDO, VICENTE AND BRAVO (2009) 3 groups Requesting prostheses Conventional prostheses Control group (neither) 78 (31, 29,18) 64.7 (10.7) Cross sectional observational Baseline and 3 months follow-up OIDP and Spanish versions Satisfaction, chewing, aesthetic function Yes OHIP- 14 14
39 REISSMANN, JOHN AND SCHIERZ(2011) Convenience sample of people seeking dental treatment at a prosthodontic unit 42 57.5 (15.7) Longitudinal observational 3 measurements within 3-4-week period post intervention. One pre-treatment for new patients OHIP-49 Influence of administration methods No 40 RING, HOFER, HEUSTON, HARRIS AND BOYLE (2005) Individuals receiving conventional denture treatment 117 64 (8) Randomised control trial Baseline before treatment and 3 month follow-up after treatment OHIP -49 Schedule for the Evaluation of Individual Quality of Life – Direct Weighing SEIQoL-DW No 41 Ryu,Tsakos and Sheiham (2008) Individuals recruited in Korean National health survey 1029 30-64 Cross sectional observational One measurement only Condition specific (CS Compare normative and socio-dental prosthodontic needs No 41 Samnieng, P Lekatana, H (2016) Community dwelling Thai aged 60 years or older 428 68.79 Cross sectional observational One measurement only GOHAI Quality of life was assessed with No 43 SOUZA, PATROCINIO, PERO, MARRA AND COMPAGNONI (2007) Edentulous conventional complete denture wearers 58 69.1 (10.3)) Longitudinal observational Baseline before surgery and 3 months after surgery OHIP EDENT – Brazilian version Validation of the version No 44 Torres, Costa, Modena, Cota, Cortes and Seraidarian (2011) 2 groups edentulous Implant supported mandibular dentures Conventional dentures 100 64.24 (10.69) 61.78 (8.92) Cross sectional observational One measurement only? (mention of 12 months prior conclusion of study) OHIP-14 Association between personality traits and quality of life in denture wearers No up
45 Tsakos, Sheiham, Iliffe, Kharicha, Harari, Swift, Gillman, and Stuck(2009) Community-dwelling elders 65 yrs. of age and older 1054 74.7 Secondary data from Randomised control trial One measurement only GOHAI Health Risk Appraisal for Older Persons (HRA-O) No 46 Veyrune, Jeanin, Dutheil and Riordan (2005) Patients seeking new dentures randomised into 2 groups. 26 64.5 (10.7) Randomised controlled trial Baseline, at denture placement, 6 weeks, 12 weeks follow up (Group 1). Group 2 after denture placement only GOHAI- French version Effect of new dentures on satisfaction Yes 47 Wolfart, Heydecke, Luthardt, Marre, Freesmeyer, Stark, Wostmann, Mundt, Pospiech, Jahn, Gitt, Schadler, Aggstaller, Talepur, Busche and Bell (2005) 2 groups RPD group Premolar occlusion group (PROC) 21 62 (10) Multi-centre randomized clinical trial (PILOT) Pre-treatment, 6 weeks, 6 months and 12 months follow-up OHIP-49 Research Diagnostic Criteria (RDC) questionnaire No 48 WOSTMANN, BALKENHOL, KOTHE AND FERGER (2008a) 3 groups No prosthesis Non-functioning prosthesis Removable partial dentures 98 60.3 (10) Longitudinal observational Baseline, 1 year follow up DIDL Crown retained RPDs impact on patient’s well being Yes 49 Wostmann, Michel, Brinkhert, Weskhott, Rehmann and Balkenhol (2008b) Group of patients capable of feeding themselves >60 years, with dentures requiring repair or replacement 47 72.6 (6.7) Longitudinal observational Baseline, 6 month follow up OHIP-G14 German version Mini Mental Status (MMS); Mini Nutritional Assessment (MNA); Serum parameters, Masticatory efficiency test (MET) No OHIP – Oral health Impact profile OIDP – Oral Impacts on Daily performance SF – Short form; GOHAI – Geriatric Oral Health Assessment Index DIDL – Dental Impact of Daily Living
Table 25. Environmental factors associated with OHQoL wearing dentures identified from the review Factors No of studies Authors & Date Study design Measure Relationship between variable and OHQoL Education 5 (Tsakos et al., 2009, Emami et al., 2010, Torres et al., 2011, Abuzar et al., 2012, Lee et al., 2012) Cross-sectional, Longitudinal, Randomised control trial OHIP Chinese, OHIP-14, GOHAI Significant association – Higher education better OHQoL 1 (Jabbour et al., 2012) Longitudinal OHIP Turkish version OHIP-20 Non-significant or no association Employment 1 (Baran and Nalcaci, 2011) Longitudinal OHIP (Turkish) Significant association – Employed better OHQoL 2 (Emami et al., 2010, Jabbour et al., 2012) Cross-sectional ,Longitudinal OHIP-20 No significance or no association Income 4 (Tsakos et al. 2009, Torres et al. 2011, Abuzar et al. 2012, Lee et al. 2012) Cross-sectional, L:ongitudinal study, Randomised control trail OHIP , OHIP Chinese, OHIP 14, GOHAI Higher income better OHQoL 2 (Emami et al., 2010, Jabbour et al., 2012) Cross-sectional, Longitudinal OHIP-20 Not significant or no association
Thus coping styles are broad, pervasive and encompassing ways of relating particular types of people (e.g.) being powerful, hostile, controlling, ambiguous, evaluative, imminent, evaluative or vice versa (Lazarus and Folkman, 1984). However, this approach was criticised for assuming to operate as a stable disposition through an individual’s life-course and underestimating complexities and variability (Lazarus and Folkman, 1984). Coping as a process or state Lazarus and Folkman’s (1984) alternative approach regarding coping was that it being a process-oriented, dynamic concept that changes according to the specific needs of individuals. This concept placed the process within conditions of psychological stress, requiring thought processes and behaviour modification (Lazarus, 1993). Coping was thus defined by them as a process of “ constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resource of the person” (Lazarus and Folkman, 1984; p.141) The Transactional model of stress and coping (Figure 2-4) explains coping as a transactional process as conceived by Lazarus and Folkman (1984). The transaction is a dynamic encounter between an individual and their environment arising as result of a stressful event. The transactional process can occur within a few moments, may continue for hours, days, weeks and even years. Stress arises as soon as the person perceives that he/she is vulnerable, threatened and cannot adequately to cope with the situation (Lazarus and Folkman, 1984).
were labelled as Avoidant/ Negative coping strategies. The second factor comprised Active Coping, Planning, Positive Reframing and Acceptance. The loadings varied within significant levels (r= 0.447- 0.887). It was labelled as Positive/Adequate coping in keeping with Heydecke and colleagues (2004) study. The third factor had Self-Blame items alone with a highly significant loading (r= 0.849 and 0.945). Table 59. Factor structure of Brief COPE at T1 after factor reduction Coping strategies/ item no. Factor 1 2 3 4 Active coping 1 -.189 .554 .321 .147 2 -.108 .678 .121 .165 Planning 3 -.010 .718 .160 .168 4 .126 .697 .137 .213 Positive Reframing 5 -.012 .554 .236 .167 6 .088 .462 .142 .177 Acceptance 7 .079 .473 .004 .089 8 .096 .447 -.132 .077 Humour 9 .402 .036 .019 .087 10 .409 .046 .046 .078 Religion 11 .214 .221 .126 .861 12 .292 .222 .082 .956 Emotional 13 .288 .292 -.096 .310 14 .267 .296 -.200 .237 Instrumental 15 .354 .291 -.074 .151 16 .370 .217 .027 .165 Self-distraction 17 .454 .221 .068 .245 18 .508 .178 .124 .388 Denial 19 .657 .063 -.052 .274 20 .675 .094 -.040 .261 Venting 21 .128 .225 .331 .270 22 .603 .091 -.007 .238 Substance misuse 23 .470 -.058 .080 .046 24 .462 -.133 .092 .061 Behavioural disengagement 25 .499 -.107 .095 .105 26 .527 -.072 .074 .115 Self-blame 27 .124 .137 .945 .122 28 .105 .211 .849 .145
outlined, the first four rungs from the bottom were assigned with a value of 1 (indicating the lowest status); rung five was assigned a value of 2; rung six with 3; rung seven with value 4 and the scores for rungs eight to ten were assigned with a value 5 (highest subjective social status). Almost half (49.3 %) of the participants perceived themselves to be of the lowest social status; almost a fifth (19%) in a low moderate status; little less than a quarter (21%) in a moderate social status. Slightly more than one tenth of participants perceived themselves as of high-moderate (6.5%) and high social status (4.5%). Table 511. Outcome variable scores at baseline (T1) and follow-up (T2) Variables Score range (min-max) Measures Mean (SD) Baseline n=201 Mean (SD) Follow-up N=191 Subjective SES 1-5 Macarthur ladder 4.02 (1.17) -NA- Concern about oral health 5-30 Maslow’s needs 13.53(4.22) 14.29 (3.78) Ageing expectations 12-48 ERA-12 40.86(5.94) 37.46 (5.93) Perceived stress 4-20 PSS-4 12.17 (3.25) 12.77(2.42) Outcome variables OHQoL 19-95 OHIP- EDENT 44.32 (13.16) 36.64 (11.13) Denture satisfaction 9-45 de Liz Pocztaruk 28.22 (10.37) 20.77 (8.501) Chewing ability 0-5 Leake’s index 1.83 (1.29) 2.44 (1.37) Concern about oral health Concern about oral health was measured using a 6-item scale derived from Maslow’s hierarchy of needs (1943) and the scale used by Marshman and colleagues (2014) to measure dental indifference. Higher scores indicated less concern about one’s own oral health. The maximum score possible for the scale was 30 while the lowest was 6. The mean scores were 13.53 (T1) and 14.29 (T2) (Table 5-11). There was a slight decrease with participants concern
Partial or no dentures (lower) 1.742 38.27 (11.54) Full dentures (lower) 35.45 (10.72) Time since last tooth loss episode Within a year 1.266 37.54 (11.56) More than a year 35.48 (10.52) Operator expertise Graduates and above -0.882 37.49 (13.52) Undergraduate students 36.40 (10.39) DEMOGRAPHIC FACTORS t Mean (SD) Age – (years) 18- 58 0.605 37.51 (11.75) 59 and above 35.72 (10.42) Marital status Married with living partner 0.153 36.91 (11.83) Single/ separated or divorced /widowed 35.94 (9.10) Education High school and above -0.316 36.30 (12.06) School dropout/ Illiterate 36.84 (10.63) Income (rupees) ₹ 4556 and above 0.399 37.00 (10.88) Upto ₹4555 per month 36.34 (11.40) Occupation Employed -0.431 36.22 (9.93) Unemployed/ Retired 36.93 (11.92) Caste Open category (with no state sponsored social benefits) -0.073 36.54 (11.40) Socially oppressed castes 36.68 (11.10) +p value significant at <0.05 (Independent t-test) Table 517. Bivariate association clinical status at baseline (T1) and OHQoL at (T2) Clinical status F Mean (SD) No. of teeth present Functional dentition (>21 teeth) 3.452* 40.30 (12.64) < 21 teeth 37.50 (11.64) No teeth 34.93 (11.13) *p value significant at <0.05 (One Way ANOVA) up
absence of occluding pairs and prosthetic need variables with denture satisfaction. Table 519. Bivariate association between number of teeth present and denture satisfaction at follow-up (T2) Clinical factor F Mean (SD) No. of teeth present) Functional dentition (>21 teeth) 1.682 22.03 (9.27) < 21 teeth 21.98 (9.00) No teeth 19.74 (7.90) ^p value significant at F <0.05 (One Way ANOVA) Table 520. Bivariate associations between clinical status, demographic variables at baseline (T1) and denture satisfaction at follow up (T2) t Mean (SD) CLINICAL STATUS Occluding pairs Present 2.161+ 22.72(9.31)+ None 19.88 (7.98)+ Prosthetic status No dentures (upper) 2.149+ 22.14 (9.05) previous experience (upper) 19.52 (7.80) No dentures (lower) 1.256 21.52 (8.60) Previous experience (lower) 19.97 (8.37) Prosthetic need Partial or no dentures (Upper) 1.816 22.26 (9.26) Full dentures (upper) 19.94(7.96) Partial or no dentures (lower) 2.024+ 22.21 (9.00)+ Full dentures (lower) 19.71 (7.98)+ Time since last tooth loss episode Within a year 2.069+ 21.89 (8.75)+ More than a year 19.34 (7.97)+ Operator expertise Graduates and above 0.015 20.79 (8.90) Undergraduate students 20.77 (8.41) DEMOGRAPHIC FACTORS Age – (years) 18- 58 years 1.424 21.62 (8.80) 59 and above 19.87 (8.12) Marital status Married with living partner 1.405 21.30 (8.90) Single/ separated or divorced /widowed 19.37 (7.25)
Education High school and above 0.046 20.81 (8.47) School dropout/ Illiterate 20.75 (8.54) Income – (rupees) ₹ 4556 and above 0.292 20.97 (9.16) Upto ₹4555 per month 20.60 (7.90) Occupation Employed 0.441 21.10 (8.97) Unemployed/ Retired 20.55 (8.19) Caste Open category (no social benefits) -1.036 19.66 (7.98) Socially oppressed castes (social benefits) 21.14 (8.65) +p value significant at <0.05 (Independent t-test) Bivariate analyses between clinical factors, coping strategies, individual variables, environmental variables, outcome variables at baseline (T1) and chewing ability at follow-up (T2) Table 5-21 presents the lagged analyses between coping strategies, individual, environmental and outcome variables at baseline with chewing ability at follow-up. Independent variables (baseline) r Coping strategies Inadequate/ negative/ avoidance 0.000 Positive/ adequate -0.019 Self-blame -0.048 Religion -0.090 Individual factors Subjective SES -0.016 Concern about oral health -0.006 Ageing expectations -0.080 (ρ) Perceived stress -0.104 Baseline (T1) outcome variables OHQoL -0.294**
BASELINE FOLLOW UP Number of teeth present^, number of occluding pairs+, prosthetic status (upper)+, prosthetic Rx need (upper)+, time since last tooth loss+ OHQoL**, Denture satisfaction*, Chewing ability* OHQoL Occluding pairs+, prosthetic status (upper arch) +, prosthetic need (lower arch)+, time since last tooth loss episode+ OHQoL*, Denture satisfaction**, Chewing ability* Denture satisfaction Age+, Occupation+ Number of teeth present^, number of occluding pairs+, prosthetic treatment need (both arches) +, time since last tooth loss episode+ OHQoL**, Denture satisfaction**, Chewing ability** Chewing ability Figure 54 Summary of significant bivariate relationships between baseline variables and coping strategies at follow-up BASELINE FOLLOW UP Prosthetic status (upper)*, prosthetic need (upper)**, No. of teeth present*, No. of occluding pairs**, Inadequate /avoidance coping**, coping* Inadequate/avoidance coping blame
LAZARUS, R. S. & LAUNIER, R. 1978. Stress-related transactions between person and environment. Perspectives in interactional psychology, 287, 327. LEAKE, J. L. 1990. An index of chewing ability. Journal of public health dentistry, 50, LEE, I. C., YANG, Y. H. & HO, P. S. 2012. Exploring the quality of life after within elders in Kaohsiung. Gerodontology, 29, e1067-77. LEUNG, D. Y. P., LAM, T.-H. & CHAN, S. S. C. 2010. Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke. BMC public health, 10, 513. LEVENTHAL, E. A. & PROHASKA, T. R. 1986. Age, symptom and health behavior. Journal of the American Geriatrics Society. LEVIN, B. & LANDESMAN, H. M. 1976. A practical questionnaire for predicting denture success or failure. The Journal of prosthetic dentistry, 35, 124. LOCKER, D. 1988. Measuring oral health: a conceptual framework. Community Dent Health, 5, 3-18. LOCKER, D. 1989. An introduction to behavioural science & dentistry, London ; New York, Tavistock/Routledge. LOCKER, D. 1992. The burden of oral disorders in a population of older adults. Community dental health, 9, 109-24. LOCKER, D. 1996. Applications of self-reported assessments of oral health outcomes. Journal of dental education, 60, 494-500. LOCKER, D. 1997. Concepts of oral health. Disease and the quality of life. In: SLADE, G. D. (ed.) Measuring oral health and quality of life. Chapel Hill, NC: Dept. of Dental Ecology, School of Dentistry, University of North Carolina. LOCKER, D. 2000. Deprivation and oral health: a review. Community Dentistry and Oral Epidemiology, 28, 161-169. LOCKER, D. 2004. Oral health and quality of life. Oral Health & Preventive Dentistry, 2(1), 247-53.
do. The ethics committee of the Sri Ramachandra University has also given permission to do this research in their University What if I wish to complain about the way in which the study has been conducted? If you have any cause to complain about any aspect of the way in which you have been approached or treated during the course of this study please contact- Mr Karthik Periyakaruppiah Phone number Email: Professor Peter G Robinson Head of Unit, Academic Unit of Dental Public Health School of Clinical Dentistry Claremont Crescent Sheffield, UK S10 2TA Telephone: + (00)44 114 2717885 Email: peter.g.robinson@sheffield.ac.uk Professor TV Padmanaban Head of Department Department of Prosthodontics, Sri Ramachandra Dental College and Hospital Sri Ramachandra University Porur, Chennai – 6000 116 Tamilnadu, India Telephone: + + 91 9381052122 Email: tvpadu@gmail.com
43. I've been getting comfort and understanding from someone. 44. I've been trying to get advice or help from other people about what to do. 45. I've been getting help and advice from other people. 46. I've been turning to work or other activities to take my mind off things 47. I've been doing something to think about it less, such as going Io movies, watching TV, reading, daydreaming, sleeping, or shopping. 48. I've been saying to myself "this isn't real” 49. I've been refusing to believe that it has happened. 50. I've been saying things to let my unpleasant feelings escape. 51. I’ve been expressing my negative feelings. 52. I've been using alcohol or other drugs to make myself feel better. 53. I've been using alcohol or other drugs to help me get through it. 54. I’ve been giving up trying to deal with it 55. I’ve been giving the attempt to cope. 56. I’ve been criticizing myself. 57. I’ve been blaming myself for things that happened. Not at all A little bit A medium amount A lot