A clinical and microbiological study on the enantiomers of delmopinol.

Objective The clinical part of this study aimed to investigate whether the racemate of delmopinol [(±)-delmopinol] is equivalent to its two enantiomers [(+)-delmopinol and (-)-delmopinol] with respect to efficiency and to determine and compare their pharmacokinetic properties. The purpose of the pre-clinical part was to elucidate possible differences in antimicrobial efficiency. Materials and methods The compounds were tested clinically in a double-blind, randomized, cross-over study comprising three treatment periods of 4 days each. The antimicrobial efficacy of the enantiomers was compared in vitro with respect to planktonic and biofilm bacteria of different species. Results No statistically significant differences in prevention of plaque formation were observed. Except for a somewhat higher systemic exposure in terms of AUC and Cmax indicated for (-)-delmopinol compared to (+)-delmopinol, the pharmacokinetic properties were similar. The most common adverse event was a transient anaesthetic feeling in the mouth. This event was reported with the same frequency for all three test solutions. The enantiomers showed similar antimicrobial effects on planktonic bacteria and their biofilms. Conclusions The enantiomers were found to be equally effective with respect to inhibition of plaque development and only minor differences were observed with respect to their pharmacokinetic properties. No differences could be observed in the adverse events reports. There is, therefore, no reason to use one of the enantiomers of delmopinol instead of the racemate. This was further supported by the antimicrobial tests. It is suggested that the combined action of cationic and neutral delmopinol is important for its effect on biofilms.

Prosthetic Survival and Complication Rate of Single Implant Treatment in the Periodontally Healthy Patient after 16 to 22 Years of Follow-Up.

BACKGROUND: Single implants were introduced in the 1980s, but long-term follow-up is scarce. PURPOSE: The study aims to retrospectively investigate the prosthetic survival and complication rates of single implants in periodontally healthy patients after 16-22 years, and to evaluate the influence of different prosthetic procedures. MATERIALS AND METHODS: Patients with a single implant were recalled for clinical examination. Prosthetic procedures included single-tooth (ST) and CeraOne (CO) abutments supporting a porcelain-fused-to-metal (PFM), all-ceramic (CER), or gold-acrylic (ACR) crown. Prosthetic survival, success, and occurrence of biological, technical, and aesthetic complications were obtained. Procedures were compared by log-rank tests. RESULTS: Fifty patients attended the examination. All implants were functional; however, 15% of abutments and 27% of crowns had been renewed. Replacements (1/4) were related to technical issues whereas the main cause was aesthetics. The abutment cumulative survival rate (CSR) differed significantly between ST-PFM (74%), ST-ACR (0%), and CO reconstructions (97%). The crown CSR was significantly lower for ST-ACR crowns (0%) compared with ST-PFM (68%) and CO (81%). Thirty-nine percent of implants remained complication free throughout the mean 18.5 years. Complications (1/3) required component replacement, and 53% occurred within 5 years after surgery. CONCLUSION: Prosthetic survival rates of single implants are encouraging after 16 to 22 years. However, 66% of the patients encountered at least one complication during follow-up.

Reimbursement systems influence prosthodontic treatment of adult patients.

OBJECTIVE: To evaluate the influence of reimbursement system and organizational structure on oral rehabilitation of adult patients with tooth loss. MATERIALS AND METHODS: Patient data were retrieved from the databases of the Swedish Social Insurance Agency. The data consisted of treatment records of patients aged 19 years and above claiming reimbursement for dental care from July 1, 2007 until June 30, 2009. Before July 1, 2008, a proportionately higher level of subsidy was available for dental care in patients 65 years and above, but thereafter the system was changed, so that the subsidy was the same, regardless of the patient's age. Prosthodontic treatment in patients 65 years and above was compared with that in younger patients before and after the change of the reimbursement system. Prosthodontic treatment carried out in the Public Dental Health Service and the private sector was also analyzed. RESULTS: Data were retrieved for 722,842 adult patients, covering a total of 1,339,915 reimbursed treatment items. After the change of the reimbursement system, there was a decrease in the proportion of items in patients 65 years and above in relation to those under 65. Overall, there was a minimal change in the proportion of treatment items provided by the private sector compared to the public sector following the change of the reimbursement system. CONCLUSIONS: Irrespective of service provider, private or public, financial incentive such as the reimbursement system may influence the provision of prosthodontic treatment, in terms of volume of treatment.

Porcelain bonding to titanium with two veneering principles and two firing temperatures.

Dental literature, as well as dental laboratories, has described problems with ceramic veneering of titanium, while clinical and in vitro studies have reported good results. The objective of this study was to investigate the effect of firing temperature, thermo cycling, and veneering methods on bond strength between porcelain and titanium. Eighty titanium specimens were prepared with one of two methods: a bonding agent firing or an oxidation firing. During veneering, half of the specimens in each group were fired at 30 degrees C above and half at the manufacturer's recommended temperature. In the bonding agent group and in the oxidation group, half of each firing group was thermocycled. Bond strength was calculated in a three-point bending test. Scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) analyses of the titanium and the porcelain fracture surfaces of one specimen from each subgroup was used in order to study the composition of the interface between titanium and porcelain surfaces after fracture. No significant difference in bond strength was found when firing at a higher temperature compared with firing at the recommended temperature. An oxidation firing before veneering yielded significantly higher bond strength in a three-point bending test than when firing with a bonding agent. SEM and EDS analyses indicated a higher frequency of titanium oxide fractures in the oxidation than in the bonding agent group.The main finding is that firing at 30 degrees C above the recommended temperature does not significantly affect bond strength between titanium and porcelain. SEM and EDS analysis indicate that fractures occur in the titanium oxide layer by oxidation firing and in the interface between titanium oxide layer and veneering material by bonding agent firing.This finding might indicate that three- point bending test is not a relevant method for determining bond strength in this case, since the firing methods might influence the ductility of the samples.

Qualitative studies of patients' perceptions of loss of teeth, the edentulous state and prosthetic rehabilitation: a systematic review with meta-synthesis.

OBJECTIVE: To conduct a systematic review and meta-synthesis of qualitative studies addressing patients' perceptions of loss of teeth, edentulism and oral rehabilitation. BACKGROUND: Qualitative studies can complement quantitative studies by achieving deep understanding of patients' subjective experiences of losing teeth and coping with edentulism. They can also explore the perception that the benefits of prosthetic rehabilitation extend far beyond primary clinical treatment goals of restoration of oral function. MATERIALS AND METHODS: The major data bases were searched extensively for relevant qualitative and quantitative studies, followed by manual searching of the reference lists of included publications. Two authors independently read all abstracts. Relevant papers were retrieved in full-text and included or excluded according to a specially designed protocol. The included articles were then appraised and rated for quality: high, moderate or low. Articles of low quality were excluded. RESULTS: The database search yielded 36 abstracts of qualitative studies; manual search disclosed one further article. All were read in full-text by two independent authors: 28 were excluded. Of the remaining nine, two (assessed as of low quality) were excluded for further analysis. Meta-synthesis, based on seven studies, disclosed two major themes: loss of quality-of-life associated with losing teeth and restored quality-of-life after oral rehabilitation. CONCLUSIONS: In this relatively new field of research, there are few published papers. Nevertheless, the studies to date show that loss of teeth is associated not only with compromised oral function, but also loss of social status and diminished self-esteem. Oral rehabilitation has broad positive implications, restoring quality of life and self-worth.

Validation of the Orofacial Esthetic Scale in the general population.

BACKGROUND: The Orofacial Esthetic Scale (OES) is an eight-item instrument to assess how patients perceive their dental and facial esthetics. In this cross-sectional study we investigated dimensionality, reliability, and validity of OES scores in the adult general population in Sweden. METHODS: In a random sample of the adult Swedish population (response rate: 39%, N=1159 subjects, 58% female, mean age (standard deviation): 49.2 (17.4) years), dimensionality of OES was investigated using factor analytic methods to determine how many scores are needed to characterize the construct. Reliability of scores was calculated using Cronbach's alpha. Score validity was determined by correlating the OES summary score with a global indicator of orofacial esthetics (OE). RESULTS: Factor analyses provided support that a single score can sufficiently characterize OE. A Cronbach's alpha of 0.93 indicated excellent reliability. A validity coefficient of r=0.89 (95% confidence interval: 0.87-0.90) indicated that OES summary scores correlated highly with a global OE assessment. CONCLUSIONS: The OES is a promising instrument to measure the construct OE. Factor analyses supported that this construct can be assessed with one score, offering a feasible and acceptable standardized assessment of OE. The present study extends the OES use to the general population, an important target population for assessment of orofacial esthetics.

Oral rehabilitation of tooth loss: a systematic review of quantitative studies of OHRQoL.

PURPOSE: This study aimed to review published quantitative studies for evidence regarding the influence of oral rehabilitation following total or partial tooth loss on self-perceived oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: Three databases were searched using specified indexing terms. The reference lists of relevant publications were also searched manually. Quality of evidence was classified according to GRADE guidelines as high, moderate, low, or very low. RESULTS: The search yielded 2,138 titles and abstracts, 2,102 of which were of a quantitative study design. Based on pre-established criteria, the full-text versions of 322 articles were obtained. After data extraction and interpretation, 5 publications of high or moderate study quality remained. The results of these 5 studies showed positive effects of oral rehabilitation on OHRQoL. Two studies showed substantial improvements. CONCLUSIONS: This is a relatively new field of research; there are very few quantitative studies of how patients perceive OHRQoL following tooth loss and subsequent rehabilitation. While this review indicates that treatment has positive effects on quality of life, the scientific basis is insufficient to support general conclusions about the influence of various interventions on the OHRQoL of patients who have experienced total or partial tooth loss. To achieve a more comprehensive analysis, it is recommended that future studies be based on a combination of quantitative and qualitative methods, ie, questionnaires and semi-structured interviews. The follow-up period must also be appropriate for the specific intervention studied.

Treatment of adult patients with edentulous arches: a systematic review.

PURPOSE: This study aimed to evaluate the outcomes of treatment methods used to rehabilitate adult patients with maxillary and/or mandibular edentulism after at least 5 years of follow-up. The risks, adverse effects, and cost effectiveness of these methods were also evaluated. MATERIALS AND METHODS: Three databases as well as the reference lists of included publications were searched using specified indexing terms. Publications that met the inclusion criteria were read and interpreted using pre-established protocols. Quality of evidence was classified according to the GRADE system (high, moderate, low, or very low). RESULTS: The search yielded 2,130 titles and abstracts. Of these, the full-text versions of 488 publications were obtained. After data extraction and interpretation, 10 studies with moderate study quality of evidence and 1 study with low quality of evidence regarding outcomes, risks, and adverse effects remained. Three studies on the economic aspects of treatment were also included (1 with moderate quality and 2 with low quality). Low-quality evidence showed that the survival rate of implant-supported fixed prostheses is 95% after 5 years in patients with maxillary edentulism and 97% after 10 years in patients with mandibular edentulism. The survival rate of implant-supported overdentures is 93% after 5 years (low-quality evidence). In implant-supported fixed prostheses, 70 of every 1,000 implants are at risk of failing in the maxilla after 5 years and 17 of every 1,000 implants in the mandible are at risk after 10 years. Regarding economic aspects, the evidence was insufficient to provide reliable results. CONCLUSIONS: Due to the low quality of evidence found in the included studies, further research with a higher quality of evidence is recommended to better understand the outcomes of treatment for patients with maxillary and/or mandibular edentulism.

Treatment of adult patients with partial edentulism: a systematic review.

PURPOSE: The purpose of this systematic review was to identify and critically appraise published studies of treatment methods used in general practice to rehabilitate adult patients with single tooth loss or partial edentulism, with special emphasis on outcomes reported after at least 5 years of follow-up. MATERIALS AND METHODS: Three databases were searched using specified indexing terms. Publications were included if the study design, research questions, and sample size satisfied pre-established criteria. Reference lists of relevant publications and systematic reviews were also searched. The quality of evidence was classified according to the GRADE system as high, moderate, low, or very low. RESULTS: The search yielded 7,675 titles, of which 1,130 were read in full text. A final total of 15 publications were deemed eligible for inclusion: 5 of moderate quality and 10 of low quality. The five studies of moderate quality were all related to implant-based treatment. The 5-year survival rates for implant-supported single crowns and prostheses were 91% and 94.7%, respectively (implant survival rates: 98.5% and 94.9%, respectively). The underlying scientific evidence was low in quality. No relevant publications were identified regarding the economic aspects of treatment. CONCLUSION: Due to the low scientific evidence of the included studies, it was not possible to compare various treatment methods used for rehabilitation of single tooth loss or partial edentulism.

Contact allergy to gold in patients with oral lichen lesions.

The aetiology of oral lichen lesions is obscure. In this study the frequency of contact allergy to gold in 83 patients with oral lichen lesions was compared with that in two control groups, comprising 319 age- and gender-matched patients with dermatitis selected from files and 83 clinically examined dermatitis patients. All patients were tested epicutaneously with gold sodium thiosulphate. The two control groups tested were under examination for a tentative diagnosis of allergic dermatitis not related to oral problems. The frequency of contact allergy to gold was 28.9% in the patients with oral lichen lesions, 18.2% in patients selected from files, and 22.9% in the clinically examined control patients. The difference in frequency between patients with oral lichen lesions and those taken from files was statistically significant.

A prospective study of implant-supported full-arch yttria-stabilized tetragonal zirconia polycrystal mandibular fixed dental prostheses: three-year results.

PURPOSE: The development of high-strength oxide ceramic materials has led to increased interest in all-ceramic fixed dental prostheses (FDPs). Success rates reported in clinical studies for all-ceramic FDPs based on high-strength oxide ceramic materials reportedly approach those of porcelain-fused-to-metal FDPs. These reconstructions, however, are still of limited size and have mainly concerned FDPs supported by natural teeth. The purpose of this study was to evaluate the clinical performance of multiunit all-ceramic FDPs supported by dental implants. MATERIALS AND METHODS: Ten patients received mandibular yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) FDPs manufactured according to the Cercon technique and supported by four Astra Tech implants. Nine patients received 10-unit FDPs and one patient received a 9-unit FDP. The FDPs were cemented with Panavia F 2.0 onto individually prepared titanium abutments. The FDPs were evaluated at baseline and after 12, 24, and 36 months. RESULTS: At the 3-year follow-up, all FDPs were in use, and all patients were fully satisfied with their treatment. None of the reconstructions had fractured. Superficial chip-off fractures of the veneering porcelain were, however, observed in nine patients (34 of 99 units, 34%). CONCLUSION: Results from this 3-year study suggest that implant-supported full-arch Y-TZP FDPs manufactured according to the Cercon technique should be viewed as a treatment alternative cautiously. A better understanding of the factors resulting in chip-off fractures is needed, together with longer follow-up studies involving larger numbers of patients, before the material and technique can be recommended for general use.

Reliability and validity of the Orofacial Esthetic Scale in prosthodontic patients.

PURPOSE: This study evaluated the reliability and validity of the Orofacial Esthetic Scale (OES)-an instrument assessing self-reported orofacial esthetics in prosthodontic patients. MATERIALS AND METHODS: The OES has seven items addressing direct esthetic impacts in the orofacial region, as well as an eighth global assessment item. The response format was a 0 to 10 numeric rating scale (very dissatisfied to very satisfied with appearance, respectively). OES summary scores ranged from 0 (worst score) to 70 (best score). Test-retest reliability (n = 27) and internal consistency (n = 119) were assessed. Content validation (asking patients about their satisfaction with the questionnaire content, n = 119) and discriminative validation (comparing OES scores between patients and healthy controls, n = 119) were performed. Convergent validity was assessed by correlating patients' own OES scores (n = 29) with ratings from a consensus expert group (n = 4) and with the Oral Health Impact Profile (OHIP) esthetic-item summary score (n = 119). RESULTS: Test-retest reliability was excellent for the OES scores (intraclass correlation coefficient = .96). Internal consistency was satisfactory for esthetically impaired patients (n = 27, Cronbach alpha = .86). Patients rated their satisfaction with the questionnaire content as 7.8 +/- 1.3 units on a 0 to 10 numeric rating scale (0 = very dissatisfied, 10 = very satisfied). OES scores discriminated esthetically impaired patients (31.4 units) from healthy controls (45.9 units, P < .001). OES scores correlated well with other measures of the same construct (r = .43 for patients' own assessment with an assessment by experts using the OES, r = -.72 for a correlation with the OHIP's three esthetic-related items). CONCLUSIONS: The OES, developed especially for prosthodontic patients, exhibited good score reliability and validity.

Development of an Orofacial Esthetic Scale in prosthodontic patients.

PURPOSE: Despite the interest and need to assess orofacial esthetics in prosthodontic patients, few self-reporting instruments are available to measure this construct, and none describe how prosthodontic patients perceive the appearance of their face, mouth, teeth, and dentures. The development of the Orofacial Esthetic Scale (OES) is reported in this article, in particular its conceptual framework, how questionnaire items were generated, and the scale's measurement model. MATERIALS AND METHODS: After test conceptualization, the authors solicited esthetic concerns from 17 prosthodontic patients by asking them to evaluate their own photographs. A focus group of 8 dental professionals reduced the initial number of concerns/items and decided on an item response format. Pilot testing in 9 subjects generated the final instrument, the OES. Exploratory factor analysis was performed to investigate OES dimensionality and item analysis to investigate item difficulty and discrimination in 119 subjects. RESULTS: Prosthodontic patients generated an initial 28 esthetic concerns. These items were reduced to 8 preliminary representative items that were subsequently confirmed during pilot testing. Analysis supported 8 items assessing appearance: face, profile, mouth, tooth alignment, tooth shape, tooth color, gums, and overall impression, measured on an 11-point numeric rating scale (0 = very dissatisfied, 10 = very satisfied). Exploratory factor analysis found only 1 factor and high positive loadings for all items (.73 to .94) on the first factor, supporting the unidimensionality of the OES. CONCLUSIONS: The OES, developed especially for prosthodontic patients, is a brief questionnaire that assesses orofacial esthetic impacts.

Decision making among Swedish general dental practitioners concerning prosthodontic treatment planning in a shortened dental arch.

The purposes of this study were to describe how dentists evaluated the importance of various patient-related items when planning for a treatment in a shortened dental arch, to analyse common dimensions of the decision-making in comparison to other decision situations, and to identify explanatory factors behind these dimensions. A questionnaire containing different statements regarding the shortened dental arch concept was sent to a random sample of Swedish general dentists (n=189), with a response rate of 54%. The dentists were asked to evaluate items to be considered when planning for a prosthetic treatment in a shortened dental arch. Differences between individuals were great as well as between groups of dentists. Especially delivery system but also place of dental education and attitudinal factors were related to the shortened dental arch decision making process.

Bonding between titanium and dental porcelain: a systematic review.

OBJECTIVES: The aims of this literature review are to provide answers to questions on how to improve bonding between titanium and dental porcelain and how to further implement, in clinical practice, ceramic-veneered titanium as an alternative to conventional metal-ceramic systems. MATERIAL AND METHODS: A literature search of PubMed and also among referenced published scientific papers was performed and 24 fulfilled the search criteria, namely mentions of titanium, ceramics and bond strength. These papers were compiled for comparison and evaluated regarding the bond strength achieved with different methods. RESULTS: The results strongly indicate that there are possibilities to improve both the present materials and methods for titanium-ceramic veneering. CONCLUSIONS: The results indicate that present knowledge is sufficient to conclude that veneering titanium with low-fused porcelain for crowns and fixed partial dentures can be recommended for routine clinical use.

Implant periapical lesion. A case series report.

One complication in implant dentistry is the implant periapical lesion-IPL--which is a lesion around the apex of a stable implant diagnosed radiographically as a radioluscency in the bone at the apical part of an implant.The IPL can perform with or without clinical symptoms such as tenderness, swelling, suppuration and fistulation. This report describes 4 cases of IPL which were treated surgically with sectioning and removal of the affected portion of a stable implant and thorough debridement of the granulomatous tissue around it. This treatment was, up to 4 years after treatment, successful in all 4 cases. It can also from this report be concluded that IPL is a rather rare condition and that it can occur at any stage of implant treatment, in these cases from 4 months up to 11 years after implant installation. Finally there is a discussion about the aetiology of IPL and a comparison to findings in other reports on IPL and it is concluded that it is difficult to claim that there is a single cause to IPL. Rather it is evident that the condition might be a sequel of the summation of many possible causes.This summation exceeds the local biological threshold for the individual patient.

Immediate loading of implants in the edentulous maxilla: use of an interim fixed prosthesis followed by a permanent fixed prosthesis: a 32-month prospective radiological and clinical study.

PURPOSE: The aim of this study was to prospectively evaluate the survival rate of splinted and immediately loaded Straumann sandblasted, large-grit, acid-etched, solid-screw dental implants in the edentulous maxilla after 32 months of loading. MATERIALS AND METHODS: Twenty-eight patients (mean age 63 years) with edentulous maxillae received 168 implants (six each) and an implant-supported fixed interim prosthesis within 24 hours after surgery. After a mean healing time of 15 weeks, the patients received permanent screw-retained prostheses. Clinical and radiological examinations were made at implant placement and after 8, 20, and 32 months of loading. All permanent prostheses were removed at the 32-month follow-up; implant stability was checked with a torque device, and the implant stability quotient was determined with resonance frequency analysis. RESULTS: Mean marginal bone loss from baseline to 8 months after loading was 1.6 mm (SD 1.16; p = .094), from 8 to 20 months 0.41 mm (SD 0.63; p = .094), and from 20 to 32 months 0.08 mm (SD 0.49; p = .039). The 32-month cumulative survival rate was 98.2%. CONCLUSIONS: The 32-month survival of solid-screw implants - immediately loaded within 24 hours after placement - was similar to survival rates reported for solid-screw implants with conventional loading. Immediate loading and splinting of implants in the edentulous maxilla is a viable treatment alternative.

Levels of gold in plasma after dental gold inlay insertion.

OBJECTIVE: Several studies have reported increased levels of gold (Au) in the blood of patients with dental gold restorations. This study analyzed gold levels in blood plasma before dental gold inlay insertion, 0-12 months after, and 15 years after. MATERIAL AND METHODS: Plasma samples from 9 patients were taken before and 0-10 months after gold inlay insertion. Fifteen years after gold inlay insertion, further blood samples taken from 8 of these patients were analyzed for gold using inductively coupled plasma mass spectrometry. An oral examination was also carried out before and 15 years after gold inlay insertion. RESULTS: Gold levels in plasma were significantly higher 0-12 months after gold inlay insertion than before treatment (p=0.008). No significant difference in gold plasma levels was found between 0-12 months after and 15 years after insertion (p=0.109), although there was a significant correlation between the number of gold alloy surfaces and the amount of gold in plasma 15 years after insertion (p=0.028). CONCLUSIONS: This study supports a dose-related release of gold into plasma from dental gold restorations, a release that appears to be stable over time.

Questions and answers on titanium-ceramic dental restorative systems: a literature study.

OBJECTIVE: Titanium ceramics has become a topic of interest for prosthetic applications, thanks to the documented biocompatibility of commercially pure titanium. A number of concepts have been presented, including metal frameworks produced by casting or milling and a number of materials and methods for veneering. However, the concept has not reached a clinical breakthrough since failures have been reported from clinical experiences. METHOD AND MATERIALS: A PubMed search on the following key words was performed: titanium ceramics, long-term results. RESULTS: This review illustrates the fact that it is possible to have success with titanium ceramics on crucial criteria: fit and marginal adaptation, bond strength between metal and ceramics, and esthetic outcome. A review of clinical studies indicates a tendency for success rates to increase with time, which must be explained as a normal learning curve for a technical concept. The learning curve also includes development of materials and methods and the fact that there is a certain amount of technique sensitivity involved in the success rate for titanium ceramics. CONCLUSIONS: There is reason to believe that the outstanding clinical properties of titanium will further catalyze the development of titanium ceramics, and recent experiences clearly indicate that titanium ceramics, being a clinical product ready for use in fixed partial dentures, might already today challenge standard metal ceramics.

Oral prostheses and oral health-related quality of life: a survey study of an adult Swedish population.

PURPOSE: The purpose of the study was to investigate whether oral health-related quality of life (OHRQOL) in an adult Swedish population could be explained by social attributes; individual attributes; dental status, with a special focus on the role of prosthodontics; and dental care attitudes. MATERIALS AND METHODS: The study was based on responses to a questionnaire sent in 1998 to a random sample of 1,974 persons aged 50 to 75 years (66% response rate). Three factors representing various aspects of OHRQOL were set as dependent variables in multiple-regression models: oral health impact on everyday activities, oral health impact on the psychologic dimension, and oral health impact on oral function. Independent variables in the models were social attributes, individual attributes, number of teeth, denture (ie, type of denture, if present), and dental care attitudes. RESULTS: General health in relation to age peers had the strongest association with all 3 dependent variables, followed by number of teeth and need care--cost barrier. When number of teeth was excluded, removable denture was found to covary with the dependent variables in each of the 3 regression models. CONCLUSION: The number of remaining teeth is more important than the type of denture in explaining OHRQOL. It is less important that a denture is fixed for those with few remaining teeth, in contrast to all others. Explanations are also found in general health and various aspects of dental care costs.