Perceived sources of stress amongst dental students: A multicountry study.

AIMS: The aim of this study was to explore the perceived sources of stress reported by dental students from fourteen different countries. METHODS: A total of 3568 dental students were recruited from 14 different dental schools. The dental environmental stress (DES) questionnaire was used including 7 domains. Responses to the DES were scored in 4-point Likert scale. Comparison between students was performed according to the study variables. The top 5 stress-provoking questions were identified amongst dental schools. Data were analysed using SPSS software program. Mann-Whitney and Kruskal-Wallis tests were used as appropriate. Logistic regression analysis was also conducted to determine the effect of the studied variables on the stress domains. The level of statistical significance was set at <.05. RESULTS: Internal consistency of the scale was excellent (0.927). Female students formed the majority of the total student population. The percentage of married students was 4.8%. Numbers of students in pre-clinical and clinical stages were close together. The most stress-provoking domain was "workload" with a score of 2.05 ± 0.56. Female students scored higher stress than male students did in most of the domains. Significant differences were found between participating countries in all stress-provoking domains. Dental students from Egypt scored the highest level of stress whilst dental students from Jordan scored the lowest level of stress. CONCLUSION: The self-reported stress in the dental environment is still high and the stressors seem to be comparable amongst the participating countries. Effective management programmes are needed to minimise dental environment stress.

Patterns of impaired oral health-related quality of life dimensions.

How dental patients are affected by oral conditions can be described with the concept of oral health-related quality of life (OHRQoL). This concept intends to make the patient experience measurable. OHRQoL is multidimensional, and Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact were suggested as its four dimensions and consequently four scores are needed for comprehensive OHRQoL assessment. When only the presence of dimensional impact is measured, a pattern of affected OHRQoL dimensions would describe in a simple way how oral conditions influence the individual. By determining which patterns of impact on OHRQoL dimensions exist in prosthodontic patients and general population subjects, we aimed to identify in which combinations oral conditions' functional, painful, aesthetical and psychosocial impact occurs. Data came from the Dimensions of OHRQoL Project with Oral Health Impact Profile (OHIP)-49 data from 6349 general population subjects and 2999 prosthodontic patients in the Learning Sample (N = 5173) and the Validation Sample (N = 5022). We hypothesised that all 16 patterns of OHRQoL dimensions should occur in these individuals who suffered mainly from tooth loss, its causes and consequences. A dimension was considered impaired when at least one item in the dimension was affected frequently. The 16 possible patterns of impaired OHRQoL dimensions were found in patients and general population subjects in both Learning and Validation Samples. In a four-dimensional OHRQoL model consisting Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact, oral conditions' impact can occur in any combination of the OHRQoL dimensions.

Confirmatory factor analysis of the Oral Health Impact Profile.

Previous exploratory analyses suggest that the Oral Health Impact Profile (OHIP) consists of four correlated dimensions and that individual differences in OHIP total scores reflect an underlying higher-order factor. The aim of this report is to corroborate these findings in the Dimensions of Oral Health-Related Quality of Life (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the project's Validation Sample (n = 5022), we conducted confirmatory factor analyses in a sample of 4993 subjects with sufficiently complete data. In particular, we compared the psychometric performance of three models: a unidimensional model, a four-factor model and a bifactor model that included one general factor and four group factors. Using model-fit criteria and factor interpretability as guides, the four-factor model was deemed best in terms of strong item loadings, model fit (RMSEA = 0·05, CFI = 0·99) and interpretability. These results corroborate our previous findings that four highly correlated factors - which we have named Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact - can be reliably extracted from the OHIP item pool. However, the good fit of the unidimensional model and the high interfactor correlations in the four-factor solution suggest that OHRQoL can also be sufficiently described with one score.

Exploratory factor analysis of the Oral Health Impact Profile.

Although oral health-related quality of life (OHRQoL) as measured by the Oral Health Impact Profile (OHIP) is thought to be multidimensional, the nature of these dimensions is not known. The aim of this report was to explore the dimensionality of the OHIP using the Dimensions of OHRQoL (DOQ) Project, an international study of general population subjects and prosthodontic patients. Using the project's Learning Sample (n = 5173), we conducted an exploratory factor analysis on the 46 OHIP items not specifically referring to dentures for 5146 subjects with sufficiently complete data. The first eigenvalue (27·0) of the polychoric correlation matrix was more than ten times larger than the second eigenvalue (2·6), suggesting the presence of a dominant, higher-order general factor. Follow-up analyses with Horn's parallel analysis revealed a viable second-order, four-factor solution. An oblique rotation of this solution revealed four highly correlated factors that we named Oral Function, Oro-facial Pain, Oro-facial Appearance and Psychosocial Impact. These four dimensions and the strong general factor are two viable hypotheses for the factor structure of the OHIP.

Jaw elevator silent periods in complete denture wearers and dentate individuals.

Functional meaning and underlying mechanisms of jaw elevator silent period (SP) have still not been completely understood. Since complete denture wearers (CDWs) have no periodontal receptors in their jaws, the aim was to examine SPs in CDWs and to compare it with dentate individuals (DIs). Thirty six DIs (skeletal/occlusal Class I) and 24 eugnath CDWs participated. EMG signals were registered using the EMGA-1 apparatus from the left and the right side anterior temporalis (ATM) and masseter muscles (MM). Ten registrations of an open-close-clench (OCC) cycle were obtained for each individual. DIs had the average latency between 12.5 and 12.9 ms and always one single short inhibitory pause (IP) with complete inhibition of motoneurons (20.1-21.1 ms). On the other hand, in CDWs various types of SPs emerged: single or single prolonged SPs, double SPs, SPs with three IPs, periods of depressed muscle activity following the first, or the second IP, SPs with relative inhibition of motoneurons or even in several registrations the SP was missing. Unless more than one IP emerged, complete duration of inhibitory pauses (CDIP) was measured. CDIP varied from 37.17 to 42.49 ms. Average latencies were from 16.22 to 16.76 ms. Based on the results of this study it is obvious that both, the duration and the latencies were significantly longer in CDWs than in DIs (p<0.05), which can be explained by different mechanisms responsible for the muscle reflex behaviour.

Relationship between body mass index and local quality of mandibular bone structure in elderly individuals.

BACKGROUND: Human bones decrease in density and increase in porosity beginning at about the third decade of life. The objective of this study was to determine whether mandibular bone mineral density (BMD) and some linear radiomorphometric measurements on dental panoramic radiograph (DPR) are correlated with different categories of body mass index (BMI) in elderly individuals. METHODS: Cortical width at gonion (GI), at antegonion (AI), and below mental foramen (MI) and the appearance of the cortex of the lower border of the mandible distal to the mental foramina due to resorptive changes (mandibular cortical index [MCI]) were measured bilaterally on the mandible on 136 DPRs of elderly individuals. Using DPRs and copper stepwedge, mandibular BMD was investigated densitometrically. All BMD values were expressed in equivalents of the actual stepwedge thickness. The patients with BMIs from 20 to 25 kg/m(2) were classified as category 1 (the generally accepted range of normal BMI), and the patients with BMIs higher than 25 were classified as category 2 (heavy individuals with a heavy skeleton and a large amount of fat in the body). RESULTS: The results revealed statistically significant differences in all measured indices between different BMI categories (p <.05 for MI; p <.001 for GI and AI). Statistically significant differences were also found in BMD values between different BMI categories (p <.05); the differences were more pronounced in women. The patients with MCI category 3 had significantly lower BMD values in comparison to MCI category 2 (p <.01). Intraobserver agreement in GI, AI, MI measurement, and MCI assessments was excellent. CONCLUSIONS: Heavy people have higher BMD and higher values in linear radiomorphometric measurements than lighter people.

Small airway testing and smoking in predicting risk in surgical patients.

A prospective study was performed on 185 surgical patients without overt respiratory disease to determine whether three sensitive tests for early airway obstruction or cigarette smoking at the time of hospitalization were useful in identifying the patient at risk for a postoperative pulmonary complication. Subjects were evaluated by questionnaire. Pulmonary function testing consisted of the single breath nitrogen test (SBN2) to determine the closing volume (CV) and slope of the alveolar plateau, and a maximum expiratory flow volume curve (MEFV) to determine expiratory flow at low lung volumes. Fifty-five patients had upper abdominal surgery and 130 a major surgical procedure under general or spinal anesthesia upon another part of the body. Ninety-six (52%) of the 185 patients were smokers. Seventy-nine patients (43%) had one or more abnormal function parameters. The CV was abnormal in 59, alveolar plateau in 18, and MEFV in 12. Fifty-four percent of smokers and 30 percent of nonsmokers had abnormal small airway tests. Sixteen of 185 patients (8.6%) developed a postoperative respiratory complication determined by review of the hospital record. Eleven were in the 96 smokers, but 13 were in the 79 patients with abnormal small airway tests. The incidence was highest (38%) in smokers with an abnormal alveolar plateau who underwent upper abdominal surgery. Identification of the patient at risk was better served by tests of small airway abnormality than by smoking history alone.

Can postoperative pulmonary complications after elective cholecystectomy be predicted?

To determine predictors of postoperative morbidity in elective cholecystectomy patients, the authors examined prospectively the consequences of age, sex, active and past smoking, respiratory history, obesity, type of surgical incision, and preoperative pulmonary function, upon the incidence of postoperative pulmonary complications and length of hospitalization. They identified 31 (14.8%) complications in 209 patients; 21 had atelectasis, 8 purulent bronchitis, and 2 pneumonia. These patients averaged 1.5 days longer in the hospital (p less than 0.001 by analysis of variance) than control patients. Abnormal spirometry (MEFV) and the single-breath nitrogen test (SBN2) were significant predictors of postoperative pulmonary complications (p less than 0.001 by discriminant analysis method). Active smoking and history of respiratory disease were associated with abnormal small airway function (p less than 0.001 by chisquare test), but did not predict postoperative morbidity. By analysis of variance, only a reduction in preoperative FVC emerged as predictive of prolonged hospitalization (p less than 0.001). These results were used to determine if the selection of patients by preoperative pulmonary function testing permits more cost-effective administration of respiratory therapy (RT) services. Neither the MEFV nor SBN2 had sufficient specificity to enhance the cost effectiveness of postoperative RT.

Evaluation of the precision of dimensional measurements of the mandible on panoramic radiographs.

The purpose of this study was to evaluate the precision of dimensional measurements of the mandible on orthopantomographic images and thus to evaluate their dimensional reliability. Different distances denoted by metal markers were measured on 25 dry mandibles. The same mandibles were then positioned in an orthopantomographic machine, and radiographic images of them were made. Measurements of the same distances were made on the panoramic images and then compared with the results of the measurements on the dry mandibles. All results were statistically analyzed. The results showed significant difference between the magnification factor listed by the manufacturer and calculated magnification factors, the latter being closer to 1.00. The study also showed that linear measurements made on only one side of the panoramic image of a mandible were very close to the actual dimensions of the dry mandible, whereas measurements that extended across the midline of the mandible were greatly enlarged because of large magnification factors; therefore, such measurements should not be made.

Early antibacterial effect of Pd-Ag dental alloy on aerobic and microaerophilic flora in oral cavity.

Early effect of Pd-Ag alloy on aerobic and microaerophilic flora from healthy oral cavity was studied. Normal microbial flora was sampled from saliva, dental plaque and gingival crevice from healthy individuals without any prosthodontic appliances or periodontal diseases. Such samples were inoculated into liquid media and were left in thermostat (37 degrees C) in aerobic condition. In some samples one or two sterile Pd-Ag alloy pieces were inoculated, while some samples were left without that pieces to be a control group. Both were kept in a thermostat for 24 and 48 hrs and after that were examined for bacterial dehydrogenic activity to reveal the amount of active bacteria in a sample. Dehydrogenic activity was registered after incubation of 0.1 ml of 3-phenyltetrazolynchloryde (TTC) into samples. TCC changes a colour of a liquid media because of bacterial dehydrogenic activity and therefore samples were analysed in a spectroscope. Statistical analysis revealed lower bacterial activity (lower TTC distinction) in samples with one or two Pd-Ag alloy pieces than in a control group. These results indicate the existence of initial inhibitory effect of Pd-Ag alloys on aerobic flora in the mouth, which might give space for anaerobic strains to increase ther growth. Presence of periodontal changes in a gingival crevice with Pd-Ag alloy crowns is probably due to anaerobic micro-organisms, as mostly anaerobic strains are responsible for periodontal disease.

A method to evaluate and compare two different intraoral radiographs of the same patient.

Objective of this study was to determine the accuracy of the method of the clinical intraoral densitometry, to compare differences in the calculation with or without subtraction of the background adjacent soft-tissues from the stepwedge (SW) and to verify which regression model best fitted the experimental data in order to express the measured values in equivalents of SW thickness. Two intraoral radiographs, one after another, were made for each of 6 patients. A copper SW (6 steps, thickness 0.05-0.3 mm) was attached to each radiograph, trying to avoid the superimposition of the bony structures. Films were processed and digitized. Grey levels were measured on each step of the SW, on the background of the SW and on the same 3 randomly chosen regions of interest (ROIs) on each digitized image. The measurement with and without the subtraction of optical densities of the background around the SW from the optical densities of the SW was performed. For the calculation of the SW thickness equivalents, the regression analysis was performed by using different regression models. The best fitting regression model was the 3rd degree polynomial. The results were more precise when using the subtraction of the background overlapping the SW.

Dimensional measurements on the human dental panoramic radiographs.

The objective of this study was to evaluate the precision of the horizontal and vertical linear dimensional measurements on orthopantomographic images. Different horizontal and vertical distances denoted by metal markers were measured on 25 dry mandibles. The same mandibles were then positioned in an orthopantomographic machine and their radiographic images were made. Measurements of the same distances were repeated on the panoramic images and compared to the results of the measurements on the dry mandibles. All results were statistically analyzed. The results showed significant difference between the magnification factor listed by the manufacturer and the calculated magnification factors, the latter being closer to 1.00. The study also showed that linear measurements made only on one side of panoramic images of mandibles were close to actual dimensions of dry mandibles, while the measurements which extended across the midline of mandibles were greatly enlarged due to large magnification factors.

The satisfaction with the removable partial denture therapy in the Croatian adult population.

Little is known about the outcomes of treatment and patient's satisfaction with removable partial dentures in adult Croatian population. Therefore patient's satisfaction with their partial dentures in relation to some socio-economic variables was studied. Patient's satisfaction with denture retention, speech, aesthetics, comfort of wearing dentures, chewing ability was also studied in relation to different denture classification, construction, material, denture base shape (major connectors), denture support and the number of missing teeth. A total of 165 patients, 59 males and 105 females between 38 and 87 years took part in this study. A questionnaire, devised for a purpose of the study, was divided into three parts. In the first part, patients answered questions about age, gender, marital status, education, general health, socio-economic status, self-supporting life, period of tooth loss and number of previous denture experiences and in the second part, patients graded their partial dentures, depending on the level of satisfaction, by using a scale from 1 to 5. In the third part a dentist determined Kennedy classification and their modifications, denture material and denture support, denture base shape and the number of missing teeth and graded a denture construction. Influence of these factors on patient's satisfaction was analyzed. A majority of the examined patients were satisfied with the partial prosthesis, but a small amount of dissatisfaction existed. More then half of them scored all the examined parameters to the best score category. Considering chewing with lower partial dentures, women were more satisfied than men (p < 0.05). Patients with more missing teeth gave lower grades for the comfort of wearing dentures (p < 0.05). Patients of higher education gave lower grades (p < 0.05) for the aesthetics. Patients were not satisfied with speech if the dentist graded a construction of a lower partial denture low (p < 0.05). Dissatisfaction was related to mastication, aesthetics, number of missing teeth and ability of speech. These findings can aid a clinician in discussing a treatment plan and help a patient understand the risk of dissatisfaction in the presence of certain factors.

Three-month change in the radiodensity of alveolar bone supporting partial-denture abutment teeth.

This study uses the intraoral microdensitometric method to examine the impact of masticatory pressure on the alveolar bone around the abutment teeth clasp. Two retroalveolar radiographs were carried out on all 30 subjects over a period of 3 months using a copper calibration stepwedge. The dental radiographs were digitized and converted into positive. Grey level values on dental radiographs in the alveolar bone area in 7 region of interest (ROI) were measured. They were converted into the equivalent thickness of the calibration stepwedge using mathematical methods and the difference of the bone density between the two radiographs was calculated. The results demonstrated that there were no statistically significant differences between the 1st and 2nd radiographs in any of ROI (p > 0.05).

Screening of fixed prosthodontic dentures after five years of use in relation to material and construction.

The aim of this study was to screen patients with fixed prosthodontic appliances that were in oral cavity for a period of 5 years or more and to assess clinically and radiologically root caries, gingival recession, pocket formation, alveolar ridge resorption, as well as gingival (GI) and plaque index (PI). The aim also was to find out the differences between materials and constructions, between abutment and non-abutment teeth, and to find out the need for replacement. A total of 260 patients and their orthopantomograms were examined, with a total of 2,265 teeth, 610 being bridge abutments and 246 being crowns. The most frequent were metal+ acrylic veneer crowns or bridges. Root caries was found under the abutments in 10-20%; however abutments with ceramic crowns had the lowest percentage of caries (p < 0.01). Alveolar ridge resorption, pocket formation deeper than 3 mm and gingival recession of various degree was found in 50% of the cases, again with the lowest percentage of ceramic-fused-to-metal appliances (p < 0.01). Pocket depth was registered in significantly higher percentage in metal-acrylic veneer appliances compared to natural teeth (p < 0.01), while there was no significant difference between metal-ceramic appliances and natural teeth (p > 0.05). Although the worst findings were recorded for metal- + acrylic veneer crowns for PI, no significant difference existed between crowns of different material or non-abutment teeth (p > 0.05). There was statistically significant difference between abutments with metal + acrylic veneer crowns, full metal crowns, metal ceramic crowns and non-abutments for GI scores. Higher percentage of scores 0 and 1 was recorded for metal ceramic crowns and non-abutments and significantly higher percentage of scores 2 and 3 was recorded for metal + acrylic veneer crowns and full metallic crowns. Almost 50% of metal-ceramic abutments had no pathologic findings. Almost 30% of the patients needed replacement, or even some abutments to be extracted and therefore a new prosthodontic appliance.

Oral status, aesthetic materials and frequency of crowns and bridges in patients with fixed prosthetic appliances living in the Metkovic region.

The aim of the study was to examine oral status in patients of the Metkovic region with fixed prosthodontic appliances. The aim was also to evaluate aesthetic materials used, and difference between the frequency of crowns and bridges dependent on patient's age and frequency of visits to dentist. The examination was performed on 212 dental patients with fixed prosthetic appliances, from the Public Health Center "Metkovic". A questionnaire was created for the purpose of this study and was filled in by the patients. The dentist registered oral status. Descriptive statistics and chi 2 tests were used for the data analysis. Following conclusions were made: 1. The examined patients had relatively high caries (tooth decay), gangrene and residual roots prevalence, the oral hygiene was not appropriate, calculus and gingivitis were diagnosed in all patients (100%) and these facts point out to the insufficient preventive oral health care in the Metkovic region, as well as to the insufficient self-perception on the proper oral hygiene maintenance. 2. Patients who visit their dentist regularly (once a year or more) have significantly more crowns than bridges than the patients who visit their dentist irregularly or when in pain (p < 0.01). 3. Almost all fixed prosthetic appliances not older than 10 years were made of porcelain (98%), while acrylic veneer crowns (or chromasite) were more frequent in appliances older than 10 or 15 years (p < 0.01). There was no gender difference dependent on the material used (p > 0.05). High frequency of porcelain was attributed to the high economic status of this region, as well as to a dentist's preference.

Analysis of occlusal contacts in different types of prosthodontic appliances, Eichner classifications, presence RCP-ICP slide and the type of occlusion.

The aim of the study was to determine the number and the type of the occlusal contacts (strong, weak) with respect to the type of the prosthodontic appliance (fixed, removable, combined fixed-removable) and with respect to the Eichner classification in patients with their appliances being in a good function for a long time. The aim of the study was also to determine the number and the type of the occlusal contacts (strong, weak) with respect to the type of occlusion (canine guided, group function or balanced) and the presence of the RCP-ICP slide. A total of 440 patients with different types of prosthodontic appliances were examined for the antagonistic occlusal contacts using occlusal strips of 11 microm and 50 microm. The average number of occlusal contacts was 10.5 for the upper and 10.46 for the lower posterior teeth, approximately 5 on each side of the tooth arch. The results of the study suggest that the biggest number of occlusal contacts were recorded for the small span fixed appliances (2 on average), the greater span fixed and fixed-removable prosthodontic appliances exhibited 1.6 occlusal contacts, and the removable complete denture exhibited 1.2 contact per the tooth in the posterior region. The number of the hard occlusal contacts was significantly greater in fixed and fixed-removable prosthodontic appliances in comparison with the complete dentures (p < 0.05), while there was no significant difference between the prosthodontic appliances for the weak occlusal contacts (p > 0.05). The overall number of the occlusal contacts, as well as the number of the hard occlusal contacts was significantly greater in the Eichner class I cases (p < 0.05) in comparison with the Eichner classes II and III. The number of the weak occlusal contacts showed no significant differences with respect to the Eichner classification (p > 0.05). There was no significant difference in the number of occlusal contacts between the appliances with RCP-ICP slide and where ICP and RCP corresponded (p > 0.05).

Relationship between the face and the tooth form.

The aim of this study was to re-examine Leon Williams geometric theory and to find the degree of correspondence between the face and the tooth form in the population of Zenica, Bosnia and Herzegovina. Two thousand individuals with intact frontal teeth, in age between 17 and 24 years, were measured for 3 horizontal distances on the face: temporal width (Ft-Ft), zygomatic width (Zyg-Zyg) and gonial width (Go-Go) and for 3 horizontal distances on the both upper incisors: cervical width (CW), contact point width (CPW) and incisal width (IW). The length of the face (Tr-Gn) as well as the length of the central maxillary incisors were also measured. The results revealed: 1. Men had significantly larger dimensions for all facial and tooth dimensions (p < 0.05) than women, except for the cervical tooth width (p > 0.05); the left and the right central incisors were of identical dimensions and forms (p > 0.05). 2. The width of upper central incisors were smaller approximately 1.5 mm than in west Europeans. 3. Upon the relation between the 3 horizontal dimensions measured on the face and upper maxillary incisor, 11 facial forms and 10 upper central tooth forms could be recognised in the study population, but 98% of the population had only 3 tooth and face forms. Face shapes: oval face--83.3%, square-tapered face--9.2% and tapered face--7%; tooth forms: tapered-square incisor--53%, oval incisor--30%, tapered incisor--16%. 4. Reversed and enlarged tooth form was in line associated with the facial form in only 30%, while the most common combination was of the oval face form and the tapered-square central incisor (45%). 5. These results disapprove William's theory and may be helpful for the choice of artificial teeth in complete denture construction and the dental industry.

The patient's and the therapist's evaluation of bridges of different materials and age.

The aim of this study was to find out patients' satisfaction with their bridges made of different materials (metal-ceramics, Au/resin, Ag-Pd/resin). One hundred and sixty four patients were examined at the Dental School, University of Zagreb, Croatia. They assessed their bridges--the overall quality, aesthetics, speech, chewing and the health of the gingiva by the scale from 1-5. The same categories were also assessed by a trained prosthodontist. The majority of the patients was really satisfied and gave the highest grades (quality, aesthetics, speech, etc.) and therefore the results were skewed and asymmetrical towards the biggest scores (biggest grades). The best gingival health was evaluated by the group of patients with ceramic crowns and bridges (p < 0.05) and the worst by the patients with Ag-Pd bridges. Speech was scored higher for the lateral than for the frontal bridges. Patients evaluated the health of the tissue surrounding their bridges, overall quality of fixed prosthodontic appliance and aesthetics with significantly higher scores than the prosthodontist (p < 0.01). The results point at a difference between the patient's and the therapist's evaluations and to the patient's insufficient care about the gingiva around the bridge abutments.

The patient's and the therapist's evaluation of complete denture therapy.

A total of 222 patients were studied. In a questionnaire patients graded their complete dentures of different age and quality, depending on the level of satisfaction, using the modified analogue-visual scale from 1 to 5. The dentist assessed the same dentures, as well as the denture bearing area. The patients' assessments were surprisingly high, the grades were bigger than the therapist's (p < 0.05), but in disappointed patients the grades were smaller than the therapist's (p < 0.05). It seems that the dentist is more critical in assessments than the patient. No significant difference existed between chewing and denture stability and between stability and the comfort of wearing lower full denture (p > 0.05). Unstable denture aggravates chewing and causes pain and discomfort on the bearing area. It seems that subjective factors in patients, expectations of the denture or the number of previous dentures play a role in satisfaction, not only the quality of denture bearing area and the quality of a denture.