Subjective and objective measures for evaluating masticatory ability and associating factors of complete denture wearers: A clinical study.

ABSTRACT

STATEMENT OF PROBLEM: The masticatory ability of complete denture (CD) wearers can be evaluated subjectively and objectively. Although an objective measure reflects a person's ability to masticate food, it is rarely used in clinical practice. Moreover, the factors associated with subjective and objective masticatory ability of CD wearers remain unclear. PURPOSE: The purpose of this clinical study was to identify subjective and objective measures that better reflect the masticatory ability of CD wearers and to investigate their associating factors. MATERIAL AND METHODS: Masticatory ability was evaluated in 130 CD wearers by using subjective and objective measures. The subjective indicators were oral impact on eating and denture satisfaction based on eating or mastication ability. Masticatory performance was objectively measured by using a median peanut particle size. The maximum occlusal force, number, and area of occlusal contacts were determined from a pressure-sensitive sheet. CD retention and stability were classified into acceptable and unacceptable denture quality following the CU-modified Kapur criteria. The occlusal pattern and oral conditions were examined and recorded. Intraexaminer reliability in determining CD quality and oral condition was shown by a Kappa score of 0.90 to 0.95. Multivariable linear and logistic regressions were performed to analyze the associations between CD quality, maximum occlusal force, and masticatory ability. The Spearman correlation was used to determine the association between subjective and objective measures. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) between subjective and objective measures were calculated. RESULTS: Unacceptable CD quality was significantly associated with oral impact on eating, eating dissatisfaction, and larger peanut particle size (P<.001). Peanut particle size increased with lower maximum occlusal force, which was related to fewer occlusal contacts and the female sex. The highest to lowest adjusted R2 values were related to masticatory performance, oral impact on eating, and eating satisfaction models. Among participants with unacceptable CD quality, 16% had higher masticatory performance, 25%, had no oral impact on eating, and 33% reported eating satisfaction. The sensitivity and specificity values of subjective measures in predicting lower masticatory performance were approximately recorded at 74% and 90%, respectively, whereas PPV and NPV were at 90% and 77%, respectively. CONCLUSIONS: CD retention and stability impact objective and subjective masticatory ability. Objective masticatory performance is the best measure for evaluating the masticatory ability of CD wearers, followed by oral impact on eating and eating satisfaction. A 3.6-mm peanut particle size is suggested as a cutoff value for identifying CD wearers with impaired masticatory ability.