The Level of Satisfaction Among Patients with Dental Bridges

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INTRODUCTION
Dental bridge treatment is one of the treatments that can be given in cases of tooth loss.A bridge denture is a dental prosthesis that is bonded chemically or mechanically to natural teeth, tooth roots, and implants to restore one or several missing teeth and cannot be removed by the patient. 1 Cases of tooth loss that are not treated for long will cause pathological migration of the remaining teeth, decreased alveolar bone in the edentulous area, decreased masticatory function, speech disorders, and can affect the temporomandibular joint. 2 The type of prosthesis often used is a conventional with crown dentures.Clinical problems that occur in dentures can affect the level of patient satisfaction with their dentures. 7atient satisfaction is an important indicator in evaluating the success of healthcare services. 8Individual satisfaction is achieved when the performance of a product or service meets expectations.There has not been much research on patient satisfaction with bridge dentures reported.The research conducted by Amalia et al. 9 reviewed patient satisfaction with bridge dentures from one aspect only, namely masticatory function.Patient satisfaction cannot be based on mastication function alone, but other aspects need to be considered, such as aesthetics, phonetics, and comfort when used. 10,11ridge denture treatment is one of the clinical requirements for students of the Professional Education Program at the Faculty of Dentistry, Universitas Padjadjaran, who carry out co-assistance activities at the Prosthodontic Polyclinic, Dental and Oral Hospital (RSGM).Dental professional students perform bridge denture treatment for the first time on a patient and are supervised by a dentist/prosthodontist.Patient satisfaction must be evaluated to determine the success rate of treatment performed by dental professional students.Research on patient satisfaction using bridge dentures has never been conducted at the Dental Hospital of Padjajaran University (RSGM Unpad).Understanding the level of patient satisfaction with bridge denture treatment is important in evaluating the results of treatment performed by dental profession students based on the patient's subjective perspective.This study aims to determine patient satisfaction treated by students of the Profession Program at the Prosthodontic Polyclinic RSGM Unpad with dental bridges regarding masticatory, aesthetic, and phonetic functions, denture maintenance, and psychological aspects.

MATERIALS AND METHODS
This type of research is a crosssectional descriptive study with survey techniques.The research was carried out online, accompanied by interviews via telephone calls.Data collection comes from primary data.Primary data was obtained from an online questionnaire in Google Forms containing questions given to the selected sample.The research procedure was done by distributing the Google form link to patients treated with dental bridges at the Prosthodontic Polyclinic, Dental Hospital of Universitas Padjadjaran (RSGM Unpad).
The population of this study was patients using bridge dentures who were treated by Professional Program students at the Prosthodontic Polyclinic RSGM Unpad.Period of treatment done from September 2022 to February 2023.The total population recorded was 86 patients.The sample inclusion criteria were female or male patients who were treated by Professional Program students at the Prosthodontic Polyclinic RSGM Unpad, patients who received PFM or full metal bridge denture treatment on the maxilla or mandible and had worn bridge dentures for at least 7 days until 6 months after fixed cementation and had made a control visit after the insertion of dental bridges.The sample exclusion criteria were patients with more than one dental bridge and those with a damaged one.The research sample was obtained using a saturation sampling technique.The samples obtained from this study were 82 out of 86 patients because some patients could not be contacted.
The research variable was patient satisfaction with bridge dentures at the Prosthodontic Polyclinic, RSGM Unpad.The variable assessment in this study used a modification of the Patient Denture Assessment (PDA) and an Indonesian version of PDA (PDA-ID) questionnaires that fulfilled the validity and reliability tests.The validity results using the Spearman Rank test showed that the instrument was valid with a correlation value of more than 0.3.The instrument reliability test showed that the instrument was reliable with a Cronbach's alpha value of more than 0.6, namely 0.895.The software used in this research was IBM SPSS Statistics 29.0.The questionnaire contained twelve questions to evaluate patient satisfaction wearing dental bridges based on indicators, including: masticatory function (questions 1 to 3), aesthetic function and phonetic function (questions 4 to 7), denture maintenance or home care (questions 8 to 10), and psychological aspects (questions 11 and 12).Satisfaction levels were categorized into 2, namely satisfied and dissatisfied.The measurement scale in this study was a modified Likert scale; the satisfied category received a score of 3-4, and the dissatisfied category received a score of 1-2 (Table 1).

RESULT
The total number of respondents in this study was 82 people.All respondents have three unit of bridges with the type of PFM bridges.Table 3 shows that most of the respondents were female (51.2%), aged less than 35 years (61%), and had higher education, namely from high school to university (96.5%).Most respondents had used dental bridges for 3 to 6 months (85.4%).Most respondents had dental bridges in the posterior jaw (91.5%).The patients were categorized as satisfied if the answer score was >3 and dissatisfied if the answer score was < 3.
Table 4 shows that most respondents were satisfied with the bridge denture used.Table 5 shows that the majority of patients using dental bridges were satisfied with the masticatory function (86.6%), aesthetic and phonetic functions (97.6%), maintenance dentures (82.9%), and psychological aspects (93.9%).The aesthetic and phonetic functions are the highest indicators of patient satisfaction with dental bridge use, totaling 97.6% of the respondents.

DISCUSSION
According to the Minister of Health of the Republic of Indonesia, patient satisfaction is the patient's perception of the performance of services provided by healthcare facilities. 12Patient satisfaction is essential to dental care because it can affect patient trust in dentists.Patient evaluation is an inexpensive and economical method of measuring denture success and can generate large amounts of data quickly.Satisfaction of bridge denture patients is generally not based on one factor but on many factors, such as aesthetics, masticatory function, phonetics, psychology, and patient compliance with oral hygiene. 11his study assessed patient satisfaction using dental bridges based on four indicator criteria: masticatory function, aesthetic and phonetic functions, denture maintenance (home care), and psychological aspects.Patients who wear dentures will feel an improvement in their masticatory function because the chewing pressure will be evenly distributed throughout the supporting tissues, thus maintaining and increasing chewing efficiency.Aesthetically, dentures will restore lip support to the face so that problems arising from tooth loss can be resolved.Dentures function to improve speech/phonetic functions because teeth are one of the speech tools. 13Dentures improve the appearance and give patients confidence to interact with others. 14Maintaining denture cleanliness is very important because plaque accumulates on teeth, and prosthetic restorations may be a major predisposing factor to poor oral health.Many patients have difficulty caring for their dentures and lack awareness of how to clean them.Instructions on maintaining fixed dentures are very important to avoid problems that will arise if not done properly. 15bjectively, masticatory ability can be assessed by chewing gum and assessing the color change from a score of 1 to 11. 16 The study results from the aspect of masticatory function showed that most respondents were satisfied (86.6%).These results align with research conducted by Amalia et al. 9 who stated that the satisfaction level of patients using dental bridges was quite high regarding masticatory function.The main reason patients undergo prosthodontic treatment, besides improving aesthetics, is to improve masticatory function. 17,18Patients want their dentures to be able to restore the function of missing teeth.The masticatory function was assessed by the dentures being comfortable and painless when chewing. 19p to 13.4% were dissatisfied with the masticatory function.Most dissatisfied patients stated that the jaw joint felt tired after chewing.Premature contact in dental bridges can increase masticatory muscle tension and pain in the temporomandibular joint. 20Patients with such concerns need to undergo follow-up appointments for a premature contact assessment and occlusion adjustment in their dental prostheses. 21esthetic success in dental bridge treatment depends on determining the appropriate design, such as through smile analysis, dentofacial orientation, and consideration of shape, color, position, and materials used, as well as establishing good communication between patients, dentists, and laboratory technicians. 18Phonetic examination in the form of clarity of word pronunciation is carried out by directing the patient to clearly mention the letters f, s, d, o, m, a, r, t without distractions. 22Table 3 shows that the aesthetic and phonetic indicators of the patient feel satisfied as much as 97.6% of respondents.Based on this, it can be concluded that most dental bridge patients are satisfied with their dentures in terms of aesthetics and phonetics.
It is supported by the results of a study conducted by Alma et al. 23 which showed that most patients stated that they were very satisfied with their dentures from an aesthetic and functional perspective.The item of the question that makes the respondent feel satisfied is that the dental bridges are comfortable to talk to.Dentures play a role in restoring phonetic function.Sound is produced through interactions between the tongue, palate, lips, teeth, and jaw. 14As many as 2.4% of respondents were dissatisfied with the aesthetic and phonetic functions.Most dissatisfied patients stated that the dental bridges' color, shape, and size did not meet the patient's expectations.Based on the interview results, the patient revealed that they did not dare to express his dissatisfaction with professional students and felt reluctant to make additional visits if his dentures had to be repaired.Communication between dentists and patients affects patient satisfaction and the fulfillment of patient expectations for their dentures. 24ased on indicators of denture maintenance, 82.9% of respondents who use dental bridges are known to be satisfied.These results indicate that most respondents were satisfied with the dental bridges in terms of denture maintenance.It is in line with a study by Geiballa et al. (11), which stated that most patients were satisfied with their dentures.The question item that makes the respondent feel satisfied is that the dental bridges do not irritate.Up to 17.1% of the respondents said they were dissatisfied with the denture maintenance indicators.
Most respondents who expressed dissatisfaction revealed that food often gets trapped under the dentures.Based on the interview results, the patient stated that he did not maintain good oral hygiene.When designing bridge dentures, it is important to consider the factors related to pontic design.The pontic design not attached to the mucosa will provide space between the pontic surface and the mucosal tissue.The goal is to avoid mucosal inflammation.However, this room can become a place for food residue and plaque to stick. 25Maintaining denture hygiene can reduce the accumulation of food debris and plaque as well as bacterial attachment to the denture surface. 26Patient awareness is needed to maintain oral hygiene and dentures.Routine visits can be made to educate about oral hygiene and motivate patients to maintain oral hygiene. 15Patients should be informed that a pontic design that provides a space between the pontic surface and the mucosal tissue serves to avoid irritation due to dentures, but patients should maintain additional oral hygiene.Thus, the room does not become a place for plaque accumulation.
Patients who are satisfied with using dental bridges regarding psychological aspects, namely 93.9% of respondents.It is supported by research conducted by Alma et al. 23 which stated that most patients were satisfied with their dentures.The question item that made the respondents feel the most satisfied was that dental bridges can increase self-confidence.Dentures provide comfort when used so that users feel confident and satisfied with their dentures.The quality of the dentures affects the comfort of using them.Good-quality dentures can restore missing teeth function. 27Patients who expressed dissatisfaction with psychological aspects were 6.1% of the respondents.Based on the results of interviews with patients who were dissatisfied, patients stated that they felt uncomfortable and afraid when chewing hard food.Discomfort when chewing can be caused by psychological factors or premature contact.Premature contact can cause discomfort in the jaw and pain in the area of the tooth experiencing premature contact.Patients with this case require a control visit for further examination and repair of their dentures. 28atisfaction is an essential element in the evaluation of treatment.Patient satisfaction data is an important source of information that can guide dentists in providing prosthodontic treatment according to patient expectations.Understanding the patient's perception and level of satisfaction regarding the desired aesthetic and functional aspects to improve these parameters can assist in designing strategies to plan and develop prosthetic devices. 23he limitations of this study were the limited number of samples and the short period of use of dental bridges due to the difficulty of contacting patients who had used dental bridges for more than six months.Further research must be conducted to evaluate patient satisfaction with bridge dentures used for more than six months.This research can be used as input for the Prosthodontics department, namely the need for follow-up control visits for long-term evaluation of the results of dental bridge treatment and additional education for dental bridge patients regarding bridge denture maintenance.

CONCLUSION
The majority of respondents were satisfied with the dental bridges in terms of masticatory function, aesthetic and phonetic functions, denture maintenance, and psychological aspects.

Table 2 .
Table 2 shows the satisfaction level category score based on variable indicators.Interval of patient satisfaction categories using dental bridges based on indicators

Table 3 .
Frequency distribution of the characteristics of patients who perform dental bridges treatment at the Prosthodontic Polyclinic of RSGM UNPAD (n=82)

Table 4 .
Frequency distribution of patient satisfaction using dental bridges at the RSGM Unpad Prosthodontic Polyclinic based on each question

Table 5 .
Distribution of patient satisfaction using dental bridges at the RSGM Unpad Prosthodontic Polyclinic based on indicators