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Deciding on dentures
| The province of Quebec has the highest population of edentulous people — people who are missing all of their teeth — in North America. To make matters worse, edentulous people are generally either poor or elderly and don't always get the best treatment.
PHOTO: OWEN EGAN
Dentistry professor Jocelyne Feine is attacking the problem by studying cost-effectiveness and health benefits of traditional dentures versus dental implants.
"We are looking at the cost-effectiveness ratios — taking all costs into account — and we define the effectiveness as the patients' satisfaction with the treatment. In previous studies, we've seen that patients are significantly more satisfied with implant prostheses than with more traditional dentures.
"Implant prostheses are more costly in the short term, but we want to know whether it has a greater cost-effectiveness ratio, which means it would really be less costly in the long run."
Implant dentures are surgically placed into the bones of the lower jaw, which adheres to and holds them tightly in place. Conventional dentures, which are removable, can be less comfortable and less stable, making it more difficult to chew solid food.
"With dentures which don't fit well, patients have to eat mostly mushy food like stews and soups. But with implants, edentulous people may show improved nutrition since they can eat more fruits and vegetables, for example."
Feine hopes that health coverage for dental care will improve in the wake of studies like hers.
"If we show that people with implant dentures are healthier and have a better quality of life, and that conventional dentures are not much cheaper in the long run, because of greater replacement and adjustment costs, then perhaps insurance companies and the government may be more likely to consider funding implants."
Currently, medicare only pays for conventional dentures, and only for people on welfare.
"The government is trying to maintain their budget, and the last thing they want is to start paying more for a condition that they don't realize has a huge impact on quality of life and health. Unless there are studies like this, that won't change."
Feine says that her research is part of a new, patient-centred trend in medicine, in which patients are actively involved in choosing their treatment, and changing it if they feel it is not working.
Another study she is conducting has implications in all fields of medicine. Working with Jewish General Hospital psychologist Zeev Rosberger, Feine is assessing the efficacy of a coping strategy called NUCARE for breast cancer patients. The intention is to examine a subject which is rarely broached in medical literature: the impact of patient preference on effectiveness of treatments.
"When you're using patient-based outcomes, you're not just giving them treatment and then putting them on some sort of physiological testing equipment. You're asking them about how much pain they have, about their quality of life... patient's preferences can give a more realistic idea of the true effectiveness of a treatment."
Along those lines, Feine and Rosberger are founding a Centre for Psychosocial Health Research, which will be a McGill/Jewish General partnership.
"Many studies only look at physiological outcomes; for example, in the case of a surgical hip replacement, they might look at the degrees of movement the patient can make in a laboratory setting. This centre will be a data bank and research centre on studies which look at patients' psychological state and social state after treatment. Up until recently, that's really been the missing piece of the puzzle, when it comes to assessing the quality of treatment."
Feine's research is funded by the Canadian Medical Research Council, the Fonds de recherche en santé du Québec (FRSQ) the National Cancer Institute of Canada and private industrial sources.