Food impaction is one of the most common concerns regarding FPD (fixed partial denture) prostheses. However, the dentist often ignores these symptoms, which causes the patient to experience pain over time. The present study aimed to investigate the knowledge of dental professionals regarding the management of food impaction associated with fixed partial denture prostheses in Riyadh. An online survey was used to conduct this cross-sectional investigation among Riyadh's dentistry practitioners. The participants were requested to complete the survey after contacting Riyadh's hospitals and dental facilities. The participants were requested to complete the survey after contacting Riyadh's hospitals and dental facilities. An online survey was created that asked questions about personal information and demographics before asking questions about the impact of food and how to handle it. Of the 410 dental practitioners who responded to the survey, 39% were female and 61% were male. In terms of educational qualifications, 28% had a master's degree or Saudi board post-graduation, and 72% had a bachelor's degree in dentistry. It is necessary to enhance the attitudes of dentists when instructing or fabricating for lab staff.
Introduction
For prosthodontic rehabilitation, FPD (fixed partial dentures), are frequently utilized [1]. On the other hand, maintaining it is equally important. The two most frequent symptoms from patients with FDP are food impaction and Dislodging of the prostheses. To minimize these occurrences and satisfy the patient's expectations, the practitioner should be aware of the food-impaction elements that contribute to FDP failures [2, 3].
To minimize the negative effects of any food impaction, the dentist should be included in the process of choosing pontic designs and should be better informed about the selection of pontic designs for various circumstances [4].
Food impaction remains amongst the most frequent concerns regarding fixed partial denture (FPD) prostheses. However, the dentist frequently ignores these symptoms, which causes the patient to experience pain over time. Therefore, before administering treatment, the practitioner should be able to assess the factors causing the food impaction. Instead of treating the underlying problem, a patient is typically treated for symptoms. The most common complaints from patients are discomfort, bleeding gums, and halitosis. In the future, improper treatment of the FI might lead to interdental bone loss, gingival abscess formation, secondary caries, and periodontal pockets [5]. Patients typically utilize dental floss, proximal brushes, or toothpicks to temporarily relieve their pain. However, increasing the frequency of such use exacerbates inflammation and causes patients to become more frustrated [6, 7].
In the future, improper treatment of the FI might lead to interdental bone loss, gingival abscess formation, secondary caries, and periodontal pockets [5]. Patients typically utilize dental floss, proximal brushes, or toothpicks to temporarily relieve their pain. However, increasing the frequency of such use exacerbates inflammation and causes patients to become more frustrated [8].
In a related study, it was found that while the knowledge was suitable, there were some gaps. Additionally, it was shown that as educational attainment increased, so did knowledge and practice [9]. Lack of understanding and practice regarding interdental cleaning, according to another study was reported. Thus, it is necessary to implement public education initiatives to raise awareness, knowledge, and practice [10].
According to a different study conducted in India, dental professionals are sufficiently knowledgeable to provide an accurate assessment, but there are still certain knowledge gaps that call for additional instruction in these areas in the undergraduate dental curriculum [11].
Study hypotheses
There was a low score of dental professionals' knowledge about the effect and management of food impaction regarding FPDs.
Aims
Materials and Methods
Study design
This cross-sectional research was conducted among dental professionals in Riyadh through an online survey.
Sample
The participants were requested to complete the survey after contacting Riyadh's hospitals and dental facilities.
Instrument
An online questionnaire was made including questions about personal and demographic data followed by questions about the impact of food and its management.
Instrument reliability and validity
Twenty participants completed the survey as part of a pilot study, and Chronbach's coefficient alpha was used to evaluate the data reliability. The questionnaire was sent to REU experts to assess its validity, but no modifications were made.
Statistical analysis
Collected data were evaluated by SPSS version 22, where inferential and descriptive statistics were done. P-value < 0.05 was announced as the significance level using the test of Chi-square.
Results and Discussion
The survey was completed by 410 dental professionals, 39% of whom were female and 61% of whom were male (Figure 1). In terms of their credentials, 28% had completed a master's degree or Saudi board post-graduation, and 72% were BDS (Figure 2). Regarding their employment experience, 67% had less than five years and 33% had more than five years (Figure 3). The frequencies of answers to the questionnaire's questions are displayed in Table 1. In the last six months, 51.8% of the individuals who took part in the study had seen fewer than five patients with food impaction complaints; the primary complaint was pain when biting; 68.7% of patients were occasionally conscious of any food impaction; the posterior lower jaw region was the region with the greatest incidence of FI (41%); 50.6% of patients according to food being effected in interproximal spaces; 48.2% indicated caries as a result of FI; 51.8% cited poor prosthesis design as the FI cause; the majority (53%) supported repeating the FPD as a therapy for FI; 28.9% said that patients generally responded well to the therapy; and 37.3% reported that symptoms mostly went away after therapy.
The comparison of survey responses by qualification is displayed in Table 2, and most of the differences are statistically significant. The most common contributing factors for the defective FPD reported by GPs were poor marginal adaptation and inadequate crown contouring by the specialists (P-value = .009), 30% of experts had received more than 10 cases over six months compared to 17% of general practitioners (P-value = .007), 43% of specialists stated caries as the FI major consequence compared to 61% of experts (P-value = .009), experts were more stringent about providing the lab technician with the necessary information than general practitioners (P-value = .000), and 35% of experts stated that symptoms had completely subsided after therapy, compared to 10% of GPs (P-value = .000).
A comparison of survey responses by work experience is shown in Table 3, where most of the differences are also of statistical significance. For example, 41% of experienced dentists reported receiving over ten instances in the last six months, compared to 17% of less practiced practitioners (P-value = .000); 22% of less practiced practitioners stated that FI happened in posteriors of maxillary, compared to 32% of more practiced dentists (P-value = .000); the most common contributing factors to faulty FPD stated by less practiced practitioners were poor margin adaptation and improper crown contour by more practiced dentists (P-value = .009).
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Figure 1. The ratio of the gender of study participants |
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Figure 2. Study participant's qualifications |
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Figure 3. Study participant's work experience |
Table 1. Frequency of responses from study participants
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Questions of survey |
Frequency of responses |
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Patients number reporting food impaction complaints in last 6 months |
< 5: 51.8% 5-10: 27.7% > 10: 20.5% |
|
Presenting complaints along with food impaction |
Pain: 41% Bleeding gums: 24.1% Halitosis: 24.1% Any other: 10.8% |
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Were the patients aware of the food impaction occurrence? |
Never: 7.2% Sometimes: 68.7% Mostly: 15.7% Always: 8.4% |
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Time elapsed after prosthesis fabrication when food impaction happened |
< 6 months: 50.6% 6 months-1 year: 34.9% > 1 year: 14.5% |
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Food impaction common site about FPD/crown |
Anterior region of the maxilla: 6% Posterior region of the maxilla: 28.9% Anterior region of the mandibular: 9.6% Posterior region of the mandibular: 41% No particular region: 14.5% |
|
Main surfaces involved in food impaction |
labial/buccal: 16.9% lingual/palatal: 14.5% interproximal: 50.6% area beneath pontic: 18.1% |
|
Food impaction observed consequences |
Proximal decay of teeth adjacent to abutment teeth: 48.2% Secondary decay under the crown about abutment: 21.7% Pocket formation about adjacent abutment teeth and abutment teeth: 20.5% Interproximal bone loss between the adjacent and abutment teeth: 9.6% |
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The presence of interdental aids use |
Never: 31.3% Sometimes: 57.8% Mostly: 7.2% Always: 3.6% |
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If yes, interdental aids utilized by the patient |
Dental floss: 37.3% Interproximal toothbrush: 13.3% Toothpicks: 15.7% Anything else: 13.3% Not applicable: 20.5% |
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The most likely reason for the lodgment of food |
Faulty FPD/crown design: 51.8% Improperly restoration of adjacent teeth: 33.7% Improper opposing teeth alignment: 3.6% Others: 10.8% |
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Contributory factors for the design of faulty FPD |
Improper connection of the crown to the crown or adjacent tooth: 30.1% Improper crown contour: 30.1% Improper pontic design: 12% Poor crown margin adaptation: 27.7% |
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Treatment cases considered |
Redoing the FPD: 53% Adjacent tooth refilling: 12% Changing the existing restoration on an adjacent tooth: 15.7% Blocking the contact area of interproximal: 6% Prescribing interdental aids: 8.4% Others: 4.8% |
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Was the essential information associated with the novel design of FPD linked to the lab technician? |
Never: 8.4% Sometimes: 59% Mostly: 20.5% Always: 12% |
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Did the patients respond to the prescribed therapy satisfactorily? |
Never: 7.2% Sometimes: 51.8% Mostly: 28.9% Always: 12% |
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Consultants/experts to whom these people can be referred |
Prosthodontist: 62.7% Periodontist: 26.5% Any other: 10.8% |
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Did the food impaction subside symptoms after the final treatment? |
Never: 8.4% Sometimes: 37.3% Mostly: 37.3% Always: 16.9% |
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Recall was accomplished after how long |
Once every month: 20.5% Once a year: 55.4% Once every 2 years: 13.3% No appointment was made for a recall: 10.8% |
Table 2. Comparisons of survey responses based on qualification
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Questions of survey |
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BDS |
Masters/Board |
P-value |
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Patients number reporting food impaction complaints in last 6 months |
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< 5: 55% 5-10: 28% > 10: 17% |
< 5: 43% 5-10: 26% > 10: 30% |
.007 |
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Presenting complaints along with impaction of food |
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Pain: 45% Bleeding gums: 23% Halitosis: 23% Any other: 8% |
Pain: 30% Bleeding gums: 26% Halitosis: 26% Any other: 17% |
.011 |
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Were the people aware of the impaction of food occurrence? |
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Never: 5% Sometimes: 72% Mostly: 17% Always: 7% |
Never: 13% Sometimes: 61% Mostly: 13% Always: 13% |
.004 |
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Time elapsed after prosthesis fabrication when impaction of food happened |
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< 6 months: 53% 6 months-1 year: 37% > 1 year: 10% |
< 6 months: 43% 6 months-1 year: 30% > 1 year: 26% |
.000 |
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Food impaction common site about FPD/crown |
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Anterior region of upper: 7% Posterior region of upper: 33% Anterior region of mandibular: 7% Posterior region of mandibular: 38% No particular region: 15% |
Anterior region of upper: 4% Posterior region of upper: 17% Anterior region of mandibular: 17% Posterior region of mandibular: 48% No particular region: 13% |
.000 |
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Main surfaces involved in the impaction of food |
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labial/buccal: 20% lingual/palatal: 12% interproximal: 50% area beneath pontic: 18% |
labial/buccal: 9% lingual/palatal: 22% interproximal: 52% area beneath pontic: 17% |
.007 |
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Consequences of food impaction observed |
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Proximal decay of teeth adjacent to abutment teeth: 43% Secondary decay beneath the crown about the abutment: 25% Pocket formation about the adjacent abutment teeth and abutment teeth: 22% Interproximal bone loss between two adjacent teeth and the abutment: 10% |
Proximal decay of teeth adjacent to abutment teeth: 61% Secondary decay beneath the crown about the abutment: 13% Pocket formation about the adjacent abutment teeth and abutment teeth: 17% Interproximal bone loss between two adjacent teeth and the abutment: 9% |
.009 |
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The presence of interdental aids use |
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Never: 30% Sometimes: 62% Mostly: 7% Always: 2% |
Never: 35% Sometimes: 48% Mostly: 9% Always: 9% |
.002 |
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If yes, interdental aids utilized by the patient |
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Dental floss: 37% Interproximal toothbrush: 13% Toothpicks: 13% Anything else: 17% Not applicable: 20% |
Dental floss: 39% Interproximal toothbrush: 13% Toothpicks: 22% Anything else: 4% Not applicable: 22% |
.009 |
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The most likely reason for the lodgment of food |
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Faulty FPD/crown design: 53% Improperly restoration of adjacent teeth: 35% Improper alignment of opposing teeth: 5% Others: 7% |
Faulty FPD/crown design: 48% Improperly restoration of adjacent teeth: 30% Improper opposing teeth alignment: 0% Others: 22% |
.000 |
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Contributory factors for the design of faulty FPD |
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Improper connection of the crown to the crown or adjacent tooth: 28% Improper crown contour: 27% Improper design of pontic: 15% Poor crown margin adaptation: 30% |
Improper connection of the crown to the crown or adjacent tooth: 35% Improper crown contour: 39% Improper design of pontic: 4% Poor crown margin adaptation: 22% |
.002 |
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Treatment options considered |
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Redoing the FPD: 50% Adjacent tooth refilling: 5% Changing the existing restoration on an adjacent tooth: 20% Blocking the contact area of interproximal: 8% Prescribing interdental aids: 12% Others: 5% |
Redoing the FPD: 61% Adjacent tooth refilling: 30% Changing the existing restoration on an adjacent tooth: 4% Blocking the contact area of interproximal: 0% Prescribing interdental aids: 0% Others: 4% |
.000 |
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Was the essential information associated with the novel design of FPD linked to the lab technician? |
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Never: 10% Sometimes: 58% Mostly: 23% Always: 8% |
Never: 4% Sometimes: 61% Mostly: 13% Always: 22% |
.000 |
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Did the people respond to the prescribed therapy satisfactorily? |
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Never: 10% Sometimes: 52% Mostly: 30% Always: 8% |
Never: 0% Sometimes: 52% Mostly: 26% Always: 22% |
.000 |
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Consultants / Specialists to whom these people can be referred |
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There is no statistically significant relationship. |
.670 |
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Did the food impaction subside symptoms after the final therapy? |
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Never: 8% Sometimes: 40% Mostly: 42% Always: 10% |
Never: 9% Sometimes: 30% Mostly: 26% Always: 35% |
.000 |
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Recall was accomplished after how long |
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There is no statistically significant relationship. |
.331 |
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Table 3. Comparisons of survey responses based on work experience
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Questions of survey |
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< 5 years |
> 5 years |
P-value |
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Patients number reporting food impaction complaints in last 6 months |
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< 5: 61% 5-10: 29% > 10: 11% |
< 5: 33% 5-10: 26% > 10: 41% |
.000 |
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Presenting complaints along with impaction of food |
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Pain: 41% Bleeding gums: 20% Halitosis: 30% Any other: 9% |
Pain: 41% Bleeding gums: 33% Halitosis: 11% Any other: 15% |
.000 |
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Were the people aware of the impaction of food occurrence? |
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There is no statistically significant relationship. |
.082 |
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Time elapsed after prosthesis fabrication when impaction of food happened |
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< 6 months: 59% 6 months-1 year: 32% > 1 year: 9% |
< 6 months: 33% 6 months-1 year: 41% > 1 year: 26% |
.000 |
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Food impaction common site about FPD/crown |
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Anterior region of maxillary: 5% Posterior region of maxillary: 32% Anterior region of mandibular: 7% Posterior region of mandibular: 45% No particular region: 11% |
Anterior region of maxillary: 7% Posterior region of maxillary: 22% Anterior region of mandibular: 15% Posterior region of mandibular: 33% No particular region: 22% |
.000 |
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Main surfaces involved in the impaction of food |
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There is no statistically significant relationship. |
.098 |
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Consequences of food impaction observed |
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There is no statistically significant relationship. |
.205 |
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The presence of interdental aids use |
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Never: 32% Sometimes: 52% Mostly: 7% Always: 2% |
Never: 30% Sometimes: 56% Mostly: 7% Always: 7% |
.040 |
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If yes, interdental aids utilized by the patient |
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Dental floss: 39% Interproximal toothbrush: 14% Toothpicks: 13% Anything else: 18% Not applicable: 16% |
Dental floss: 33% Interproximal toothbrush: 11% Toothpicks: 22% Anything else: 4% Not applicable: 30% |
.000 |
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The most likely reason for the lodgment of food |
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Faulty FPD/crown design: 50% Improperly restoration of adjacent teeth: 38% Improper opposing teeth alignment: 5% Others: 7% |
Faulty FPD/crown design: 56% Improperly restoration of adjacent teeth:26% Improper opposing teeth alignment: 0% Others: 19% |
.000 |
|
Contributory factors for the design of faulty FPD |
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Improper connection of the crown to the crown or adjacent tooth: 27% Improper crown contour: 27% Improper design of pontic: 16% Poor crown margin adaptation: 30% |
Improper connection of the crown to the crown or adjacent tooth: 37% Improper crown contour: 37% Improper design of pontic: 4% Poor crown margin adaptation: 22% |
.000 |
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Treatment options considered |
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Redoing the FPD: 46% Adjacent tooth refilling: 9% Changing the existing restoration on an adjacent tooth: 21% Blocking the area of interproximal contact: 9% Prescribing interdental aids: 13% Others: 2% |
Redoing the FPD: 67% Adjacent tooth refilling: 19% Changing the existing restoration on an adjacent tooth: 4% Blocking the area of interproximal contact: 0% Prescribing interdental aids: 0% Others: 11% |
.000 |
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Was the essential information associated with the novel design of FPD linked to the lab technician? |
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There is no statistically significant relationship. |
.000 |
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Did the people respond to the prescribed therapy satisfactorily? |
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Never: 11% Sometimes: 52% Mostly: 30% Always: 7% |
Never: 0% Sometimes: 52% Mostly: 26% Always: 22% |
.000 |
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Consultants / Specialists to whom these people can be referred |
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There is no statistically significant relationship. |
.572 |
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Did the food impaction subside symptoms after the final therapy? |
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Never: 11% Sometimes: 36% Mostly: 39% Always: 14% |
Never: 4% Sometimes: 41% Mostly: 33% Always: 22% |
.017 |
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Recall was accomplished after how long |
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Once every month: 21% Once a year: 57% Once every 2 years: 9% No appointment was made for a recall: 13% |
Once every month: 19% Once a year: 52% Once every 2 years: 22% No appointment was made for a recall: 7% |
.002 |
The goal of the current study was to ascertain the dental professionals' knowledge and approach to food impaction issues about fixed partial dentures. Inflammation that results in pain, bleeding, and edema surrounding the mucosa is caused by untreated and persistent food impaction around a fixed prosthesis. Additionally, it plays a role in the development of pocket formation, papillary loss, halitosis, tooth movement, and bone loss. Understanding the distinctions between food lodgment and food impaction is crucial. Lodgment of food is the simple accumulation of debris and food particles in the mucosa around the permanent prosthesis, which can be eliminated by the body's normal self-cleaning processes, as opposed to food impaction, which is a more chronic problem. Clinicians should therefore recall and check patients for the faulty development or contacts of open proximal and occlusion every 3–6 months to prevent the food impaction onset around the prosthesis [12]. However, only 20.5% of our study participants regularly followed this practice every month.
According to survey participants, the primary reason for food impaction is a flawed FPD or crown design. The easiest way to avoid food impaction from a poorly made restoration is to take the right safeguards when constructing the prosthesis. Heat-pressed glass-ceramic material has been widely employed for restoration in recent years. In people who have maintained adjacency communication between the distal and proximal middle surfaces of their teeth, it can reduce the likelihood of food impact. When it came to reducing food impaction and achieving a satisfactory edge closure, the repair of the surrounding area did not perform any better than the conventional whole-crown restoration [13].
Our research revealed that the most frequent issue with food impaction and prosthesis was pain, which was followed by halitosis and bleeding gums. A related study by Ashok and Sangeetha [14] in Chennai, India, enumerated the typical issues with permanent prosthesis and revealed that 40% of patients had experienced pain and halitosis as a result of food impaction [14]. Poor patient care following insertion accounts for the majority of FPD failures, with the remaining ones being caused by flawed design and subpar laboratory and clinical procedure execution. About the second problem, it was observed that 59% of our study sample infrequently provided the lab technician with the information they needed regarding the new FPD design.
When our respondents' comments were compared to those of another study of a similar nature by Nagarsekar et al. [6], it was found that the majority of frequent complaints that their dentists received from individuals were bleeding gums. However, according to a similar question in our study, the most frequent presenting complaint was discomfort. Furthermore, the majority of dentists indicated the posterior mandibular region as the common site of food impaction when asked, which is consistent with the reports from research participants. Additionally, the Indian study reported redoing the FPD when asked about therapy choices for food impaction; this was comparable to what we obtained from our research samples. Finally, recall time was reported to be once a year among most dentists in their research, which was also like to our research observations.
Conclusion
In conclusion, The dentist's attitude when giving or fabricating instructions to technicians of the lab requires to be improved. Our study participants appear to have few options for treating food impaction; therefore, they should broaden their horizons and read up on current research to enhance their understanding and application. The attitude and experience of consultants/specialists participating in this research were reported remarkably better as compared to general practitioners. Compared to recent graduates, dentists with more expertise had greater exposure and a more positive attitude about managing the issue of impaction of food.
Acknowledgments: The authors of this study would like to acknowledge the support and cooperation of the research center of Riyadh Elm University.
Conflict of Interest: None
Financial Support: None
Ethics Statement: None
