The Psychological Disturbance Associated with Tooth Loss Questionnaire Revisited: Validation on a National Greek Sample

Abstract

Background. Edentulism is considered a chronic disability since tooth loss, and the required prosthodontic rehabilitation with removable prostheses might irreversibly affect function and aesthetics and significantly impact patients’ psychological well-being and social interactions. The present study aimed to translate, validate, and adapt in the native population the recently developed nine-item self-reporting psychological disturbance associated with tooth loss questionnaire (PDATL). The well-established Depression, Anxiety, and Stress Scale (DASS-21) questionnaire was also employed to identify potential emotional states of depression, anxiety, and stress caused by tooth loss and denture-wearing. Methods. For the present analysis, nationwide baseline data from two samples were used. The participants were using clinically acceptable complete or partial dentures for at least 1-year and were interviewed from May 2021 to October 2021. The dentures were fabricated in two different Dental School settings, the National Kapodistrian University of Athens (NKUA) and the Aristotle University of Thessaloniki (AUTH). Data from both clinical studies were analyzed similarly, in a parallel fashion, to enhance the generalizability of the results. Cronbach’s alpha coefficient measured internal consistency reliability, whereas Principal Component analysis using a Varimax with Kaiser Normalization rotation was subsequently performed to test the questionnaire’s internal structure regarding its pattern and structure matrix. All analyses were performed at α = 0.05 level of significance with statistical software (SPSS Statistics for Windows, v20.0; SPSS Inc. (Chicago, IL, USA)). Results. In both data sets, all items except for “discomfort/pain” and “difficult to relax” contributed significantly to the scale structure. The two items that presented weaker contributions indicated that they were redundant. DASS-21 statements revealed no severe negative emotional symptoms in both data settings. However, tooth loss was acknowledged by the participants as a critical factor of distress in their life. Conclusion. The PDATL questionnaire has several advantages since it allows for summary score calculation, and due to its shortened content, it can be easily distributed during a telephone interview. This is important in older tooth loss sufferers where digital technology has an additional advantage as it allows for remote denture fabrication through digital workflow.