REMOVABLE

LOUIS BLATTERFEIN,

PROSTHODONTICS
ROBERT M. MORROW, S. HOWARD PAYNE, Section editors

Measurement to patient

of

personality with

traits complete

and

their dentures

relation

satisfaction

Mary Smith, B.D.S., L.D.S.R.C.S., MS.* The Ohio State University, College of Dentistry,

Columbus,

Ohio

J-he loss of all the teeth is a traumatic event in a persons life. Subsequent adaptation to complete dentures is influenced considerably by the ability of the person to come to terms with the edentulous condition. Satisfaction with dentures is thought to be influenced primarily by the persons personality. The technical quality of the dentures, however, may be of secondary importance. DeVan and Miller2 have suggested that the technical quality accounts for less than half of the total success of the dentures. Even the concept of success itself often is defined differently by dentists and patients, since dentists consider dentures to be successful when they meet certain technical standards, whereas patients evaluate them from the viewpoint of their personal satisfaction. DeVan3 Heartwell, and others consider that the dentists ability to understand a patients psychologic makeup frequently determines whether the patient will accept or reject dentures. House was an early leader in this field. He classified his patients into the four personality types of philosophic, exacting, hysterical, and indifferent and predicted their denture success accordingly. To attempt to clarify these rather nebulous relationships, a study was organized to determine the incidence of the personality traits of hypochondriasis, depression, hysteria, and manifest anxiety in patients being treated for new complete dentures. Then traits were statistically related to the patients satisfaction with their dentures and to the actual technical quality of the dentures. All information was gathered by means of several questionnaires. This article was condensed from a thesis presented in partial fulfillment ments for a Master of Science degree at The Ohio State University.
Read before The Academy of Denture Prosthetics, Washington, D. C. *Formerly, Assistant Professor, Department of Removable Prosthodontics.

of the require-

492

Volume 35 Number 5

Personality

and satisfaction

with

dentures

493

SELECTION OF PATIENTS FOR THE STUDY

Seventy complete denture patients were selected at random from those under treatment in the graduate and undergraduate clinics of the College of Dentistry at The Ohio State University. In order to participate, the patient had to answer the questionnaires after the purpose of the project was explained and return six weeks after placement of the new dentures for examination of the dentures by a panel of dentists. The patient must have successfully completed six years of school. This educational level was necessary to answer the questionnaires without difficulty.0 Elderly or physically handicapped patients were not included in the study, since it would be inconvenient for them to return for the extra visit. The standard methods of the College of Dentistry were used for denture construction.7

EVALUATION OF PERSONALITY
Personality can be assessed by use of interviews, questionnaires, self-rating tests, and projective tests such as the ink blot test.8 The questionnaire was chosen for this study because of its ease of administration and evaluation by someone with no training in psychology. For this study the questionnaire chosen was a shortened form of the M.M.P.I.,* since this personality questionnaire is believed to give one of the most accurate profiles of a persons personality. The M.M.P.I. consists of 556 true-false questions which, when scored, measure the personality traits of hypochondria&, depression, hysteria, psychopathic deviations, masculinity and feminity, paranoia, psychasthenia, schizophrenia, and hypomania. The trait of manifest anxiety can also be measured on the M.M.P.I. by using a scale developed by Taylor.g The validity of this scale has been tested and verified. In this study, only the traits of hypochondriasis, depression, hysteria, and manifest anxiety were measured, since they are thought to have an effect on patient satisfaction with complete dentures. The shortened M.M.P.I. was completed for each patient on the day of placement of the new dentures but before the dentures were delivered. This was done to standardize the time of administering the questionnaire to avoid possible effects of the new dentures on the personality of the patient. Each patient was given a code number, and the strict confidentiality of his answers was emphasized. He was asked to read the instructions which were then repeated verbally. The first two questions were then rehearsed with the patient to ensure his understanding of how they were to be answered, No help was given with the interpretation of any questions, and no interruptions were allowed. The shortened M.M.P.I. was scored using stencils,1 and a score was obtained for each patient for each of the four personality traits. The raw scores were then converted to T-scores using tables formulated by the inventors of the M.M.P.1.l These T-scores were formulated in such a way that a theoretically normal person has a T-score of 50 + 10 for each trait. *Minnesota
N. Y. Multiphasic Personality Inventory, Psychological Corporation, New York,

494

Smith

J. Prosthet. Dent. May, 1976

The so-called normal group had scores of under 60 or nonelevated scores. The subjects exhibiting the trait being tested had scores of over 60 or elevated scores. EVALUATION OF PATIENT SATISFACTION WITH NEW COMPLETE DENTURES

After the patients had worn their new complete dentures for six weeks, they were asked to return for evaluation of their dentures. Fifty of the original 70 returned. The 20 who did not were sent the patient-satisfaction questionnaire, and of these, 13 completed and returned the form. At this appointment, the patients first answered the questionnaire on patient satisfaction. This questionnaire was based on the one used by Bolender and coworkerP in their study in 1963. This questionnaire was modified to emphasize the patients degree of satisfaction with rather than the patients opinion of certain aspects of the dentures. The new questionnaire covered the same six aspects of comfort, ability to taste, ability to eat, fit, appearance, and speech plus a question on general satisfaction. Each question was placed on a separate sheet with the item under question at the top of the page. This helped the patient to concentrate on one question at a time. Each question could be answered by a response of very satisfied (e.g., I am very satisfied with how I look with my new teeth . . . they have a nice, natural appearance . . . ) or by a response of fairly satisfied (e.g., I am fairly satisfied with how I look with my new teeth, but I feel I could look a little better . . .) or they could answer, very dissatisfied (e.g., I am very dissatisfied with how I look with my new teeth-they do not look at all the way I would like . . .). Since it was believed that these responses would be very subjective, rather than trying to assess a general satisfaction score from all the answers, the individual answers were analyzed. A patients general satisfaction with the dentures was assessed by his answer to the question on general satisfaction. EVALUATION OF THE TECHNICAL QUALITY OF THE DENTURES

After the questionnaire on patient satisfaction had been answered, the technical quality of the dentures was evaluated by a panel of four dentists. A panel of four was used, since Rayson and associates I3 showed that a subjective evaluation by one dentist is not reliable. A questionnaire was designed to objectively determine the quality of certain features of the dentures. Eight questions were asked concerning centric relation, vertical relation, balanced occlusion, retention, stability, esthetics, condition of soft tissues, and the character of the denture support. Of these questions, only the first six were used in scoring the technical quality of the dentures. Each question had two parts. In order to avoid variation, the first part told the dentist how to test for each condition. The second part gave a list of possible results. The four dentists were required to mark the appropriate responses in the exact order previously listed to ensure that their opinions were not influenced by the mouth conditions. The patients were asked not to converse with the dentists so as not to influence the dentists opinions. The dentists were not aware of the results on any of the questionnaires or the other dentists opinions. The dentures were examined on the same day that the patient-satisfaction questionnaire was given, since any adjust-

Volume 35 Number 5

Personality

and satisfaction

with

dentures

495

ments of the dentures afterward might have modified the answers on the technicalquality questionnaire without the necessary modification to the patient-satisfaction questionnaire. The scoring system was designed to weigh certain technical features according to their considered importance in the over-all technical quality of the dentures. The harmony of centric occlusion with centric relation was tested by observing the intercuspation of the teeth when the mandible was pulled back as far as it would go and the patient made light contact. Vertical relation was determined by noting the space between the premolars when the patient was speaking. Vertical relation was scored with centric relation, since by definition, centric relation is the most posterior relation of the mandible to the maxillae at the established vertical relation. I4 Since maximum stability and efficiency of complete dentures are obtained only when centric occlusion coincides with centric relation, harmony of centric occlusion with centric relation was considered to be the most important feature of the new dentures. Therefore, if centric occlusion was in harmony with centric relation at the correct vertical relation, 12 points were given; if centric occlusion was in harmony with centric relation at an incorrect vertical relation, 6 points were given; and if centric occlusion was not in harmony with centric relation, no points were given. Balanced occlusion is important in complete dentures. However, it is difficult to evaluate in the mouth because of the soft tissue displacement which occurs on eccentric jaw movements. The test for balanced occlusion consisted of placing a wire between the central incisors and asking the patient to close the teeth lightly together and then move the lower jaw from side to side and forward. The movement of the wire was watched. Since this test showed only whether a smooth articulation was present, irrespective of the stability of the dentures, a maximum of 6 points was assigned to balanced occlusion : the wire moved very little, 6 points; there was some movement of the wire, 3 points; and there were gross movements of the wire, no (0) points. Retention of the maxillary denture was tested by pulling on the central incisors after they had been dried with gauze. The retention of the mandibular denture was tested by applying a backward and upward force with a wooden pointer. Since retention is dependent on the supporting structures as well as the quality of the denture, a maximum of 4 points was assigned for retention, 2 points for each denture, as follows: extremely difficult to dislodge the denture = 2 points; some resistance felt before dislodging denture = 1 point; and no resistance to dislodgment felt = 0 points. To test stability for both dentures, the index fingers were placed on the first molars. First, a direct pressure was applied equally on both sides; then a direct pressure was applied first on one side and then on the other; and then a rotational force was applied. An additional test for stability of the mandibular denture was to ask the patient first to protrude the tongue and then to touch first one cheek and then the other cheek with the tongue, noting the movement of the denture. Since these tests for stability are also very dependent on the supporting structures, again a maximum of four points was assigned: minimal movement on applying di-

496 Table

Smith

J. Prosthet. Dent. May, 1976

I. Incidence of the personality traits of hypochondria&, and manifest anxiety

Tom1 group Trait No. 22 48 27. 43 32 38 17 53 1 96 32.4 68.6 38.6 61.4 45.7 54.3 24.3 75.7 No. 4 21 8 17 11 14 1 24 Men 1

depression, hysteria,

Women 96 16 84 32 68 44 56 4 96 No. 18 27 19 26 21 24 16 29 ( 96 40 60 42.2 57.8 46.7 53.3 35.6 64.4

Hypochondria& Elevated score Nonelevated score Depression Elevated score Nonelevated score Hysteria Elevated score Nonelevated score Manifest anxiety Elevated score Nonelevated score

Table

II. Distribution

of the answers to questionnaire on patient satisfaction with

dentures
Answers Very satisfied Questions 1. Comfort 2. Fit 3. Speech 4. Appearance 5. Ability to eat 6. Ability to taste 7. General satisfaction Men Women No. 32 31 39 41 33 51 40 17 30 1 56 50.8 49.2 61.9 74.6 52.4 81.0 63.5 68.0 66.6 Fairly satisfied No. 18 26 21 10 20 11 15 6 9 1 96 28.6 41.3 33.3 15.9 31.7 17.5 23.8 24.0 20.0 Dissatisfied No. 13 6 3 6 10 1 8 2 6 1 A 20.6 9.5 4.8 9.5 15.9 1.6 12.7 8.0 13.4

rect and rotational pressures = 2 points; some movement on applying either direct pressure or rotational pressure = 1 point; and dentures tended to slide and rotate with applied pressure = 0 points. The esthetic quality of the dentures was scored in two parts. The first part was an observation of the harmony between the shape and color of the teeth and the patients face: teeth in harmony with the patients face = 4 points; size and shape of the teeth not in harmony with the patients face = 0 points; and color of the teeth not in harmony with the patients face = 0 points. The second part consisted of an evaluation of the anteroposterior position of the anterior teeth and the orientation of the occlusal plane, The anteroposterior position of the teeth was evaluated by watching the relationship of the teeth to the lip when

Volume 35 Number 5

Personality

and satisfaction

with

dentures

497

Table III. Evaluation of technical quality of dentures

Evaluation 1. Centric occlusion in harmony with centric relation Yes No No. 23 % 46 30 24 68 32

Split decision
2. Vertical relation of occlusion

15 12
34

Correct Incorrect
3. Balanced occlusion

16 20 25 5

Smootharticulation Few interferences

Many interferences
4. Retention

40 50 10

Upper: Good Fair Poor Lower: Good Fair Poor

5. Stability

40 9 1 17 24 9

80 18 2 34 48 18

Upper: Good Fair Poor Lower: Good Fair Poor

6. Appearance

29 20 1 28 21 1 26 15 9 17 6 27

58 40 2 56
42 2

Teeth in harmony with face Teeth not in harmony with face Split decision Teeth in correct A-P position* Teeth in incorrect A-P position Correct position but regular *Anteroposterior position.

52 30 18 34 12 54

.the patient was pronouncing certain letters. This part was scored as follows: teeth in the correct anteroposterior position for the patient with a natural arrangement and the correct occlusal plane = 4 points; teeth in the correct anteroposterior position but with a picket fence arrangement or an incorrect occlusal plane = 2 points; and teeth in the wrong anteroposterior position for the patient = 0 points. The points from each question were added to arrive at a total score for the dentures. The mean total score of the four dentists was then used to place the dentures into four categories as follows: Category 1, excellent dentures (30 to 34 points) ; Category 2, good dentures (23 to 29 points) ; Category 3, fair dentures ( 17 IO 22 points) ; and Category 4, poor dentures (0 to 16 points). The categories were arranged so that it was impossible for dentures with dis-

498

Smith

.J. Prosthet. Dent. May, 1976

harmony between centric occlusion and centric relation to be placed in Category 1 01 2. It should be noted that dentures could be rated as excellent despite poor supporting tissues because the questions on retention and stability were given low priority. RESULTS Part I. Distribution and the technical

of patients by personality quality of the dentures

traits,

satisfaction

with

dentures,

Personality traits. The distribution of the personality traits of hypochondriasis, depression, hysteria, and manifest anxiety in the 70 men and women is shown in Table I. The most common trait exhibited was hysteria, with 32 (46 per cent) of the total group showing this trait and with similar percentages for men and women. The traits of hypochondriasis and manifest anxiety, however, were much more evident in women than in men. The least-exhibited trait was manifest anxiety with only 24 per cent of the total group showing this trait. There was wide variation in the percentages for the men showing each personality trait, whereas the women showed similar percentages for each trait. Patient satisfaction. Table II shows the distribution of the answers to the second questionnaire concerning patient satisfaction with dentures. Sixty-three patients answered this questionnaire. Question 7 asked, In general, how satisfied are you with your new dentures? Forty patients (63 per cent) out of the 63 answered very satisfied, 15 (24 per cent) answered fairly satisfied, and eight (13 per cent) answered dissatisfied. Analysis of the answers to the more specific questions (Questions 1 to 6) revealed that most patients were very satisfied with their appearance (75 per cent) and ability to taste food (81 per cent). Very few patients were dissatisfied with their ability to taste food (2 per cent) and speak (5 per cent). The most dissatisfaction was with comfort (21 per cent) and ability to eat (16 per cent). Technical quality of the dentures. Table III shows the distributions of the results of the denture examination. Of the original 70 patients in the study, 50 returned for denture examination. Using the evaluation system previously outlined, seven dentures were rated excellent ( 14 per cent), seven were rated good ( 14 per cent), 18 were rated fair (36 per cent), and 18 were rated poor (36 per cent). With the four examiners in this study, some divided or split decisions were inevitable, but even with this possibility, it was believed preferable to have four rather than three examiners. Divided opinions had no effect in the over-all evaluation of the dentures, since the answers of each dentist were first scored and then averaged. Question 1 concerned centric relation which can only have a yes or no answer. Table III, therefore, has a separate category for divided opinions concerning the harmony of centric occlusion with centric relation. Part 2. Determination of the significance of the distribution in Part 1

The chi-square test was used to determine the significance of the distributions.15 This test was used because the data were in discrete categories of an ordinal scale.

Volume 35 Number 5

Personality and satisfaction with dentures

499

The chi-square tests the hypothesis that the test groups differ with respect to some characteristic and, therefore, with respect to the relative frequency with which group members fall into the different categories. It is calculated with the formula shown:

(o-E)* X2= cE

where 0 = observed number of patients in any category and E = expected number of patients in any category. Table IV shows that the degree of patient satisfaction on each of the first six questions as compared with the degree on the question about general satisfaction was significantly different from that which would be expected if the distributions were random. In other words, any answer on the first six questions was positively correlated with a similar answer on general satisfaction. It was noted that despite all the precautions taken to avoid it, a specific answer on one question was linked with a similar answer on the general-satisfaction question. For example, a very satisfied answer on the first six questions was usually associated with a very satisfied on general satisfaction. Therefore, although each individual question on the patientsatisfaction questionnaire was analyzed with all the other variables, these results are not included, since a lack of correlation with general satisfaction indicated no correlation with any of the individual questions. Table V shows the relation between personality traits and general satisfaction. There was no relationship between the personality traits of hypochondriasis, depression, hysteria, or manifest anxiety and the degree of the patients general satisfaction at the 95 per cent level of confidence. If personality is not related to patient satisfaction with dentures, it would be reasonable to assume that satisfaction is determined by the technical quality of the dentures. Table VI, however, shows no relationship between the over-all technical quality of the dentures and the patients general satisfaction with the dentures. When comparing the individual aspects of the dentures tested with general satisfaction, only stability of the upper denture was found to have a positive correlation or a nonrandom distribution.

DISCUSSION
The high incidence of hypochondriasis, depression, hysteria, and manifest anxiety .n the patients in this study may seem alarming, but in the midtown Manhattan project, 31 per cent of the 50- to 59-year-old subjects interviewed were classified as emotionally impaired, the proportion increasing with age.lG In view of this, the incidence of the traits in this study should not be viewed with alarm, since the exhibition of a personality trait at the cutoff point does not necessarily signify emol.ional impairment. Many authors have written about the effects of hypochondriasis, depression, hysteria, and manifest anxiety on patient satisfaction with complete dentures. In this study, however, this influence was not shown, and I have been unable to find

500 Table

Smith

J. Prosthet. Dent. May, 1976

IV. Relation between general satisfaction and satisfaction on individual

questions
Questions 1. Comfort 2. Fit 3. Ability to speak 4. Appearance 5. Ability to eat 6. Ability to taste df=4 *P ( 0.001. iP Q 0.01. Table V. Relation between personality traits and general satisfaction Traits Hypochondriasis Depression Hysteria Manifest anxiety df= 2 *P < 0.05. Chi-square with general satisfaction 0.07* 0.62; 1.06* 3.19* Chi-square with general satisfaction 23.91. 24.69* 14.72t 32.08* 40.76. 15.58t

any research reports to verify or contradict my findings. It was observed that the proportions of very satisfied, fairly satisfied, and dissatisfied answers to Question 7 of the second questionnaire were approximately the same for men and women, although the women exhibited a higher incidence of the four personality traits. This observation tends to confirm that the personality traits have no effect on patient satisfaction. It could be postulated that the personality of the patient might affect the performance of the student during denture construction. This does not seem to occur, since there was no significant difference between the technical quality of dentures for patients with elevated scores and that for patients with nonelevated scores. This study was designed to determine patient satisfaction with individual aspects of the dentures as well as general satisfaction. Despite the precautions taken, however, it was found that the degree of satisfaction on any one answer was significantly related to the degree of general satisfaction. These results agree with those of Carlsson and co-workers,17 who found that the patients opinion of the retention and esthetics was markedly related to the over-all appreciation of the dentures. It could be suggested that patients who are dissatisfied with their dentures cannot localize their dissatisfaction. Perhaps this lends weight to the argument that dentists should rely more on what they see in the mouth rather than on the opinions of the patient. In 1949, YounglS reported the results of a survey which showed that 25 per cent of complete denture wearers became satisfied with their dentures only after a long

Personality and satisfaction with dentures Table VI. Relation between general satisfaction and the technical quality of the dentures
Technical quality 1. 2. 3. 4. 5. 6. Over-all technical quality Centric relation Vertical relation Balanced occlusion Retention Upper Lower Stability Upper Lower Appearance Harmony Position P < 0.05. Chi-square with general satisfaction 5.82 3.71 1.00 1.37 8.48 8.21 11.06* 3.92 3.74 0.86 4 4 4 4 2 4 4

501

period of time and that 10 per cent of complete denture wearers were never satisfied. It would appear that 25 years of progress in prosthodontics has not increased the SWcess rate, since my results agree with those of Young. Langer and associatess found similar percentages, with 69 per cent of their subjects satisfied, 19 per cent satisfied but with some minor objections, and 12 per cent dissatisfied. If personality were not related to patient satisfaction with dentures, it would seem likely that satisfaction would be related to the technical quality of dentures. The findings of this study, however, do not support this supposition. The findings of YoshizumiZO and Carlsson and associates do support this supposition. Too much importance should not be attached to the significant relation of stability of the upper denture to general satisfaction, although this result does agree with that of another study.ll The reason is that too few fair and poor categories of stability were reported to validate the chi-square results. The insignificant relationship between quality of the denture support and patient satisfaction with dentures is in agreement with the findings of other investigators.17s l9 It appears that the success of complete dentures expressed in terms of patient satisfaction is not dependent on either patient personality or the technical quality of the dentures. What, then, does influence satisfaction? It may be dependent on the patients attitude toward wearing dentures or on his relationship with the dentist. Perhaps patients do not know what to expect from complete dentures, since it has been said that patients are satisfied with inadequate dentures because they do not know any better. There is always the possibility that the psychologic, biologic, anatomic, and construction factors are so closely interrelated that the importance of any single factor cannot be assessed. Whatever makes patients satisfied, however, it appears that patients cannot discriminate between good and bad dentures, and therefore, it is imperative that all dentists accept their responsibility for providing the best possible denture service.

502 Smith
CONCLUSIONS

J. Prosthet. Dent. May, 1976

1. There was a high incidence of the personality traits of hypochondriasis, depression, hysteria, and manifest anxiety in the 70 complete denture patients of this study. 2. Most patients in this study were satisfied with the complete dentures received.
3. There chondriasis, was no significant hysteria, relationship between the personality traits of hypodepression,

and manifest

anxiety

and the degree

of patient

satisfaction with dentures. 4. There was no significant relationship between the personality traits of hypochondriasis, depression, hysteria, and manifest anxiety and the technical quality of dentures. 5. There was no significant relationship between the technical quality of complete dentures and the degree of patient satisfaction with the same dentures.
the assistance of the late Dr. Carl 0. Boucher and Dr. Herbert Psychology Department, in designing the project. The author also thanks Drs. Brian J. Smith, Bruce S. Graham, and Israel M. Finger for evaluating the dentures. The author acknowledges

Mirels of The Ohio State University,

References 1. DeVan, M. M.: Procedures Preceding the Prosthodontic Prescription, J.

13: 1006-1010, 1963.
PROSTHET. DENT.

2. Miller, A.: Psychology of Denture Failures, Oral Hygiene 50: 54-55, 1960. 3. DeVan, M. M.: Physical, Biological, Psychological Factors to be Considered in the Construction of Dentures, J. Am. Dent. Assoc. 42: 290-293, 1951. 4. Heartwell, C. M.: Psychologic Considerations in Complete Denture Prosthodontics, J. PROSTHET. DENT. 24: 5-10, 1970. 5. House, M. M.: An Outline for Examination of Mouth Conditions, Dominion Dent. J. 33: 97-100, 1921. 6. Dahlstrom, W. G., and Welsh, G. S.: An M.M.P.I. Handbook, A Guide to Clinical Practice and Research, Minneapolis, 1960, The University of Minnesota Press, chap. 1. 7. Boucher, C. O., editor: Swensons Complete Dentures, ed. 6, St. Louis, 1970, The C. V. Mosby Company, chaps. 14-18. 8. Cinotti, W. R., Grieder, A:, and Springhob, H. K.: Applied Psychology in Dentistry, ed. 2, St. Louis, 1972, The C. V. Mosby Company, chap. 4. 9. Taylor, J. A.: A Personality Scale of Manifest Anxiety, J. Abnorm. Sot. Psychol. 48: 285-291, 1953. 10. Dahlstrom, W. G., and Welsh, G. S.: An M.M.P.I. Handbook, A Guide to Clinical Practice and Research, Minneapolis, 1960, The University of Minnesota Press, Appendix I; Tables 16, 40, 79, 82; pp. 450-456. 11. Dahistrom, W. G., and Welsh, G. S.: An M.M.P.I. Handbook, A Guide to Clinical Pxac-

tice and Research, Minneapolis,

12. 13.

1960, The University

of Minnesota Press, Appendix H;

14. 15.

Table 3; pp. 439-440. Bolender, C. L., Swoope, C. C., and Smith, D. E.: The Cornell Medical Index as a Prognostic Aid for Complete Denture Patients, J. PROSTHET. DENT. 22: 20-29, 1969. Rayson, J. H., Rahn, A. O., Ellinger, C. S., Wesley, R. C., Frazier, Q. Z., Lutes, M. R., Evaluation in Clinical ReHenderson, D., and Haley, J. V.: The Value of Subjective search, J. PROSTHET. DENT. 26: 111-118, 1971. Hickey, J. C., Boucher, C. O., and Hughes, G. A., editors: Glossary of Prosthodontic Terms, ed. 3, St. Louis, 1968, The C. V. Mosby Company, p. 16. Siegel, S.: Nonparametric Statistics for the Behavioral Sciences, New York, 1956, McGraw-Hill Book Company, Inc., chap. 8, pp. 174-l 79.

~$-$g,, ,

Personality and satisfaction with dentures

503

16. Scrole, L.: Mental Health in the Metropolis: The Midtown Manhattan Study, New York, 1962, Blakiston Division/McGraw-Hill Book Company, Inc., p. 160, Table 9-2. 17. Carlsson, G. E., Otteriand, A., and Wennstrom, A.: Patient Factors in Appreciation of Complete Dentures, J. PROSTHET. DENT. 17: 322-328, 1967. 18. Young, H. A.: Diagnosis of Problems in Complete Denture Prosthesis, J. Am. Dent. Assoc. 39: 185-200, 1949. Satisfaction With Com19. Langer, A., Michman, J., and Seifert, I.: Factors Influencing plete Dentures in Geriatric Patients, J. PROSTHET. DENT. 11: 1019-1031, 1961. 20. Yoshizumi, D. T.: An Evaluation of Factors Pertinent to Success of Complete Denture Service, J. PROSTHET. DENT. 14: 866-878, 1964. % Ms. J. H. &ES 78 WISBECH RD. LITTLEPORT,~AMBS ENGLAND

CB6 1JJ

ARTICLES
When to glaze-An
Nasser Barghi,

TO APPEAR IN FUTURE
electron microscope
D.M.D.,

ISSUES
D.Sc., M.S.

study
and Robert A. Draughn,

D.D.S.,

Lee Alexander,

Reliability
Donald

of fully

adjustable

articulators

using

a computerized
M.S.

analysis

B. Beck, B.S., D.D.S.,

M.S., and Florian

J. Knap, D.D.S.,

Radiation

complications
III, D.D.S.,

in edentulous
M.S., Thomas

patients
A. Curtis, D.D.S., and Robert B. Morrish, Jr.,

John Beumer, D.D.S.

Prosthetic
Seymour

management
Birnbach, D.D.S.

of the

congenital

cleft-palate

patient

A reliable

technique

of post soldering
Bernard

of nonprecious
D.D.S.,

ceramic
Richard

units
Jr.,

Richard Blustein, M.S., D.D.S., and Keith A. Green

M. DePaul,

C. Barnhart,

long-term

implant
D.D.S.,

denture
Raymond

histology
J. Melrose,

and comparison
D.D.S.,

with

previous

reports
Ph.D.

Roy L. Bodine,

and Dale E. Grenoble,

Allaplastic

tooth

implants
Ph.D., D.D.S.

Louis J. Boucher,

A review
Charles

of concepts

of silver amalgam

retention
D.M.D.

F. Bouschor,

D.D.S., and Jobe R. Martin,