Journal of Oral Rehabilitation 1999 26; 53–71
The relationship between satisfaction with mouth and
number, position and condition of teeth: studies in
Brazilian adults
A . C . E L I A S & A . S H E I H A M Department of Dental Public Health, University College London Medical School and
St Bartholomew’s and The Royal London School of Medicine and Dentistry, London, U.K.
SUMMARY The objective of this study was to analyse
adults’ subjective perception of satisfaction in rela-
tion to number, position and condition of natural
teeth. Subjective perception of satisfaction was
assessed by interview. Dental status was assessed.
Two types of survey were carried out in Brazil: a
longitudinal and a cross-sectional survey. The longi-
tudinal study commenced in 1990, with 227 dentate
people aged 45–54 years, of two social classes. Of the
227 subjects examined in 1990, 126 were re-examined
and interviewed 3 years later. The cross-sectional
survey used the same methods used for the longi-
tudinal study. Six hundred and fifty-seven dentate
Introduction
A common concept in prosthetic dentistry is that
missing teeth should be replaced to prevent detrimental
changes such as loss of function, poor aesthetics, migra-
tion of teeth and disorders of the temporomandibular
joint (Zarb et al., 1978). This view has been challenged
by Käyser (Käyser, 1979, 1981, 1984). Käyser and
coworkers (Käyser, 1979, 1981, 1984; Käyser, Witter &
Sopanauf, 1987, Käyser et al., 1988, Käyser, Meewissen,
& Meewissen, 1990; Witter, van Elteren & Käyser,
(1987, 1988) Witter et al. (1989, 1990a,b, 1994a,b) in
a series of studies enumerated the clinical effects of
reductions in the numbers of molar teeth to the
Shortened Dental Arch (SDA). They found that people
over the age of 45 years, and with 20 teeth, from
© 1999 Blackwell Science Ltd
males aged from 35 to 54 years were examined and
interviewed. There was a positive correlation
between satisfaction and position of teeth. Premolar
pairs had a higher correlation with satisfaction in
both studies. Anterior teeth were the most signi-
ficant predictors of satisfaction. There was no differ-
ence in the percentage of satisfied persons between
the baseline and follow-up studies. The results
indicate that adults with three premolar pairs and
intact anterior sextants were satisfied with their
oral status. Keeping a certain number of teeth,
depending on their position and condition, gave
more satisfaction than having the missing teeth
replaced with partial dentures.
premolar to premolar had enough teeth to satisfy their
needs in relation to appearance and function. Their
conclusion was based on clinical examinations and
interviews with subjects with missing teeth. There have
been environmental changes in the human habitat, and
in particular, the diet. From an evolutionary perspective,
whereas a full dentition may have been important for
survival for hunter gathering homo sapiens, the need for
32 teeth in contemporary people is questionable.
The concept of the shortened dental arch was tested
in longitudinal studies. Witter et al. (1994a) investigated
long-term occlusal stability and oral comfort in SDA in
a longitudinal 6-year follow-up study. They found that a
SDA consisting of 3–5 posterior occlusal pairs (premolars
and molars opposing each other, hereafter called POPS)
provided durable occlusal stability. There were minor
53
54 A.C. ELIAS & A. SHEIHAM
changes in inter-dental spacing which occurred shortly
after the extractions. Changes with respect to occlusal
stability in SDA were not prevented by the insertion of
free-end removable partial denture. Lower alveolar
bone support in the SDA and SDA plus removable
partial denture group tended to decrease to the same
degree as the control group who had complete natural
dentitions. The main reservation Witter et al. had was
that in people with a combination of existing periodontal
disease and increased occlusal loading, such as in SDA,
there was an increased probability of further loss of
teeth. In relation to oral comfort and craniomandibular
dysfunction Witter et al. (1994b) found that: the absence
of molar support was not a risk factor for cranio-
mandibular dysfunction. SDA (3–5 POPS) did provide
sufficient oral comfort in the long term. Replacing
missing POPS with a free-end removable partial denture
in the lower jaw did not improve oral function in terms
of oral comfort (Witter et al., 1994b).
There are only a few studies concerning the replace-
ment of missing teeth. Most of the studies on reduced
dentitions were clinical trials which assessed chewing
function. Only a few of them assessed subjective
perceptions (Imperiali et al., 1984; Aukes, Käyser &
Felling, 1988; Meeuwissen, 1992; Meeuwissen et al.,
1995; Leake, Hawkins & Locker, 1994). Imperiali et al.
(1984) and Aukes et al. (1988) assessed only one dimen-
sion, subjective chewing performance. Meeuwissen et al.
(1995) and Leake et al. (1994) assessed different impacts
in elderly populations. Leake et al. (1994) used the
number of occluding pairs of teeth and asked questions
concerning pain, communication, aesthetics and func-
tion. These latter investigations were cross-sectional
studies. They did not investigate the perception of
satisfaction over time. The only longitudinal survey,
assessing reduced dentitions, was related to shortened
dental arches and clinical assessments of oral function
(Witter et al., 1994a,b).
As most of the studies did not have adequate measures
of satisfaction and were conducted on populations who
had considerable dental care, studies were planned to
assess the responses of Brazilian populations using more
detailed measures of satisfaction. The objective of this
study was to determine the relationships between dental
status (number, position and condition of teeth) and
subjective perception of satisfaction with mouth and
teeth in a group of individuals aged 35–54 years. This
was a younger group than was assessed by Meeuwissen
(1992), Meeuwissen et al. (1995) and Leake et al. (1994).
In addition, an objective was to investigate changes in
satisfaction and dental status over time in a longitudinal
study. The main hypothesis was that perceived satisfac-
tion with the mouth is affected by the number, position
and condition of the natural teeth.
Materials and methods
To test the proposed hypothesis three types of data were
collected: socio-economic, measures of satisfaction, and
clinical data. A questionnaire was developed consisting
of five dimensions. Clinical oral health status was
assessed to relate the socio-dental measures to clinical
status. The research instrument was tested in a pilot
study. The same methodology was applied in both the
longitudinal and the cross-sectional study.
There is a dearth of data on relationship between
dental clinical condition and satisfaction with the
mouth and so an observation design was used in this
study (Reisine & Bailit, 1980; Reisine, 1981, 1988;
Meeuwissen, 1992).
Study populations
The longitudinal study commenced in 1990, with 227
people aged from 45 to 54 years, of two social classes,
both sexes and with three different levels of oral status;
low, medium and high DMFT. A pilot study was carried
out prior to the main studies. Fifty subjects, aged from
45 to 54 years, selected from a Factory (CEMINA) of
Anapolis, Brazil, were examined and interviewed by
the investigator in 1990. In the main longitudinal study
the population was selected as follows. The establish-
ments were randomly selected through information
given by the Social Service of Industry (SESI). Three
main sites were selected; Pilot Plane (centre of Brasilia),
the industrial sector and satellite cities. Subjects were
selected from lists of workers in selected factories. The
selection was made taking age into account. All those
aged 45–54 years were selected and a letter was sent.
The individuals that did not attend the first invitation
were invited at least three more times. Of the 302
persons invited to join the baseline survey 276
accepted, 49 of these were excluded because they were
edentulous. Two hundred and twenty-seven manual
and non-manual male and female subjects aged from
45 to 54 years were interviewed and examined in 1990.
One hundred and twenty-six of the 227 subjects from
the baseline study who were still working in the same
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factories were re-examined and interviewed for a second
time 3 years later in 1993/1994. The same methods
were employed in both examinations and interviews
for the baseline and follow-up.
The study was carried out in specially allocated rooms
or workrooms. The clinical findings were tape-recorded
and later transcribed to a specially designed form. Each
examination took an average of 10 min. In order to
assure consistency of the examinations, at least one out
of every 10 was re-examined. The interview took an
average of 20 min.
The cross-sectional survey used the same methods as
those used for the longitudinal study. The cross-sectional
study was restricted to males of manual social class to
ensure that social and gender factors were controlled.
A convenience sample of male transport workers, bus
drivers and conductors, was used. A pilot study was
conducted on 68 subjects, aged from 35 to 54 years.
They were selected from a transport establishment
(REAL) in Brasilia. Of 834 individuals invited to join
the main survey, 761 accepted, 104 were excluded
because they were edentulous or had missing anterior
teeth without prosthetic replacement. Therefore in the
main study, 657 males aged from 35 to 54 years were
examined and interviewed. The population was selected
as follows. All the main transport companies of Brasilia
were visited. Three main sites were selected: Pilot Plane
(centre of Brasilia), the industrial sector and satellite
cities. Subjects were selected from lists of workers in
transport companies. All males aged 35–54 years were
selected. The individuals that did not attend the first
invitation were invited for at least three more times. The
clinical examinations and interviews were conducted by
the researcher and were identical to the longitudinal
baseline and follow-up studies.
Questionnaire
A questionnaire was developed to measure satisfac-
tion. The questionnaire had two sections. The first was
related to general items measuring perceived satisfac-
tion concerning oral function and the second to items
regarding the use of partial dentures. The subjective
impacts were grouped in dimensions according to the
questions. ‘Reliability analysis’ (Cronbach’s Alpha) was
applied to group the variables, according to their
inter-relations. Twelve dimensions, six for each section
of the questionnaire were created (appearance, pain,
communication, function, comfort and satisfaction).
© 1999 Blackwell Science Ltd, Journal of Oral Rehabilitation 26; 53–71
55
Principal component analysis was applied to reduce
the six dimensions into one total measurement of
satisfaction for each section of the questionnaire. The
final questionnaire had 141 questions.
Principal component analysis (factor analysis) was
also applied to reduce the six dimensions into one
satisfaction measurement entitled ‘total satisfaction’
dimension. This scale will be the main subjective
measurement of the Brazilian studies. The item scores
of the dimensions were standardized to the z-scores
(zi 5 (xi – x)/sx). The first part had 89 general questions
concerning the six aspects of satisfaction. All of the
participants was asked the questions in the first section.
The second part had 52 questions and only the people
with partial dentures were asked these questions. The
population was divided into the whole sample, denture
wearers and non-denture wearers: They were then
grouped into three different levels of satisfaction: satis-
fied (scores of 1 1·0 or above), relatively satisfied (scores
between – 1·0 and 1 0·9) and dissatisfied (with scores
of – 0·9 or below) for each dimension and for the ‘total
satisfaction’ measurement of both cross-sectional and
longitudinal studies. This division was carried out for
each dimension. To enable the use of multivariate
statistical techniques, where outlyers are not acceptable,
transformations to ‘normality’ were applied. Pearson
correlation coefficients was applied to determine the
relationship between the different dimensions (appear-
ance, pain, communication, function, comfort, satisfac-
tion and ‘total satisfaction’).
Questions about socio-economic status were asked of
each participant according to a Brazilian social class
system: ABA ABIPEME (1978). This system has five
social classes: A, B, C, D and E. The classes are deter-
mined by the level of education of the head of family
and seven economic indicators.
Multivariate statistical tests such as multiple linear
regression and multiple logistic regression was applied
in order to study the relationship of one outcome
variable to several other variables or to ‘explain’ or
‘predict’ one response variable from a set of independent
variables. The main purpose of the multiple linear
regression was to compare the findings of the Brazilian
studies with other investigations. The main purpose of
the multiple logistic regression was to determine the
influence of the clinical dental variables in subjective
perceived satisfaction besides explaining the degree of
satisfaction from the clinical dental variables corrected
for confounding variables.
56 A.C. ELIAS & A. SHEIHAM
Bivariate statistical tests, cross-tabulations with chi-
squared tests of significance, were applied between each
individual clinical condition and satisfaction. These tests
were done in order to better understand the effects of
individual clinical status on satisfaction. Since many
variables may influence satisfaction a multiple logistic
regression model was applied to evaluate the effects of
the different variables on satisfaction. The multiple
logistic regression analyses the relationship of each
clinical indicator of oral health, as well as the combina-
tion of them, to satisfaction. The same model used by
Barenthin (1977) was applied in the Brazilian studies.
Another multivariate statistic test, multiple linear
regression, was applied to compare the results of this
investigation with other studies. For both tests, the
logistic and the multiple regression, four models tested
satisfaction in relation to oral status. The first one tested
number, the second, position, the third condition and
finally the fourth a combination of number, position
and condition of teeth in satisfaction. Levels of satisfac-
tion were calculated for ‘total satisfaction’ in relation to
dental groups, Eichner index and levels of DMFT index.
The interviews took an average of 20 min.
Clinical examination
The clinical data was collected by oral examinations
carried out in selected establishments. The clinical
examinations used the WHO Oral Health Assessment
criteria proposed by the World Health Organisation
(WHO, 1987) with the inclusion of some items from
Cushing, Sheiham & Maizels (1986) and Greene &
Vermillion (1964). To assure consistency, at least one
out of every 10 subjects was re-examined. Subjects
were divided in three groups: low, medium and high
DMFT. High DMFT ranged from eight to 21 teeth, the
medium DMFT from 20 to 13 teeth and the low DMFT
from 12 to zero teeth. In addition to the DMFT index
each of its components and two other indices, the T-
HEALTH and Functioning Teeth, were used to determine
the dental condition (Sheiham, Maizels & Maizels,
1987). These indices attribute low values to decayed
and missing teeth. The T-HEALTH has values for miss-
ing 5 0, decayed 5 1, filled 5 2 and sound 5 4 while
the Functioning Teeth index consists of aggregating the
sound teeth with those that are filled and have no
caries, each being given equal value. The periodontal
status was also determined by the absence or presence of
periodontal pockets, calculus and bleeding on probing.
Even though the clinical examinations determined the
severity of periodontal pockets and calculus they were
not used in the analysis.
Teeth grouping
As the main purpose was to determine satisfaction with
respect to each satisfaction dimension and the dental
indicators of position, two approaches to grouping of
the teeth was applied; the Eichner index (Eichner, 1955)
and ‘dental groups’ (Elias, 1996 ). The Eichner index is
a widely use dental classification while ‘dental groups’
was created for this study. Both dental classifications
are based in the number of posterior occlusal contacts.
Eichner index. A dental classification of partially
edentulous arches commonly used is the Eichner index
(Eichner, 1955). Therefore it was used in this study in
order to compare the findings with other data. The
Eichner index is a dental classification based on the
number of areas of support of posterior teeth. It is
divided in three main groups according to the number
of antagonist contacts (A, B and C). Group A (four
support zones), two in the premolar, right and left and
two in molar area, right and left, is subdivided in Group
A1 (four supporting zones and no open spaces); A2
(four supporting zones and one open space); and A3
(four supporting zones and open spaces in both arches).
Group B (one to three supporting zones) is subdivided
in Group B1 (three support zones); Group B2 (two
support zones); Group B3 (one support zone) and Group
B4 (contact outside areas of support). Group C (no
antagonist contact) is subdivide in Group C1 (teeth in
both jaws without antagonist contact); C2 (one jaw
edentulous but teeth in the other jaw) and C3 (both
jaws edentulous). Group C was not used in this research
since total or partially edentulous persons were not
used in the Brazilian studies.
Dental groups. All the subjects had natural or artificial
anterior teeth. Edentulous subjects were not included.
People were divided according to the position of
posterior occlusal units. The posterior occlusal units
were divided into 15 groups with premolar and molar
occlusal pairs present. The occlusal units were recorded
as natural or artificial and natural and artificial teeth
together. The dental groups were divided according to
the location of POPS. Dental groups were divided into
15 main groups. Group 1 (no functional unit-pairs of
premolar or molar teeth); Group 2 (one functional unit-
pair of premolar and no functional unit-pairs of molar
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teeth); Group 3 (two functional unit-pairs of premolar

and no functional unit-pairs of molar teeth); Group 4
(three and four functional unit-pairs of premolar teeth
and no functional unit-pairs of molar teeth); Group 5
(one and two pairs of functional unit-pairs of premolar
teeth and one functional unit-pair of molar teeth);
Group 6 (three functional unit-pairs of premolar teeth
and one functional unit-pair of molar teeth); Group 7
(four functional unit-pairs of premolar teeth and one
functional unit-pair of molar teeth); Group 8 (one and
two functional unit-pairs of premolar teeth and two
functional unit-pairs of molar teeth); Group 9 (three Fig. 1. Probability of being satisfied in relation to the number
functional unit-pairs of premolar teeth and two func- of teeth.

tional unit-pairs of molar teeth); Group 10 (four

functional unit-pairs of premolar teeth and two func-
tional unit-pairs of molar teeth); Group 11 (two and
three functional unit-pairs of premolar teeth and three
functional unit-pairs of molar teeth); Group 12 (four
functional unit-pairs of premolar teeth and three
functional unit-pairs of molar teeth); Group 13 (two
and three functional unit-pairs of premolar teeth and
four functional unit-pairs of molar teeth); Group 14
(four functional unit-pairs of premolar teeth and four,
five or six functional unit-pairs of molar teeth) (only
natural teeth); Group 15 (four functional unit-pairs of
Fig. 2. Probability of being satisfied in relation to the number of
premolar teeth and four, five or six functional unit- molar pairs.
pairs of molar teeth) (natural and artificial teeth)
(Elias, 1996).

Results
The main hypothesis of this study was that perceived
satisfaction with mouth is affected by the number,
position and condition of the natural teeth. To test this
hypothesis the number, position and condition of teeth
were analysed separately and then combined.

Number of teeth and satisfaction

There was a direct relationship between number of
teeth and total satisfaction (Fig. 1). As the number of
teeth increased satisfaction increased. Persons with 10
teeth had 0·50 probability of being satisfied with their
condition with an increase to 0·80 for 20 teeth and 0·90
for 28 teeth. The number of teeth had an influence on
the probability of satisfaction but beyond possession of
a certain number of teeth there were only small changes
in the level of satisfaction.
When considering the number of molar pairs, there
Fig. 3. Probability of being satisfied in relation to the number of
premolar pairs.
were small differences between zero, one, two or three
molar pairs (from 0·72 to 0·85) on the one hand and
the probability of satisfaction on the other (Fig. 2). For
premolar pairs there was a significant difference in the
probability of satisfaction with an increase in number
of premolar pairs (0·65 for none to 0·80 for two reaching
a maximum of 0·90 for four pairs of premolar) (Fig. 3).
The independent variables used in the multiple

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58 A.C. ELIAS & A. SHEIHAM

Table 1. Estimated coefficients of the logistic model for number of teeth: cross-sectional and longitudinal studies

Variable Cross-sectional Longitudinal baseline

B s.e. Sig B s.e. Sig

Number of teeth 0·1278 0·0409 0·0018 0·0958 0·0851 0·2605

Number of premolar pairs 20·1114 0·1106 0·3142 0·1905 0·2384 0·4242
Number of molar pairs 0·1393 0·1133 0·2188 0·0422 0·2374 0·8588
Constant 21·3882 0·6599 0·0354 20·6549 1·2927 0·6124

Table 2. Multiple regression for ‘total satisfaction’ in relation to number of teeth: cross-sectional and longitudinal studies

Cross-sectional Longitudinal baseline

Dependent variable:
‘total satisfaction’ B Sig T B Sig T

Number of teeth 0·022 094 0·0004 0·015 369 0·1941

Number of premolar pairs 0·015 694 0·3375 0·018 848 0·5486
Number of molar pairs 20·022 970 0·1216 20·007 281 0·7887
Constants 0·319 770 0·0023 0·482 246 0·0098
R2 0·068 0·063

regression to test the number of teeth and satisfaction Table 3. Cross-tabulation between premolar pairs and ‘total
(Table 1) were the same as in the logistic regression satisfaction’: cross-sectional and longitudinal studies

(number of teeth, number of premolar pairs and

number of molar pairs). The dependent variable was ‘total satisfaction’
the ‘total satisfaction’ scale (Table 2). The number of
Cross-sectional Longitudinal baseline
teeth was a significant predictor in the cross-sectional
model. Persons having up to seven missing teeth were Premolar Satisfied Unsatisfied Satisfied Unsatisfied
satisfied with their oral status with an increase to nine pairs n % n % n % n %
missing teeth for the relatively satisfied group.
Bivariate analysis was applied in the sample in order 0 67 63 38 36 26 72 10 27
1 96 77 28 22 36 76 11 23
to understand the individual relationships between the
2 108 83 21 16 26 86 4 13
number of premolar and molar pairs and satisfaction. 3 129 86 21 14 33 89 4 10
There was a significant difference between the number 4 136 91 13 8 38 95 2 5
of premolar pairs and ‘Total Satisfaction’ (Table 3). There
was a direct proportional increase in satisfaction with Chi-squared 5 35·16; 4 d.f.; P , 0·01.
the increase in the number of premolar pairs. There
was a direct relationship between the number of pre-
are not as important as lower numbers of premolar
molars pairs and satisfaction in both cross-sectional and
pairs in relation to satisfaction.
longitudinal studies (Table 3). The reported levels of
satisfaction increased with increases in the number
Position of teeth and satisfaction
of premolar pairs. From zero to two premolar pairs
there was an increase by almost 20% in satisfied people The variables used to test satisfaction in relation to
in the cross-sectional study. the position of teeth were: number of anterior teeth,
There were small increases in the percentages of number of posterior teeth, number of premolar pairs,
people satisfied with increases in the number of number of molar pairs, dental groups and the Eichner
molar pairs in the cross-sectional study and longi- index. These same variables were used for the logistic
tudinal studies (Table 4). Lower number of molar pairs regression model and multiple linear regression model.

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Table 4. Cross-tabulation between molar pairs and ‘total

satisfaction’: cross-sectional and the longitudinal baseline study

‘total satisfaction’

Cross-sectional Longitudinal baseline

Satisfied Dissatisfied Satisfied Dissatisfied

Molar pairs n % n % n % n %

0 148 74 50 25 59 77 17 22
1 123 82 27 18 31 83 6 16
2 114 81 26 18 32 86 5 13
3 77 88 10 11 15 83 3 16 Fig. 5. Probability of being satisfied in relation to the number of
4 46 86 7 13 12 100 – – posterior teeth present.
5 17 94 1 5 5 100 – –
6 11 100 – – 5 100 – – to two pairs of premolar. From two to three and three
to four premolar pairs there was a constant but smaller
Chi-squared 5 14·37; 4 d.f.; P , 0·05.
increase. For molar pairs this same trend was main-
tained. However, the differences in probability of satis-
faction between two and six pairs of molar teeth were
low. There was a higher probability of satisfaction
between the initial levels of satisfaction in the molar
than the premolar pairs.
A multiple regression model was created to test the
relationship between position of teeth and satisfaction
using the same variables used for the logistic regression
model for position of teeth (Table 5). The position of
teeth model explained 8% of the variance of the ‘Total
Satisfaction’ score for the cross-sectional study and 11%
for the longitudinal study. The number of anterior teeth
Fig. 4. Probability of being satisfied in relation to the number of emerged as a significant predictor (P , 0·01) in both
anterior teeth present. studies and dental groups in the cross-sectional study
(P , 0·05).
There was an increase, in the cross-sectional study, from To assess the relationship between position of poster-
0·50 to 0·85 in the probability of satisfaction between ior teeth and satisfaction, the sample was divided into
persons with one and 12 anterior teeth present (Fig. 4). groups with zero, one, two, three and four pairs of
Even with a partial prosthesis replacing missing anterior premolar and no molar teeth (Groups 1,2,3 and 4) and
teeth, persons with a lower number of natural anterior one, two, three, four, five or six pairs of molar teeth
teeth were less satisfied with their oral condition. This and one, two, three and four pairs of premolar teeth
same relationship was found for number of posterior (Groups 5–15). There was not enough persons with no
teeth. The higher the number of posterior teeth the premolar teeth and one, two, three, four, five or six
higher was the probability of satisfaction. The number pairs of molar teeth.
of natural anterior teeth was the most significant vari- In the cross-sectional study a highly significant differ-
able in both models. There was small differences in ence was found between the level of satisfaction of the
probability of satisfaction for persons with 10 compared 15 dental groups (Table 6). In Group 1 (persons without
to 20 posterior teeth (Fig. 5). There was a direct relation- any pairs of posterior teeth) only 54% were satisfied
ship with premolar pairs. The higher the number of with their oral status while the opposite was found in
premolar pairs the higher was the level of satisfaction. Group 14 (four or more premolar and molar pairs) with
The probability of satisfaction increased considerably on 98% satisfied. In Group 15 (four or more natural or
going from zero to one pair of premolar and from one artificial premolar and molar pairs) only 75% were

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60 A.C. ELIAS & A. SHEIHAM

Table 5. Results of the multiple regression for ‘total satisfaction’ in relation to position of teeth: cross-sectional and longitudinal studies

Cross-sectional Longitudunal baseline

Dependent variable
‘total satisfaction B Sig T B Sig T

Number of anterior teeth 0·031 137 0·000 6 0·042 684 0·010 2

Number of posterior teeth 0·014 247 0·195 2 20·020 323 0·318 7
Number of premolar pairs 0·024 430 0·202 4 0·035 777 0·354 6
Number of molar pairs 20·026 961 0·224 9 0·011 428 0·756 6
Dental groups 0·010 629 0·049 2 0·003 279 0·638 6
Eichner index 0·013 772 0·449 9 20·057 398 0·247 4
Constant 0·163 007 0·275 8 0·748 086 0·086 2
R2 0·076 40 0·110 33

Table 6. Cross-tabulation between dental groups and ‘total 4 (three and four pairs of premolar teeth and no molar
satisfaction’: cross-sectional and longitudinal studies pairs). In Group 4 there was almost as many satisfied
people (98%) as Group 14 (with all posterior natural
‘total satisfaction’ pairs) and 20% more than the 75% satisfied in Group
15 (complete arches with natural and artificial teeth).
Cross-sectional Longitudinal baseline
The same proportion of satisfied people, 75%, was
Dental Satisfied Dissatisfied Satisfied Dissatisfied found in Group 5 (one and two pairs of premolar and
group n % n % n % n % one pair of molar). Group 6 was similar to Group 5 in
terms of posterior pairs. They had one more pair of
1 14 53 12 46 11 64 6 35 premolars. In Group 7 with one more premolar pair
2 26 74 9 25 18 85 3 14
(four) than Group 6 but still with the same number of
3 25 71 10 28 9 75 3 25
4 40 95 2 4 9 90 1 10 molar pairs as in Groups 5 and 6, the proportion of
5 35 74 12 25 2 66 1 33 satisfied subjects increased to 87%, even though the
6 35 81 8 18 6 66 3 33 percentage was not as large as the 95% of Group 4
7 27 87 4 12 8 100 – – (three and four premolar pairs and no molar pairs). In
8 30 85 5 14 11 91 1 8 Group 8 (one and two pairs of premolar and two pairs
9 21 70 9 30 1 50 1 50
of molar teeth) 86% of the total population was satisfied
10 39 90 4 9 11 78 3 21
11 25 80 6 19 3 100 – – with their dental condition. Surprisingly there was a
12 54 94 3 5 16 94 1 5 decrease from 86 to 70% in the proportion satisfied in
13 25 83 5 16 4 80 1 20 Group 9 (three pairs of premolar and two pairs of molar
14 46 97 1 2 19 100 – – teeth). However, in Group 10 with one more premolar
15 71 75 23 24 17 81 4 19
pair (four) and with the same number of molar pairs
there was an increase to 91% of people who were
Chi-squared 5 47·76; 14 d.f.; P , 0·01.
satisfied with their dental condition. In Group 11 with
a decrease in the number of premolar pairs to one or
satisfied with their dental condition. Group 2 (one two, even having one more molar pair (three) than
pair of premolar and no molar pairs) had the same Group 10, there was a decrease to 81% compared
proportion of satisfied subjects as in Group 15 (75%). with the 91% of Group 10 that had almost the same
The members of Group 2, with only one pair of premolar proportion (86%) of satisfied persons as in Group 8,
teeth, were as satisfied as those that had all the posterior with one pair less of premolar and molar teeth. Group
teeth replaced with partial dentures. The same trend 12 (four pairs of premolar teeth and three pairs of molar
occurred in Group 3 with 71% of subjects with two teeth) and Group 4, had a similar proportion of satisfied
pairs of premolar teeth being satisfied with their dental people (95%) as Group 14, subjects who had a complete
condition. A large increase to 95% in satisfaction in dentition, in which 98% of persons were satisfied with
relation to the first three groups was observed in Group their dental condition. With the decrease in the number

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S AT I S F A C T I O N W I T H M O U T H B A S E D O N N U M B E R , P O S I T I O N A N D C O N D I T I O N
of premolar pairs to two and three even maintaining
the four molar pairs in Group 13 there was a decrease
to 83% in the proportion of satisfied persons.
Levels of satisfaction between the different dental
groups in the longitudinal study were similar to the
cross-sectional study. The tendency was for people in
the longitudinal study to be more satisfied than those
in the cross-sectional. Groups 7, 11, and 14 had no
dissatisfied persons. At the other end of the spectrum,
Groups 5, 6 and 9 had lower levels of satisfaction
than in the cross-sectional study. There was very little
difference in levels of satisfaction, in the cross-sectional
study between groups 4–13 and group 14. There was a
decrease in levels of satisfaction in group 15 in relation
to groups 4–13 (Table 6).
The Eichner index was used to compare the findings
of this investigation with other studies. In the cross-
sectional study Group A, with support in four posterior
zones, had the highest probability of satisfaction,
between 0·80 and 0·90 compared to Group B, with
support in three zones between 0·70 and 0·82 on the
logistic regression test. Group B1 with support in three
zones, had the highest probability of satisfaction in B
division (0·82). Group A3 (support in four zones with
open spaces) had the highest level of probability of
satisfaction on Group A. There were statistically signi-
ficant differences between the different categories for
satisfaction and the Eichner index.
There was a tendency to have higher levels of satisfac-
tion in the longitudinal than in the cross-sectional study
using the Eichner index even though the relationship
was the same. There were more satisfied persons in
Group A than Group B. All the persons in subgroups
A1 and A2 were satisfied with their oral condition, as
were 92% of subgroup A3. As in the cross-sectional
study, Group B4 had the lowest levels of satisfaction
but with a higher proportion of satisfied persons (68
compared with 46%). There was a decrease of satisfac-
tion from subgroup B2 to subgroup B3 as in the cross-
sectional study. In both studies persons with two areas
of support (B2) were more satisfied than persons with
three areas of support (B1). The position of these areas
of support probably affected satisfaction more than the
number of teeth.
Position and replacement of teeth and satisfaction
In order to assess the differences in satisfaction levels
between persons with tooth-bound and free-end
© 1999 Blackwell Science Ltd, Journal of Oral Rehabilitation 26; 53–71
61
spaces, with and without partial dentures replace-
ment, these variables were compared. Persons without
partial dentures replacement, in both groups, tooth-
bound and free-end spaces (95 and 87%, respectively)
were more satisfied with their condition than denture
wearers (80% for tooth-bound and 78% for free-end).
There was a higher number of satisfied persons for
tooth-bound partially edentulous arches (96%) than
for free-end arches (87%). The proportion of satisfied
in both was high. The same trend occurred in the
longitudinal study. Persons with tooth-bound and free-
end spaces without partial dentures were more satisfied
(100% and 85%) than denture wearers (87% for tooth
bound and 75% for free end spaces).
Condition of teeth and satisfaction
In the logistic model, the DMFT index, decayed, missing
and filled teeth, attrition, bleeding, calculus and period-
ontal pockets the higher the clinical indicator the lower
the level of satisfaction except for filled teeth. Filled
teeth showed a direct relationship with probability of
satisfaction, the higher the number of filled teeth the
higher was the satisfaction. Bleeding gums did not have
a strong effect in the probability of satisfaction. A
multiple regression model, with the same variables used
in the logistic regression model, was created to test
the hypothesis that the condition of teeth can affect
satisfaction. The model explained 13% of the variance
of the total satisfaction score with the Functioning Teeth
index being the most significant predictor of condition
in the cross-sectional study. In the longitudinal study
the model explained 15% of the variance of the total
satisfaction and the number of decayed, number of
missing and the Functional index were significant
predicators.
When comparing the mean decayed teeth, missing
and DMFT index for the ‘total satisfaction’ dimension
there was a decrease in values from the dissatisfied
to the satisfied group. For the decayed group the
dissatisfied had a mean of 2·8 decayed teeth, the rela-
tively satisfied a mean of 1·6 and the dissatisfied a mean
of one tooth while for missing teeth the dissatisfied
group had 11·8 missing teeth, the relative satisfied 9·1
and the satisfied group, 7·0. The DMFT index had a
similar relationship as the separate components with
the exception of the number of filled teeth. The dis-
satisfied group had a mean of 21·4 for DMFT, the
relatively satisfied group, 19·2 and the satisfied, 17·0.
62 A.C. ELIAS & A. SHEIHAM

Table 7. Estimated coefficients of the combined logistic model for condition of teeth: cross-sectional and longitudinal studies

Variable Cross-sectional Longitudinal baseline

B s.e. Sig B s.e. Sig

Number of teeth 0·4428 0·3309 0·1808 0·1080 0·1360 0·4271

Molar pairs 20·1793 0·1416 0·2052 0·1762 0·3443 0·6089
Premolar pairs 0·1195 0·1330 0·3689 0·2019 0·3275 0·5376
Dental group 0·0544 0·0338 0·1532 20·0198 0·0591 0·7371
Eichner index 0·1520 0·1208 0·2083 20·0792 0·4403 0·8573
Decayed teeth 20·4463 0·3370 0·1853 20·1441 0·1183 0·2235
Filled teeth 20·3201 0·3370 0·3421 20·0732 0·1052 0·4864
DMFT index 0·2956 0·3229 0·3600 0·3884 0·8569 0·6503
Attrition 20·2127 0·1204 0·0773 20·2761 0·2673 0·3016
Bleeding 20·0210 0·3900 0·9570 20·8821 0·5609 0·1158
Periodontal pockets 20·4503 0·1772 0·0110 20·0335 0·3650 0·9268
Calculus 0·1758 0·1321 0·1834 0·0830 0·2865 0·7721
Constant 210·4508 10·6877 0·3282 2·1891 5·3219 0·6808

In contrast the filled teeth was 6·0 for the dissatisfied,
for the relatively satisfied and 8·4 for the satisfied group.
The tendency to be satisfied with the condition of the
teeth was the same as for number and position of
teeth. The dimensions appearance, satisfaction, func-
tion, communication, comfort, pain and ‘total satisfac-
tion’ were inversely related to dental condition; the
lower the number of decayed, missing and DMFT index
the higher was the level of satisfaction. For filled teeth
the inverse was observed; the higher the number of
filled teeth the higher the satisfaction level.
Number, position and condition of teeth and satisfaction
Logistic and multiple regression was applied to all the
variables (numbers, position and condition of teeth)
to assess the relationship of them, as a whole, and
satisfaction. The same relation observed in the separate
logistic regression models for number, position and
condition of teeth was observed for the combined
logistic analysis for the combined different combinations
(Table 7).
Correlations between number and position of teeth and
dimensions of satisfaction
The main clinical determinants of number and position
of teeth (dental groups, Eichner index, molar pairs,
premolar pairs, number of anterior teeth and number
of posterior teeth) were correlated with the dimensions
(appearance, pain, communication, comfort, satisfaction
and ‘total satisfaction’ for both studies: for cross-
sectional see Table 8. The correlations of the dental
groups with dimensions was very similar in both cross-
sectional and longitudinal studies. There was no signi-
ficant correlation between function or comfort and
dental groups for both studies. There was a highly
significant (P , 0·01) association between communica-
tion or ‘total satisfaction’ and dental groups for the
cross-sectional study while for the longitudinal group
it was just significant (P , 0·05). The Eichner index was
inversely correlated with all dimensions for both studies
Molar pairs had significant associations (P , 0·01)
with all the dimensions except pain and comfort
(P , 0·05) in the cross-sectional study. For the longi-
tudinal study significant correlations (P , 0·05) with
appearance, satisfaction and ‘total satisfaction’ and no
significant correlations with pain, communication,
function and comfort. The only dimension where pre-
molar pairs was not highly significantly correlated was
with pain, in both studies, and satisfaction in the
longitudinal study. The number of anterior teeth did
not correlate with comfort and pain but had a significant
correlation (P , 0·05) with appearance and satisfaction
in the longitudinal study whereas it was highly signi-
ficantly correlated (P , 0·01) in the cross-sectional
study. Communication, function and ‘total satisfac-
tion’ had a highly significant correlation with the
number of anterior teeth (P , 0·01) in both studies.
The number of posterior teeth had highly significant
correlations with all the dimensions, except pain, in the
cross-sectional study (P , 0·01). In the longitudinal
study only ‘total satisfaction’ had highly significant

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S AT I S F A C T I O N W I T H M O U T H B A S E D O N N U M B E R , P O S I T I O N A N D C O N D I T I O N 63

Table 8. Pearson correlation between number and position of teeth present and subjective measures of oral health: cross-sectional study

Dimensions

Appearance Pain Communication Function Comfort Satisfaction ‘Total’

Dental groups 0·12** 0·04 0·17** 0·07 20·01 0·12** 0·14**

Eichner index 20·12** 20·02 20·11** 20·05 20·04 20·09* 20·10*
Molar pairs 0·12** 0·06 0·13** 0·12** 0·08* 0·14** 0·17**
Premolar pairs 0·23** 0·02 0·18** 0·21** 0·12** 0·16** 0·26**
No. anterior teeth 0·14** 0·03 0·15** 0·14** 0·10* 0·14** 0·19**
No. posterior teeth 0·17** 0·04 0·17** 0·17** 0·11** 20·15** 0·22**

*P , 0·05; **P , 0·01.

Table 9. Pearson correlation between clinical and subjective measures for the whole sample: cross-sectional study

Dimensions

Appearance Pain Communication Function Comfort Satisfaction ‘Total’

Decayed teeth 20·30** 20·14** 20·17** 20·05 20·08* 20·24** 20·25**

Missing teeth 20·19* 20·04 20·19** 20·20** 20·13** 20·18** 20·26**
Filled teeth 0·12** 0·05 0·10** 0·07 0·01 0·09* 0·12**
DMFT index 20·16** 204 20·12** 20·12** 20·13** 20·15** 20·19**
T-HEALTH index 0·28** 0·08* 0·23** 0·21** 0·17** 0·25** 0·32**
Functional index 0·34** 0·11** 0·27** 0·23** 0·16** 0·29** 0·37**

*P , 0·05; **P , 0·01.

correlation with the number of posterior teeth
(P , 0·01) while appearance, communication and satis-
faction were significantly associated (P , 0·05). Pain,
comfort and function did not have significant correla-
tions with the number of posterior teeth.
Correlations between clinical conditions and dimensions of
satisfaction
Association between clinical conditions (decayed, miss-
ing and filled teeth, DMFT index, T-HEALTH index,
Functional Teeth index, periodontal status) and
subjective measures of oral health (appearance, pain,
communication, function, comfort, satisfaction and
‘total satisfaction’) were tested. A Pearson correlation
coefficient was applied to find the association between
the dimensions, the ‘total satisfaction’ scale and the
clinical indicators of oral health for the cross-sectional
study (Table 9). On the whole the correlations were
weak even though most of them were significant
(P , 0·01).
Filled teeth had a highly significant positive asso-
ciation with the ‘total satisfaction’ score and appearance
and communication (P , 0·01). For satisfaction the
correlation was significant (P , 0·05) (Table 9)
indicating that as the number of filled teeth increased
the level of satisfaction increased. The higher the
number of filled teeth, the higher was the ‘total satisfac-
tion’, appearance, communication and satisfaction.
There was no significant correlation between filled teeth
and the dimensions in the longitudinal study.
In the cross-sectional study the correlations between
missing teeth and the dimensions were very significant
(P , 0·01) except for pain. Pain is not associated with
number of missing teeth. All the associations between
missing teeth and dimensions were negative (Table 9).
As in the cross-sectional study pain was not associated
with missing teeth in the longitudinal study. The correla-
tion between missing teeth and comfort, satisfaction
and function was not highly significant (P , 0·01) as it
was for the cross-sectional study even though it was
significant (P , 0·05) (Table 9). Therefore as the
number of missing teeth decreased, satisfaction
increased for all dimensions.

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64 A.C. ELIAS & A. SHEIHAM
Decayed teeth had a highly significant correlation
(P , 0·01) with all the dimensions except comfort
(P , 0·05) and function in the cross-sectional study
(Table 9). In general the coefficients of correlation of
the longitudinal study were lower and less significant
than the cross-sectional study.
The DMFT index in the cross-sectional study had very
significant negative associations with all the dimensions
(P , 0·01) except with pain. As DMFT increased persons
were less satisfied.
Discussion
The main hypothesis is that perceived satisfaction is
related to number, position and condition of teeth.
Perceived satisfaction seldom coincides with established
clinical assessments. Health is not considered only as
absence of physical disease. The concept of health
goes far beyond the absence of disease. Contemporary
definitions of health include subjective aspects in addi-
tion to clinical factors. Clinical criteria of measurement
alone, are not sufficient to satisfy an individual’s well-
being concerning their mouth (Cohen & Jago, 1976;
Heloe & Heloe, 1977; Smith & Sheiham, 1980;
Tuominen, 1987; Ettinger, 1987; Locker, 1988;
Oosterhaven et al., 1988; Reisine et al., 1989). There is
usually a big difference, especially in elderly people,
between the assessments of professionals and subjective
treatment needs (Smith & Sheiham, 1980). The reasons
for this difference between health professionals and
individuals is an unequal development of clinical, in
comparison with subjective criteria (Locker, 1988).
Many dental investigators have questioned the view
that an intact natural dentition with 28 natural teeth,
artificial or a combination of both, is necessary to
perform normal oral functions (Kapur & Soman, 1964;
Mumma & Quinton, 1970; Pilot, 1976; Helkimo,
Carlsson & Helkimo, 1978; Haraldson & Carlsson, 1979;
Käyser, 1979, 1981, 1984, 1990; Wayler & Chauncey,
1983; Witter et al., 1987, 1988, 1989, 1990a,b, 1991;
Käyser et al., 1987, 1988, 1990). These studies
assessed clinical aspects concerning the number and
spatial relationship between the upper and lower teeth,
and the possible oral dysfunctions caused by missing
teeth. Subjects functioned and communicated without
having a complete natural or artificial dentition. They
adapted to their changed oral condition.
Clinical criteria alone have limited relevance in
evaluating an individual’s oral health (Reisine & Bailit,
1980). Therefore leading dental authorities evaluated
dental status in terms of subjective oral function
(Agerberg & Carlsson, 1981; Carlsson, 1984; Imperiali
et al., 1984; Aukes et al., 1988; Ekelund, 1989; Morita
et al., 1989; Witter et al., 1990b; Leake, 1990). They
found a tendency for individuals to adapt to new dental
conditions. The results of the present investigation
agree with the above-mentioned findings, in terms of
subjective perception of satisfaction. Individuals were
satisfied with their mouths, even when they had miss-
ing teeth.
Appearance is the main reason to seek prosthetic
treatment (Zarb et al., 1978). Speech and masticatory
difficulties are not as important as appearance. In the
Brazilian studies, aesthetics was important when
associated with communication. Therefore the position
of missing teeth have important implications in the
replacement of missing teeth. The location of the
remaining teeth were important for people’s subjective
perception. Subjects with missing anterior teeth had a
higher perceived need to have the missing anterior
teeth replaced and were less satisfied with their oral
condition (Bjorn & Owall, 1979; Tervonen, 1988; Owall
& Taylor, 1989; Schuurs et al., 1990). Anterior teeth
have an important role in social interactions. Com-
munication is an important oral function (Käyser,
1981). Confirming these trends, the Brazilian studies
found that function and communication were important
indicators influencing satisfaction concerning oral
health. These dimensions had highly significant
correlations with the ‘total satisfaction’ scale.
As in other studies, satisfaction was defined as a
measure of perceived oral health status or psycho-
logical well being in relation to oral health status
(Kiyak & Mulligan, 1987; Gordon, Fryer & Niessen,
1988; Meeuwissen, 1992; Rosenoer & Sheiham, 1995).
Most studies assessing perceived satisfaction or oral
health discussed only superficially the methods used to
measure satisfaction. Different measures of satisfaction
can compromise comparisons of findings between differ-
ent investigations.
The level of satisfaction was similar in people with a
complete dentition and those with four pairs of pre-
molars and one molar pair (Group 7) and with persons
with four and three premolars pairs and no molar pairs
(Group 4). At the other end of the spectrum, only 50%
of persons with no premolar or molar teeth (Group 1)
were satisfied with their mouths. There was an
increase in satisfaction by replacing the missing teeth
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S AT I S F A C T I O N W I T H M O U T H B A S E D O N N U M B E R , P O S I T I O N A N D C O N D I T I O N
with removable partial dentures. For communication
there was an increase in the level of satisfaction when
missing posterior teeth were replaced. However, even
persons with higher numbers of premolar pairs and
just one or no molar pairs were as satisfied as persons
without premolar pairs replaced with removable partial
dentures. The replacement of missing teeth only
enhanced satisfaction for persons who did not have
anterior or premolar teeth. There was no difference in
satisfaction when the molar teeth were replaced. These
findings suggest that communication affected satisfac-
tion in relation to oral status.
In contrast to communication, for the cross-sectional
study, there was no difference in chewing ability
between persons with missing posterior teeth and with
dentures. A higher proportion of persons with three
and four premolar pairs (the closest group to Käyser’s
SDA) were satisfied with their chewing ability. Chewing
ability did not appear to be compromised by missing
posterior teeth. This finding is in accordance with Witter
et al. (1990b) who reported that only a few subjects with
an SDA complained about chewing ability, indicating an
adaptation to this condition. Subjects with reduced
dentitions may compensate for their compromised
masticatory function by chewing with the side on
which they have the most teeth, or by chewing longer
(Wayler & Chauncey, 1983; Gunne, 1985), swallowing
larger particles of food (Helkimo et al., 1978) and even
a combination of the three (Oosterhaven et al., 1988).
Käyser (1981), Chauncey et al. (1984) and Luke & Lucas
(1985) found a direct relationship between the number
of posterior teeth (chewing platform area) and objective
chewing performance. There was a smaller percentage
of Brazilian persons satisfied with their chewing ability
than in Meeuwissen’s (1992) study; 97 compared to
75% for the cross-sectional and 64% for the longitudinal
study, although the percentages were higher than in
Agerberg & Carlsson’s (1981) study.
Even when number of teeth affected chewing per-
formance, food selection was changed only in cases of
severe dental impairment (Chauncey et al., 1984). In
the Brazilian studies, a small percentage of persons said
they had to change the food they ate because of teeth,
or dentures. The majority could eat all the indicator
foods and people could chew hard foods such as dry
meat.
Gordon et al. (1988) found that function was more
important than appearance or comfort. The comfort
dimension included dental and temporomandibular
© 1999 Blackwell Science Ltd, Journal of Oral Rehabilitation 26; 53–71
65
variables. In the reliability analysis there were negative
correlations between the temporomandibular and the
other variables. Therefore the temporomandibular vari-
able was not used to form the satisfaction scale. The
temporomandibular individual variables were cross-
tabulated with number of premolar and molar pairs.
As in other investigations there was no relationship
between tempomandibular variables and number of
premolar and molar pairs (Witter et al., 1988; Leake
et al., 1994). Probably the clinical adaptation to missing
posterior teeth affected subjective perceptions (Witter
et al., 1988).
One of the major problems in research on subjective
factors is the measurement of satisfaction. Satisfaction
can be affected by several impacts. Therefore, care must
be taken to cover all the impacts in order to have a
complete measure of satisfaction. Different dimensions
were created in this study to assess satisfaction (appear-
ance, pain, communication, function, comfort, satisfac-
tion). These dimensions were combined to a general
measurement of satisfaction called ‘total satisfaction’.
of these dimensions communication and function were
important determinants of satisfaction. Appearance was
linked to communication. More people were concerned
about having missing anterior or premolar tooth
replaced than molar tooth because of social interactions
rather than just for self-perceived cosmetic reasons.
Function was another important dimension to perceived
needs. There was no difference in satisfaction levels
concerning the function dimension between persons
who had missing teeth or missing teeth replaced with
partial dentures.
Number of teeth and satisfaction
There was a direct relationship between number of
teeth and satisfaction in the cross-sectional study. The
higher the number of teeth, the higher was the
probability of satisfaction. These results agree with those
of Reisine and Bailit 1980, Locker & Slade (1994);
Rosenoer and Sheiham (1995) and Matthias et al.
(1995). In the Brazilian studies there was a relationship
between the probability of satisfaction and the increase
in number of teeth until about 23 teeth. Thereafter
there was almost no difference in the probability of
satisfaction with increased number of teeth. This
trend was observed in both Brazilian studies. The same
tendency for number of teeth was observed for numbers
of premolar pairs. The higher the number of premolar
66 A.C. ELIAS & A. SHEIHAM
of pairs the higher was the probability of satisfaction
until three premolar pairs. There were no differences
in satisfaction levels between three and four premolar
pairs. However, beyond four molar pairs the probability
of satisfaction was higher for the longitudinal than the
cross-sectional study.
Position of teeth and satisfaction
In both the Brazilian studies, the number of anterior
teeth was the clinical variable that had the most effect
on satisfaction (Bjorn & Owall, 1979; Tervonen, 1988;
Owall & Taylor, 1989; and Schuurs et al., 1990). Even
after having missing anterior teeth replaced with partial
dentures, the probability of satisfaction was lower for
subjects that had fewer than nine anterior teeth present.
There was no difference in satisfaction for subjects with
nine or more anterior teeth present. The opposite trend
occurred in relation to the number of posterior teeth
present. The tendency was that the higher the number
of posterior teeth, the higher the level of satisfaction.
In relation to molar pairs, there were few differences
in mouth satisfaction between persons that had no or all
molar pairs. The probability of satisfaction for premolar
pairs was very similar for both studies. There was an
increase in satisfaction up to three pairs of premolars;
after that there were very few changes. This finding
suggests that even less than the four pairs of premolar
teeth; the SDA found in Käyser’s clinical evaluation of
minimal number of teeth necessary to satisfy functional
requirements. Subjectively, people need even fewer
teeth than was determined by objective clinical trials.
Groupings of premolar and molar pairs can give a
better insight into the relationship between position of
teeth and satisfaction. Other studies have used groups
of premolar and molar pairs, but have nor combined
premolar and molar pairs (Rosenoer & Sheiham, 1995)
or have used only the number of occluding posterior
surfaces without mentioning their position; whether
they were premolar or molar pairs (Meeuwissen, 1992;
Leake et al., 1994). Some only assessed people with
natural teeth, or prosthesis or a combination of both
artificial and natural teeth (Barenthin, 1977). The
probability of satisfaction for the dental groups, of
both Brazilian studies, increased with the group
number. There was a tendency for persons in the
lower groups to be more satisfied with their oral condi-
tion than the higher number groups. This was probably
due to the lower number of POPS in the low than the
high number groups, with the exception of Group 15.
Satisfaction with mouth was related to the number
of premolar pairs present. Those in the dental groups
with higher numbers of premolar pairs were more
satisfied with their mouth. All the groups that had the
four premolar pairs had high percentages of satisfied
persons for both studies (Table 10). The group with four
pairs of premolar teeth that had a smaller percentage
satisfied, showed greater satisfaction than groups with
fewer premolar pairs.
For molar pairs, even the groups such as Group 7
(both studies) and Group 10 (cross-sectional study) that
had lower numbers of molar pairs were satisfied with
their oral condition. Satisfaction was not related to the
number of molar pairs, since groups with lower numbers
of molar pairs were as satisfied as groups that had a
higher number of molar pairs.
The groups with lower percentage of satisfied persons
were the low dental groups of the cross-sectional study
(Groups 1, 2, 3 and 5) and longitudinal study (Groups
1, 3, 5 and 6) (Table 11). Apart from the low groups,
Groups 9 and 15, of the cross-sectional study and Group
9 of the longitudinal study had a lower proportion of
satisfied persons than the other groups. Group 15, of
the cross-sectional study, had all teeth, because the
missing were replaced with partial dentures. The
replacement of missing teeth with partial dentures did
not increase satisfaction to a high level. Other factors
such as age or social class probably affected satisfaction
since the longitudinal study consisted of 45–54 year
olds and two different social classes whereas there
were only manual workers in the cross-sectional study.
Surprisingly, Group 9, for both studies, had lower levels
of satisfaction than the other Groups. This was the only
dental group, of the cross-sectional study with a high
number of premolar pairs (three) but with lower levels
of satisfaction. In the longitudinal study, Group 9 and
Group 6 with three premolar pairs had lower levels of
satisfaction (50 and 66·7%, respectively). Other factors
such as the condition of teeth may have affected satisfac-
tion of persons of this group.
The Eichner index has been used to test satisfaction
in relation to position of teeth. Levels of satisfaction
were similar between persons with complete and partial
dentitions. Persons in subgroup B2 with two zones of
posterior support, had higher levels of satisfaction than
the group with a complete dentition. The results of the
longitudinal study were similar to Meeuwissen (1992).
However, she found that only subgroup A1 were satis-
fied with their oral condition. In the Brazilian studies
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S AT I S F A C T I O N W I T H M O U T H B A S E D O N N U M B E R , P O S I T I O N A N D C O N D I T I O N 67

Table 10. Cross-tabulation between dental groups and ‘total satisfaction’ for the cross-sectional and longitudinal studies. Dental groups
with higher percentage of satisfied persons

Cross-sectional Longitudinal baseline

Dental groups Pre/molar pairs % Dental groups Pre/molar pairs %

Group 14 4/4, 4/5, 4/6 97 Group 14 4/4, 4/5, 4/6 100

Group 4 4/0, 3/0 95 Group 7 4/1 100
Group 12 4/3 94 Group 11 2/3, 3/3 100
Group 10 4/2 90 Group 12 4/3 94
Group 7 4/1 87 Group 8 1/2, 2/2 91
Group 4 4/0, 3/0 90

Table 11. Cross-tabulation between dental groups and ‘total satisfaction’ for the cross-sectional and longitudinal studies. Dental groups
with lower percentage of satisfied persons

Cross-sectional Longitudinal baseline

Dental groups Pre/molar pairs % Dental groups Pre/molar pairs %

Group 1 0/0 53 Group 9 3/2 50

Group 9 3/2 70 Group 1 0/0 64
Group 3 2/0 71 Group 5 1/1, 2/1 66
Group 2 1/0 74 Group 6 3/1 66
Group 5 1/1, 2/1 74 Group 3 2/0 75
Group 15 4/4, 4/5, 4/6 75

persons with partial dentitions were as satisfied as the
persons with complete dentitions. As expected, groups
of persons that had teeth contact outside the areas of
support or just contact on one zone of support (subgroup
B2) were less satisfied with their dental condition.
These results support the hypothesis that satisfaction
with mouth is affected by the position of teeth present
in the oral cavity. Anterior teeth were the most
important in determining individuals’ subjective percep-
tion of satisfaction with mouth (Bjorn & Owall, 1979;
Osterberg, Hedegard & Sater, 1983; Owall & Taylor,
1989). However, Leake’s (1990) results were different
in terms of the order of importance of types of teeth,
in relation to position in the oral cavity. The most
significant group of teeth according to his analysis was
the presence or absence of posterior natural teeth,
followed by functioning pairs of premolar and
anterior teeth. The possible differences between this
investigation and Leake’s survey (1990) might be that
the latter was concerned exclusively with chewing
ability while in this investigation, satisfaction with
mouth was analysed as a whole, and other impacts
beside subjective function were assessed.
Condition of teeth and satisfaction
Of the different DMFT components, Missing (M) was
more associated with satisfaction than the other com-
ponents (D and F) in the Brazilian studies. This is in
agreement with other studies (Reisine & Bailit, 1980;
Slade & Spencer, 1994; Rosenoer & Sheiham, 1995;
Matthias et al., 1995). Locker (1992) reported a correla-
tion between the chewing index and the number of
functional units and the mean periodontal index. Slade
& Spencer (1994) testing the ‘Oral Health Impact Profile’
(OHIP) in relation to clinical indicators of tooth loss,
caries and periodontal disease, found that the strongest
correlation was between the number of missing teeth
and the physical disability. Other clinical indicators that
correlated with the OHIP were the number of functional
units and the number of posterior functional units. In
the Brazilian studies the higher the number of missing
teeth the lower was the level of satisfaction for all the
dental categories. The probability of satisfaction for
persons with 22 missing teeth to be satisfied was high.
After 12 missing teeth the probability of satisfaction
decreased significantly. According to Giddon et al. (1976)

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68 A.C. ELIAS & A. SHEIHAM
missing teeth ‘had no substantial influence on percep-
tions of either the state of the teeth and the need for
treatment’. The results of this investigation differed
from Giddon et al. (1976). Missing teeth had an effect
on satisfaction. Factors such as the number and position
of missing teeth had different effects on satisfaction
but overall, missing teeth was a strong predictor of
satisfaction. Giddon et al. (1976) considered decayed
teeth as the most important correlate of perceived state
of oral health.
The Brazilian studies agree with other studies that
there was an inverse relationship between the number
of decayed teeth and satisfaction with mouth (Giddon
et al., 1976; Barenthin, 1977; Reisine & Bailit, 1980).
Chen (1991) found that the number of decayed teeth
was significant for the three indicators of perceived
well-being, symptoms and level of functioning. In the
longitudinal study the same trend was observed for
all three groups: partial denture wearers, non-partial
denture wearers, and the whole sample. The higher the
number of decayed teeth the lower was the probability
of satisfaction of the cross-sectional and longitudinal
studies.
In the Brazilian studies there was a direct relationship
between the number of filled teeth and satisfaction with
mouth in all three groups: partial denture wearers, non-
partial denture wearers and the whole sample. Even
though the differences in levels of satisfaction were
small between the groups with more and less filled
teeth. Similar findings were reported by Leao (1993)
that the higher the number of filled teeth the higher
was satisfaction with the oral status.
Combined number, position and condition of teeth and
satisfaction
The model that combined number, position and condi-
tion of teeth confirmed the trend of the individual
models for the cross-sectional and longitudinal studies.
The differences in the probability of satisfaction for the
combined and non-combined individual models were
similar, with a tendency for a slight increase in levels
of satisfaction for the combined models. It is important
to stress that the differences for the combined or non-
combined models were very small. Only for the position
model (dental groups, Eichner index) did a non-
combined model have a slightly higher probability of
satisfaction than the combined. It seems that when the
number and condition of teeth were combined with
position the probability of satisfaction decreased prob-
ably because the condition was affecting satisfaction.
This shows that the position of teeth, by itself, was an
important predictor of satisfaction. The number of teeth
model affected satisfaction as did the position and the
condition. When they were combined this trend was
confirmed. The probability of satisfaction increases due
to a combination of the number, position and condition
of teeth.
Replacement of teeth and satisfaction
The Brazilian studies were not designed to assess satis-
faction with partial dentures, but, since persons with
partial dentures were included, the replaced teeth were
considered as teeth present to form the dental groups,
it is important to assess if there was differences in
condition of teeth of denture and non-denture wearers
that could affect satisfaction. The use of artificial teeth
as functioning teeth was suggested by Vehkalahti &
Paunio (1988). They considered the functional capacity
of the dentition of an elderly population should be
based on the number of natural and artificial teeth
present since a removable partial denture would add
functional units.
Oral function has an objective masticatory perform-
ance as well as the subjective masticatory ability. Two
studies suggested that oral function increased after the
insertion of removable partial dentures (Gunne, 1985;
Carlsson, 1984). The Brazilian studies showed that the
benefit to oral function of replacing posterior teeth is
not predictable. A finding supported by Jemt, Hedegard
& Wickberg (1983), Battistuzzi, käyser & Kanters (1987)
and Witter et al., (1989). Almost the same percentage
of Brazilians with removable partial dentures replacing
missing teeth (Group 15) compared with those who did
not have dentures even though having no occluding
posterior pairs of teeth (Group 1) were satisfied with
their mouth.
A large number of complaints are related to lower
bilateral distal extension partial dentures (Watson et al.,
1986; Witter et al., 1990b). However, where removable
partial denture added occlusal units to the dentition,
satisfaction appeared to increase (Van Waas et al., 1994;
Käyser & Witter, 1985; Witter et al., 1990a; Witter et al.,
1990b and Witter et al., 1991). In the Brazilian study, a
higher percentage of persons with no artificial replace-
ments of the posterior missing teeth were satisfied with
their oral function. They were persons who had the
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S AT I S F A C T I O N W I T H M O U T H B A S E D O N N U M B E R , P O S I T I O N A N D C O N D I T I O N
most premolar pairs and missing molar pairs that had
not been replaced (Group 4). All the other dental groups
had a higher percentage of satisfied persons than in the
group that had persons with removable partial dentures
replacing all missing teeth.
Acknowledgments
This study was supported by a grant from the Conselho
Nacional de Pesquisa e Desenvolvimento (CNPq) of
Brazil and the British Council
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