Dissertation mrs. P. Destilda first year m. Sc
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PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION MRS. P.DESTILDA FIRST YEAR M.SC (NURSING) MEDICAL SURGICAL NURSING YEAR 2010-2012 IKON NURSING COLLEGE, BEEMANAHALLI,B.M. MAIN ROAD RAMANAGARAM DISTRICT BIDADI, BANGALORE-562109 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
6. BRIEF RESUME OF THE INTENDED WORK 6.1 INTRODUCTION “BLESSSED ARE YE THAT WEEP NOW; FOR YE SHALL LAUGHS” - Luke 6:21 The mouth is an important zone for communication between people through speech but much of socialization and pleasure is derived from food and drink. Poor oral function, hygiene, and chronic oral problems can lead to loss of life satisfaction. Ageing is an inevitable phenomenon in all biological beings. It is a time when people move away .From previous more desirable situations. In traditional Indian culture, old age is considered as one of the stages of human development where a person attains wisdom, maturity, social and economic recognition and emotional fulfilment. The physical and structural changes namely altered metabolism, loss of teeth, and difficulty in mastication, taste bud atrophy, reduced gastric volume and atrophy of gastro-intestinal tract of elderly affect their food intake. 1 Brown and Meskin found that elders today are more aware of facial aesthetics, self esteem, and the desire to maintain a high quality of life, people ages 65 to 69 with higher incomes experience less severe tooth loss than older adults with lower incomes but this diminishes with increasing age. Half the people in the study over the age of 80 had no teeth. Depending on the severity of dry mouth, the elder may complain about a burning sensation or difficulty chewing. Swallowing, speaking, or retaining upper dentures. The commercially available substitutes contain a lubricant-sweetener such as glycerine or Sorbitol, salt ions, and a flavouring agent; a few contain fluoride. Saliva substitutes come as sprays, rinses, or swishes and can be used as often as the individual wants. Generally, the aged are seen by the dentist when it is too late to salvage the teeth. It is therefore imperative to conscientiously include appropriate dental care to maintain and preserve the existing teeth of the aged person. Dental care begins at home and should be reinforced by the care giver when the aged person requires assistance in meeting this activity of daily living. 2 Dental health of the aged is a basic need that is increasingly neglected with advanced age, debilitation, and limited mobility. One reason for this neglect may be the general assumption that older people are edentulous. The aged, they, believe that losing their teeth is a natural consequence of growing old. The problem with this attitude is that it fosters neglect of an essential body part: the mouth. Thus assessing knowledge of geriatrics regarding their usage of denture is important aspect; if they are not aware of the importance of usage of denture in their daily use it may cause health hazards. Background of the Study “ DENTAL HEALTH FOR A LIFE TIME”-Carl Anderson The anxiety is natural and quite understandable. There is no human who is not concerned about his appearance. And what can be more embarrassing than an unattractive smile. Some, unfortunately, are born with a bad dental structure. But most have made themselves so, by poor upkeep. And result: crooked teeth, splintered teeth, smelly mouth known as halitosis. In today's world, you no longer need to put up with this kind of embarrassment. Thanks to modern dentistry, you are entitled to have a straight and pretty set of teeth. Even if it has to be a denture, let it be, as latest ones looks very natural and gorgeous. Prevention is the watchword, and the time to begin is childhood. Perhaps a view of bacteria in plaque would help you understand dental disease. Plaque is a Jellylike deposit on teeth where bacteria proliferate. It covers teeth like a thin blanket. Harmful effects result when the bacteria are allowed to organize and attack.3 As identified in a report by the United States surgeon General in 2000, Oral health is a very important component of a persons physical and psychological sense of well-being.4
- Carl Anderson A significant number of elders are edentulous and wear complete dentures. Denture helps maintain adequate nutrition and psychologically aid to preserve appearance, social contacts, and relationships that a person has cultivated. Many elders believe that once they have dentures there is no longer a need for oral care. Older adults with dentures should be taught the proper home care of their dentures and oral tissue which prevents odour, stain and plaque build up, and removes debris under dentures that causes pressure and shrinkage of the underlying support structures. The dentures must be worn constantly. They should be removed at bedtime and replaced in the mouth in the morning to allow relief of the compression on the gums. Prevalence studies are important to determine the oral health status and treatment needs of elderly people. The prevalence of oral mucosal conditions in Turkish elderly ratios was calculated with 95% confidence intervals. Oral mucosal condition was recorded in 40.7% of the study sample. The denture related lesions accounted for 36.4%.The prevalence of oral mucosal condition was related to length of denture use.5 The current profile of dentate status and use of dental health services among adults in Denmark at the turn of the millennium, to assess the impact of dentate status of sociodemographic factors and use of dental health services in adulthood and in childhood, and to highlight the changes overtime in dental health conditions among adults. The intention of the study was to evaluate the Danish dental health care systems level of achievement of the official goals for the year 2000 by the World Health Organization and the National Board of Health. National representative sample of 16690 Danish citizens aged 16 years and older; response rate 74.2%.A subsample took part in a survey of dental care habits in childhood and Prevalence of removable dentures; 66% of persons selected responded. Interviews were used to collect data on dental care habits by self administered questionnaires. In all, 80% of interviewed persons were edentulous while 80% had 20 or more natural teeth .At age 65-74 years, 27% were edentulous and 40% had 20 teeth or more; 58% were removable dentures. Among persons interviewed,80% paid regular dental visits. At age 35-44 years 95% had regular dental care in childhood against 49% of 65-74-year-olds.6 The attitude towards replacement of teeth among patients who reported to the department of prosthodontics in the institute of Dental sciences, Belgaum, which is located in the north-western part of the state of Karnataka in the southern region of India. A fourteen item, closed ended questionnaire was completed by 365 volunteer patients. Collected data from 365 patients were statistically analyzed. Among these 365 patients,228 were in a waiting period of soft tissue healing after extraction of tooth; 19.7% of the patients gave financial constraints;7.1% reported that they lacked the time to have teeth replaced; 6.9% had low felt needs; and 3.8% they did not know that teeth could be replaced.7 The findings indicate that awareness needs to be increased regarding the other functions of teeth like aesthetics and phonetics. So that the investigator can help older adults find dental services that offer reduced rates and that are accessible to those with impaired mobility and can help prevent dental and gum disease through education about routine dental care. Therefore the investigator felt that there is a need to create awareness among Geriatrics regarding denture use.
“A Study to assess the effectiveness of self instructional module on knowledge and attitude of geriatrics regarding the usage of dentures at selected urban community in Ramanagara District, Bangalore.’’ 6.4 OBJECTIVES OF THE STUDY
6.5 OPERATIONAL DEFINITIONS Assessment Assessment refers to the statistical analysis of information gathered through multiple choice questionnaire related to the knowledge geriatrics regarding their usage of dentures. Knowledge In this study knowledge refers correct response to the knowledge of questions on usage of dentures which is measured by the structured knowledge quesionnare information in focus of knowledge scores. Attitude It refers to opinion, belief and feelings expressed by people regarding the usage of dentures. Geriatrics In this study geriatrics refers to those who are in the age group of above 50 years and staying in selected urban community, Bangalore Self Instructional Module It refers to printed material has prepared and organised by the investigator to provide information on selected community as of usage of dentures. Projected Outcome Self instructional module is used to enhance the knowledge of the geriatrics on usage of dentures in selected urban community, Bangalore 6.6 ASSUMPTIONS It is assumed that;
H1 - There will be significant correlation between the pre test and post test knowledge and attitude score of geriatrics regarding usage of dentures. H2 - There will be significant association between knowledge and attitude of geriatrics regarding the usage of dentures with their demographic variables. 6.8 REVIEW OF LITERATURE “THEN WAS OUR MOUTH FILLED WITH LAUGHTER” -psalms 126 : 2 The term literature review is used to design a written summary of the state of the amount of research problem. This also refers to the activities involved identifying and searching information on a topic and developing understanding of the state of knowledge on the topic. Therefore the researcher has reviewed literature with regard to the problem by referring journals, books, thesis etc. In this chapter the review of literature is presented under the following headings. 1. Studies related to the knowledge, attitude and practice of dentures users
1. Studies related to the knowledge and practice of dentures users A comparative study was conducted by J AM Dental Association, in the year of 2000 to determine if reducing mandibular denture Movement through the use of a denture adhesive improves chewing function in edentulous patients. The authors compared the mean chewing rates of 10 denture wearers who used and did not use a denture adhesive with that of a control group of 10 dentate people. The authors recorded mandibular movements using a multichannel magnetometer tracking system. They made recordings for the test subjects without the use of denture adhesive and at zero, two and four hours after Fixodent denture adhesive cream. The authors found statistically significant increases in the mean chewing rates for the test group after the denture adhesive was applied at all time points. This study found the use of denture adhesive increased mean chewing rate.8 Department of Prosthodontic was conducted a study to investigate the influence of denture design on patient acceptance of partial dentures. A total of 317 patients provided with partial dentures by the Department of Prosthodontics, Newcastle Dental School 2-3 years previously, were asked to complete a postal questionnaire about their use of these dentures. Design variables included material, the number and distribution of replaced teeth, denture support and connector design. Non-wearers were more likely to have no replacement anterior teeth, fewer replacement teeth and, in the lower, a lingual bar. This study found the use of a lingual bar did not influence denture wearing habits.9 An Experimental study was conducted by Department of Dental Prosthetics and Gerontology, University of Dundee in U.K. This study suggested that incomplete or faulty processing leading to a high level of residual monomer is a factor in denture whitening. Laboratory tests which simulate the cleaning procedures used by patients presenting with whitened identurss have been carried out on specimen strips of acrylic Klenturefr base material. The results show that these samples exhibit similar changes and that the high level of residual monomer had no effect on the whitening process. However, some physical properties were adversely affected by a high residual monomer content which has serious consequences for denture wearing patients.10 A comparative study was conducted by University of Alabama at Birmingham, USA to evaluate the relationship between denture thickness and the dimensional stability of acrylic resin denture bases as a result of the compression molding process. Forty-Eight maxillary complete dentures were fabricated in 3 different thicknesses using 4 curing and cooling cycle combinations. After processing the dentures were replaced on the original cast. The different curing cycles tested the thicker dentures had less molar-to-molar linear shrinkage, but more dimensional change in the posterior palatal area as compared to the thinner dentures.11
A Comparative study was conducted by Huaiqin Zhang, Research Institute of Stomatology, Nanjing Medical University, China in the year of 2007 to know the relationship between plasma treatment time and efficacy Test specimens were prepared from an acrylic resin denture material in the size of 2 mm x 10mm x 10mm. Plasma treatment was carried out on the surface of Polymethyl methacrylate at different time. XPS studies, IR spectra studies and measurement of wetting angle were performed. As the reaction proceeded, wetting angle increased slightly. Equilibrium was reached for introducing oxygen-containing groups and changing of C-H. As the treatment proceeded, wetting angle increased slightly.12 A study was conducted by Department of Prosthodontics, Tokyo Dental College in the year of 2010 to determine the effect of number of chewing strokes on change in blood flow in dentures-supporting maxillary mucosa in Turkish elderly. Subject consisted of 11 healthy dentate men. Mastication was simulated by intermittent loading on a lateral area of the hard palate. A non-contact laser Doppler blood flow meter was used to determine change in blood flow and time taken for recovery to 110% of the pre-loading value. Mean blood flow at pre-loading and at each duration of intermittent loading were compared using a repeated measures ANOVA and the Dunnett test. Three subjects showed no increase in mean blood flow with loading. Eight subjects showed an increase in mean blood flow during intermittent loading relative to at pre-loading.13 A Household health interview survey of 3,673 was conducted in non institutionalized people aged 65 and over in two rural Iowa counties included questions about loss of teeth, use of dentures, and presence of oral health problems. About 40 per cent had dentures that were over 20 years old, with half of these being over 30 years old. Many dentures were loose and causing soreness in the mouth or difficulty in eating. These elderly people appeared to expect some problems with dentures and oral pain and accepted them without feeling a need to seek treatment.14 3. Studies relate to the dental care and effects of denture adhesive A descriptive study was conducted by Department of removable prosthodontics, Tsurumi University in the year of 2010 to clarify whether the treatment of complete dentures and the use of partial dentures influence the brain function activity as determined by electroencephalograms.18 complete and 20 partial denture wearers participated in the study. To evaluate brain function activity, electroencephalogram data obtained employing ESA-pro were analysed using DIMENSION. The occlusal contact area significantly increased after complete denture treatment in all 18 subjects and significantly increased with wearing partial dentures in all 20 subjects. It was revealed that brain function activity was enhanced by the improvement of complete dentures, and by wearing partial dentures.15 A comparative study was conducted by Department of prosthodontics, university of Washington in the year of 2005 to assess the importance of published fabrication standards in determining the outcome of treatment with mandibular distal extension removable partial dentures in patients of community practices. Eighty-two people treated in private dental practices who responded to a mail survey about satisfaction with a partial denture were examined. Patient satisfaction was assessed by questionnaire. Associations between variables were assessed by contingency tables and odds ratios. This study found partial support for the validity of design/fabrication standards for removable partial dentures.16 A Delphi Technique survey was conducted by academic prosthodontist, department of epidemiology & dental medicine in United states to know the use of denture adhesives and their role in prosthodontics has been an intriguing and conflicted topic, both in clinical practice and dental education. This "study generated discussion, and if possible, obtained a consensus on a series of issues related to denture adhesives among a group of leading academic prosthodontists. The Delphi Technique survey method was used. It consists of a series of survey questionnaire rounds to a panel of experts to either develop a consensus. A 24-item Delphi questionnaire was sent to an expert panel that consisted of a 33% regionally stratified random sample of program. Directors of undergraduate complete denture courses in UnitedState dental schools.The prosthodontists concluded that denture adhesives are useful adgent in denture prosthesis services17 A workshop was conducted by Department of Psychiatry, Duke University, Durham in the year of 1999 to entitled Taste and Smell in the Elderly: Behavioural and Nutritional Consequences was to review the current state of knowledge in the area of taste and smell, with emphasis on age- related changes, to identify existing gaps in our knowledge, and to develop future research strategies. There was general agreement that, the majority of scientific studies have found impairments in taste and smell acuity in the elderly. However, there are gaps in our knowledge of the basic mechanisms by which aging and environmental factors may impair the chemical senses in the –elderly. Further research is also required in a variety of areas to understand fully the impact of chemosensory dysfunction on older individuals.18 A study was conducted by Department of Prosthodontics, Faculty of Dentistry, and Marmara University, Turkey in the year of 2008. The aim of this study was at assessing the effect of gender, the number of the dentures used before, the length of time of denture usage, education and age on the satisfaction of the complete denture wearers. The subjects were 39-89 years of age with a mean of 61.62 years. The attitude toward dentures in general was measured by means of 11 items of a questionnaire. The 10 main questions of the questionnaire were answered by the participants. The patients displayed statistically significant differences only in the topics of their ability of cleaning their dentures, due to education and number of previously used Ventures.19 7. MATERIALS AND METHODS The study was designed to evaluate the effectivenss of self information module on usage of dentures among geriatrics (above 50 years) at selected urban community in Bangalore 7.1 Source of Data The data will be collected from geriatrics (above 50 years) at selected urban community in Bangalore 7.2 Method of data collection Research design Pre-experimental-One group pre test and post test design will be used to assess the knowledge and attitude of geriatrics of urban community regarding the usage of dentures. Setting Setting of the study will be conducted selected urban community at Bangalore. Population Population for the present study consists of urban people (men and women) living at Bangalore Method of data collection Sampling procedure Non probability Convenience sampling techniques is adopted for selecting the sample Sample size Men and women at the age group of above 50 years are in the inclusion criteria and sample size is 60 Inclusion criteria
Exclusion criteria
Instruments intended to be used Section A: Self administered structured questionnaire scheduled to assess the Demographic data of geriatric in the urban community at Bangalore Section B: Self administered structured questionnaire scheduled to assess the knowledge of men and women living in urban community, Bangalore Section C: Likert scale 5 point to assess the attitude of men and women in the urban community, Bangalore regarding usage of dentures 7.2.6 Method of data collection Phase 1: After obtained a prior formal permission from the significant authority, demographic data will be assessed for 15 minutes followed by which structured questionare will be administered for 45 minutes to assess the knowledge and attitude of men and women, in urban community, Bangalore regarding the usage of dentures. Phase 2: Followed by that Self Instructional Module will be given to the persons and after 7 days post test will be conducted. Phase 3: Investigator may distribute the pamphlet at the end of the study based on the results obtained. Descriptive Statistics:
Inferential statistics:
Projected outcome After the study the researcher will know the level of knowledge and attitude of men and women in the urban community in Bangalore about the usage of dentures. Based on the study results the researcher may distribute pamphlets to the men and women urban community about the usage of dentures, which will motivate the people towards the knowledge of usage of dentures. 7.3Does the study require any investigation to the patient or other human beings or animals? Yes, because the Self Instructional Module can change the knowledge and attitude of the sample 7.4Has ethical implication will be obtained for your institution? Yes, the permission obtained from the selected urban leaders authorities and subjects, privacy, confidentiality and aunominity will be guarded, scientific objectivity of the study will be mainted with honesty and impartiality. LIST OF REFERENCES
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