Fear of dental implants among edentulous patients by Jordan Nemes, B.Sc. Faculty ofDentistry, McGill University, Montreal April 2007 A thesis submitted to McGill University in partial fulfillment of the requirements of the degree of Master' s in Dental Science © Jordan Nemes 2007 Library and Bibliothèque et 1+1 Archives Canada Archives Canada Published Heritage Direction du Branch Patrimoine de l'édition 395 Wellington Street 395, rue Wellington Ottawa ON K1A ON4 Ottawa ON K1A ON4 Canada Canada Your file Votre référence ISBN: 978-0-494-32848-4 Our file Notre référence ISBN: 978-0-494-32848-4 NOTICE: AVIS: The author has granted a non­ L'auteur a accordé une licence non exclusive exclusive license allowing Library permettant à la Bibliothèque et Archives and Archives Canada to reproduce, Canada de reproduire, publier, archiver, publish, archive, preserve, conserve, sauvegarder, conserver, transmettre au public communicate to the public by par télécommunication ou par l'Internet, prêter, telecommunication or on the Internet, distribuer et vendre des thèses partout dans loan, distribute and sell th es es le monde, à des fins commerciales ou autres, worldwide, for commercial or non­ sur support microforme, papier, électronique commercial purposes, in microform, et/ou autres formats. paper, electronic and/or any other formats. The author retains copyright L'auteur conserve la propriété du droit d'auteur ownership and moral rights in et des droits moraux qui protège cette thèse. this thesis. Neither the thesis Ni la thèse ni des extraits substantiels de nor substantial extracts from it celle-ci ne doivent être imprimés ou autrement may be printed or otherwise reproduits sans son autorisation. reproduced without the author's permission. ln compliance with the Canadian Conformément à la loi canadienne Privacy Act some supporting sur la protection de la vie privée, forms may have been removed quelques formulaires secondaires from this thesis. ont été enlevés de cette thèse. While these forms may be included Bien que ces formulaires in the document page count, aient inclus dans la pagination, their removal does not represent il n'y aura aucun contenu manquant. any loss of content from the thesis. ••• Canada 111 ABSTRACT Fear of dental implants among edentulous patients Despite implant-supported overdentures' advantages over conventional dentures, edentulous patients often refuse dental implants for reasons that may be related to fear. Objective: The purpose of this study was to uncover and explain the various forms and sources of dental implant-related fear among edentulous patients. Methods: A convenient sample of 8 edentulous/semi-edentulous participants was used. Participants were recruited from a current study at McGill University's Faculty of Dentistry, posting of recruitment flyers, and local homes and community centers for seniors. One-on-one interviews were conducted in Montreal from March 2005 to February 2006, transcribed verbatim, and coded into multiple theme~based sections. Results: Three categories of implant-related ~ .. fear were identified: 1) fear of dental implant surgery; 2) fear of the recovery period; and 3) miscellaneous fears. As weIl, four main sources of dental implant-related fear were uncovered: 1) past negative experiences at the dentist; 2) "horror stories" of dental implant surgery; 3) having relatively little knowledge of dental implants; and 4) po or dentist-patient relationship. Discussion: The various forms of dental implant-related fear seem to play a substantial role in influencing a patient's decision to undergo implant surgery. IV RÉSUMÉ Malgré les avantages des implants dentaires sur les dentiers conventionnels, les patients édentés refusent souvent les implants dentaires pour des raisons qui peuvent être reliées à la peur. Objectif: Le but de cette étude était de découvrir et d'expliquer les diverses formes et sources de peurs reliées aux implants dentaires parmi les patients édentés. Méthodes: Un échantillon pratique de 8 participants édentés/semi-édentés a été utilisé pour cette recherche. Les participants ont été recrutés à partir d'un groupe de personnes d'une étude de l'Université de Mc Gill (Faculté de médecine dentaire), à l'aide de prospectus et en demandant dans des maisons et centres communautaires pour personnes âgées. Des entrevues individuelles ont été menées à Montréal entre mars 2005 et février 2006. Elles ont été retranscrites mot par mot et codées dans des sections basées selon des thèmes multiples. Résultats: Trois catégories de la peur d'implants dentaires ont été identifiées: 1) la peur de la chirurgie de l'implant dentaire; 2) la peur reliée au temps de guérison; et 3) peurs diverses. De même, 4 sources principales reliées à la peur de l'implant dentaire ont été également identifiées: 1) une expérience passée négative chez le dentiste; 2) des « histoires d'horreurs» entendues sur la chirurgie d'implants dentaires; 3) une connaissance très limitée sur les implants dentaires; et 4) une mauvaise relation entre le dentiste et son patient. Discussion: Les diverses formes de peurs reliées aux implants dentaires semblent jouer un rôle important dans la décision du patient de subir ou non une chirurgie d'implants. v Acknowledgements rd like to thank Dr. Christophe Bedos for aIl the support and guidance he has given me over the past two years. His expertise knowledge in qualitative research and public health dentistry were invaluable in helping me realize the results of this study. Moreover, his thorough and intuitive approach to research has helped me further my own research skills and develop as a Master's student. FinaIly, his patience, kindness, and willingness to help have driven me to perform at my best. Secondly, l would like to thank the ITI Foundation for their funding and contribution to my research. Without their help, this study would not be possible. As weIl, l would like to thank Drs. Mark Thomason and Jocelyne Feine for allowing me to be part of their ITI research team. The past two years have been a great educational experience and l am truly appreciative for this opportunity. Furthermore, the involvement of the Cummings Jewish Centre for Seniors was pivotaI in this study's participant recruitment process. l would like to thank Benita Goldin for granting me permission to use the facilities, Linda Strohl for her cooperation and help in finding potential participants, as weIl as aIl the administration, staff and volunteers at the centre who have helped contribute to my research. l would also like to thank Drs. Alissa Levine and Steven Jordan for their contributions to the development of this research project, as weIl as their guidance and knowledge of qualitative research. In addition, thank you to Nicolas Drolet and Mrs. Marta Hauptman for their facilitation of additional participant recruitment. Furthermore, l' d like to thank Dr. Antoine Chehade for allowing me the opportunity to observe dental implant surgery first hand. VI As weIl, 1 would like to thank aIl the participants of this study for taking the time to meet with me and discuss their dental-related experiences. 1 would also like to thank Quintessence Publishing Co, Inc. for permission to use their pictures. These pictures are copyrighted and cannot be reproduced without the permission of the publisher. FinaIly, l' d like to thank my family for their endless support and continuous motivation in helping me see this project to fruition. As weIl, a very special thank-you to my fiancée Naomi Hauptman for aIl of her editing contributions, empathy, love and support, and for always being there for me. VIl TABLE OF CONTENTS 1 Introduction .................................................................................... 1 2 Literature Review ..............................................................................2 2.1 Edentulism .............................................................................. 2 2.2 Dentures .................................................................................. 5 2.3 Dental Implants ........................................................................... 7 2.4 Fear of Dental Implants .............................................................. 13 2.5 Summary ............................................................................... 15 3 Objective ..................................................................................... 17 4 Methods............................................................... .................... 18 4.1 Research Design ..................................................................... 18 4.2 Sample Recruitment ...................................................................20 4.2.1 Sample Criteria ............................................................... 20 4.2.2 Recruitment ...................................................................20 4.3 Interview Procedure .................................................................. 24 4.4 Data Analysis .........................................................................26 5 Results ........................................................................................ 30 5.1 Fear of dental implant surgery ..................................................... .30 5.1.1 Fear ofPain .................................................................. 30 5.1.1.1 Fear ofNeedles and Anesthetic ................................ 30 5.1.1.2 Fear of Dental Instruments ..................................... 32 5.1.1.3 Fear ofGum-Pain ...............................................