A number of studies have suggested that many people are satisfied with less than 28 natural teeth. This review assesses the evidence. The main conclusion was that less than a complete dentition can satisfy oral functional needs. Missing posterior teeth were not very important from a subjective aspect. The demand for replacement of missing teeth is related to the position of missing teeth. Most studies agree that individuals were more concerned about missing anterior teeth and having anterior rather than posterior teeth replaced. Aesthetics is more important than function for a great majority of individuals. However, certain socio-demographic factors, such as age, can change the subjective need for replacement of missing teeth. Some studies have assessed the social and psychological impacts on oral health status. The position of missing teeth was assessed, in terms of groups of missing teeth, anterior or posterior, that would affect an individuals' subjective need for replacement by partial prosthesis. Large numbers of people that have free end removable partial dentures made do not wear them because subjective needs are lower than normatively determined needs for replacement of missing teeth. Some studies have proposed alternatives to the replacement of missing teeth, such as the shortened dental arch concept.

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The objective of this study was to analyse adults' subjective perception of satisfaction in relation 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 longitudinal 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 longitudinal study. Six hundred and fifty-seven dentate 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 significant predictors of satisfaction. There was no difference 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.

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BackgroundIn Puerto Rico, relative to the United States, a disparity exists in detecting oral precancers and early cancers. To identify factors leading to the deficit in early detection, we obtained the perspectives of San Juan healthcare practitioners whose practice could be involved in the detection of such oral lesions.MethodsKey informant (KI) interviews were conducted with ten clinicians practicing in or around San Juan, Puerto Rico. We then triangulated our KI interview findings with other data sources, including recent literature on oral cancer detection from various geographic areas, current curricula at the University of Puerto Rico Schools of Medicine and Dental Medicine, as well as local health insurance regulations.ResultsKey informant-identified factors that likely contribute to the detection deficit include: many practitioners are deficient in knowledge regarding oral cancer and precancer; oral cancer screening examinations are limited regarding which patients receive them and the elements included. In Puerto Rico, specialists generally perform oral biopsies, and patient referral can be delayed by various factors, including government-subsidized health insurance, often referred to as Reforma. Reforma-based issues include often inadequate clinician knowledge regarding Reforma requirements/provisions, diagnostic delays related to Reforma bureaucracy, and among primary physicians, a perceived financial disincentive in referring Reforma patients.ConclusionsAddressing these issues may be useful in reducing the deficit in detecting oral precancers and early oral cancer in Puerto Rico.