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A group of 109 subjects received a short questionnaire concerning their general health status. The subjects were invited to recall all the (health) problems experienced in the foregoing 6 months. Every participant in this study had visited the dentist, in the 6 months preceding the investigation, because of a dental problem. If these dental problems were important for the respondents they would recall them spontaneously, when a general question regarding health problems was posed. Only eight subjects mentioned dental problems spontaneously, of which seven concerned "pain-complaints". Only in two cases had the dental complaints been experienced more than 3 months ago. Eighteen respondents said that they could not remember the dental visit or their specific dental problem. Thirteen of these 18 persons visited their dentist because of an aesthetic problem. The results indicate that the impact of (some) dental problems on a person's feeling of being healthy was small. On the other hand, this study shows that the comparability of (most) dental problems and general health problems is limited. A typology of the significance of dental problems for the public and comparability with the concept of general health is presented and discussed in this study.

Reasons for full mouth extraction in an urban and a rural area in The Netherlands (dentist-patient ratio 1:2500 and 1:5700 respectively) have been studied. Patients who participated in this combined sociodental research project were those who received full mouth extractions over a period of 1 yr. The combined patient response was 75% and the overall dentist response 90%. In the urban and the rural areas respectively 137 and 237 cases of full mouth extraction were recorded. When comparing the dentists' diagnoses with the conditions of the dentitions there appeared to be a fair degree of agreement in most of the cases, although some striking deviations were also found. In the relationship between the patient's opinion and the condition of the dentition some unexplained discrepancies were found: 37% of the dentitions in which the teeth and attachment were in a healthy condition were perceived as bad by the patients. Dentists and patients agreed in their perceptions of the dental conditions in 60% of the cases. In 27% there was a strong disagreement. In most of the discrepancies found plausible explanations could be given. In some cases this was not possible. As this involves a substantial minority of cases, dentists should be aware of reasons other than the clinical condition in the disabling treatment of full clearance.

The process of not attending the dentist is a vicious cycle in which anxiety plays a crucial role. A research project concerning the disease and non-disease reasons for full mouth extraction provided an opportunity to describe the dental histories in terms of dental attendance pattern and related factors which resulted in full dentures. Three profiles of dental histories could be outlined: 1) The regular attenders (19%). Because of their age (means = 47 yr), their positive attitude towards dentistry together with their positive attitude towards full dentures, it is suggested that the possibilities of keeping the natural dentition were exhausted so that full mouth extraction was an acceptable solution. 2) The symptomatic attenders (38%). Because anxiety, which was widespread in this group, was not based on negative experiences, it is suggested that anxiety is caused by social learning. Together with their positive attitude towards full dentures, the high prevalence of full dentures in their social environment and their low socioeconomic status, the conclusion is drawn that these patients lived in a culture which supports behavior that leads to total tooth loss. 3) Once regular attenders (43%). In this group anxiety leads to a negative perception of dental visits and to a negative attitude towards dentists. As a consequence dental visits are deferred, which results in deterioration of the dentition. Experiences with dentists are distorted in a negative way, which increases dental anxiety. Facilitated by a positive attitude towards full dentures, their bad dental condition finally urges them to take full dentures at early age.

The perception and significance of dental appearance was investigated in three groups of patients. One group had a missing front tooth replaced by partial dentures, which were taken out during the tests. A second group had some missing (pre-)molars. A third group had a complete natural dentition and they acted as control group. Color photographs of the teeth were made and a clinical examination was carried out. The psychological impact of dental appearance was measured by way of a scale of words with affective connotations. Social impact was assessed by way of changes in daily activities. Dentists and lay-persons were asked to give an opinion of the dental appearance on the basis of the pictures. It was found that a missing front tooth resulted in less positive feelings and more negative feelings and also that this condition affected daily life activities strongly. Missing (pre-)molars caused less of an aesthetic problem. Dentists and lay-persons were quite alike in their appreciation of dental appearance, whereas the respondents themselves had different opinions. An explanation for these differences and their implications for dentists are discussed.

Full mouth extraction is the final step in a continuous process in which not only dental but also social processes play a role. In a research project concerning the reasons for full mouth extractions in The Netherlands, it was found that over one-third of the patients had considered full mouth extractions at least once before, and 16% considered it frequently over a period of many years. Anxiety was the most important reason for not visiting a dentist. In the patients' view in 86% of the cases they were the initiator of the decision to have all their teeth extracted. According to the dentist the patients initiated full mouth extraction in 70% of the cases. Dentists and patients agreed that irregular attenders more often took the initiative than regular attenders. Most patients (87%) had discussed the decision to have all teeth extracted with one or more persons; different contacts were reported by 14% percent of the patients. According to Freidson's lay referral theory two groups could be identified: a group with a severely truncated lay referral structure and a group characterized by a more extended lay referral structure. The first group was older (46 versus 36 yr) and had a more positive attitude towards full dentures. In order to avoid problems dentists are recommended to involve (a representative of) the patient's social network when important decisions have to be taken.

The impact of loss of teeth on chewing ability was investigated in three groups of patients. One group already had missing teeth replaced by partial dentures, which were taken out during the tests. This group was taken as not being adapted to chew without a complete dentition. A second group had their missing teeth not replaced by partial dentures. During the test they were considered adapted to chew without a complete dentition. A third group had a complete natural dentition and they acted as control group. Tests were carried out regarding chewing ability and swallowing threshold. In addition, a clinical examination was carried out. It was found that the loss of molars significantly reduced chewing performance. Moreover the number of chewing-strokes before swallowing the food-bolus and the mean of the particle size at the point of swallowing were increased. Loss of molars resulted in less positive feelings concerning chewing. Both groups of persons with missing molars showed a similar chewing performance. The group of not adapted patients felt on average more negative about their chewing ability and they indicated more changes in daily activities because of missing teeth.

A hypothesis was developed that the impact or importance of oral health problems may be reflected in a person's ability to remember these problems occurring in a given period spontaneously. That means that the recollection should occur on a nonspecific stimulant, i.e. a general question regarding recall of health problems. This hypothesis was first tested on existing data. A representative sample (n = 1622) of the Dutch population was asked to list all the health problems they had experienced the preceding year. Only 13 persons mentioned an oral health problem. From more specific questions on dental matters it appeared that about 15% of the sample had experienced oral health problems in this period. One hundred and forty-six respondents indeed had received dental care because of acute pain. These data indicate that the impact of oral health problems on a person's daily life is small. Otherwise the oral health problem would have been mentioned spontaneously more often. Three possible explanations for this phenomenon are discussed.