Impact of prosthodontic rehabilitation on oral health-related quality of life in the Serbian Armed Forces personnel

Nenad Jelić; Miroslav  Dragović; Stefan  Vulović; Ljubiša  Ristić; Mile  Eraković; Marko  Milosavljević; Tatjana  Lemić; Aleksandra  Milić Lemić

doi:10.2298/VSP260201033J

Nenad Jelić Military Medical Academy, Dental Clinic, *Department of Prosthodontics, Belgrade, Serbia
Miroslav Dragović University of Belgrade, Faculty of Dental Medicine, Department of Prosthodontics, Belgrade, Serbia
Stefan Vulović University of Belgrade, Faculty of Dental Medicine, Department of Prosthodontics, Belgrade, Serbia
Ljubiša Ristić Military Medical Academy, Dental Clinic, Department of Prosthodontics, Belgrade, Serbia
Mile Eraković Military Medical Academy, Dental Clinic, Department of Oral Surgery, Belgrade, Serbia
Marko Milosavljević University of Kragujevac, Faculty of Medical Sciences, Department of Prosthodontics, Kragujevac, Serbia
Tatjana Lemić Military Medical Academy, Dental Clinic, Department of Oral Surgery, Belgrade, Serbia
Aleksandra Milić Lemić University of Belgrade, Faculty of Dental Medicine, Department of Prosthodontics, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP260201033J

Keywords: dental prosthesis;, military personnel;, oral health;, quality of life;, serbia;, surveys and questionnaires.

Abstract

Background/Aim. Although prosthodontic rehabilitation restores the structural integrity of the stomatognathic system, its impact on patients’ oral health–related quality of life (OHRQoL) remains insufficiently explored, particularly within the military population. The aim of this study was to evaluate the association between the type of prosthetic rehabilitation and OHRQoL, with a specific focus on functional, esthetic, and psychosocial dimensions, as well as to investigate the relationship between these findings and objective oral health indicators. Methods. A cross-sectional study was conducted to assess patient-reported outcomes using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The study included active duty personnel of the Serbian Armed Forces with natural dentition, as well as personnel with fixed or removable prostheses. Dental status was evaluated through comprehensive clinical examinations conducted by two experienced examiners. Biological parameters included the Caries Activity Factor (CAF) index, the Community Periodontal Index of Treatment Needs (CPITN), the plaque index (PI), and the gingival index (GI). Chronic systemic disease was recorded and included as a covariate in the analyses. Nonparametric statistical tests and multivariable regression analyses were employed to identify independent predictors of OHRQoL. Results. Participants with prostheses reported significantly higher OHIP-14 scores than those with natural dentition (p < 0.0001). No significant differences were observed between fixed and removable prostheses in overall OHIP-14 scores, except within the functional limitation domain, in which fixed prostheses demonstrated a measurable advantage. Multivariable analysis identified oral status, CAF and CPITN indices, and the presence of chronic systemic diseases as independent predictors of OHRQoL, whereas PI, GI, and age were not statistically significant after adjustment. Conclusion. According to the results of this study, prosthetic rehabilitation is associated with improved functional outcomes, but it did not fully alleviate the psychosocial burden associated with tooth loss. The severity of biological oral diseases and general health status were significant predictors of OHRQoL, suggesting that these factors may influence overall quality of life.

References

World Health Organization. Global oral health status report: to-wards universal health coverage for oral health by 2030 [In-ternet]. Geneva: WHO; 2022 [cited on 2026 Apr 23]. Availa-ble from: https://www.who.int/publications/i/item/9789240061484

World Health Organization. Oral health data portal [Internet]. Geneva: WHO; 2023 [accessed 2026 Apr 15; cited on 2026 Apr 23]. Available from: https://www.who.int/data/gho/data/themes/oral-health-data-portal

Lekić M, Lazić Z, Pandjaitan Donfrid P, Bokonjić D, Lemić T, Daković D. Assessment of oral health of the Serbian Armed Forces members. Vojnosanit Pregl 2020; 77(6): 575–81. DOI: 10.2298/VSP180414111L.

Milić Lemić A, Rajković K, Radović K, Živković R, Miličić B, Perić M. The use of digital texture image analysis in determining the masticatory efficiency outcome. PLoS One 2021; 16(5): e0250936. DOI: 10.1371/journal.pone.0250936.

Hong CL, Thomson WM, Broadbent JM. Oral health-related quality of life from young adulthood to mid-life. Healthcare (Basel) 2023; 11(4): 515. DOI: 10.3390/healthcare11040515.

Abolfotouh MA, Alhayf MD, Al-Shaer AS, Almutairi FK, Alo-taibi DF, Alhawas NA, et al. Prevalence and predictors of poor oral health-related quality of life among the Saudi elderly. BMC Public Health 2025; 25(1): 2622. DOI: 10.1186/s12889-025-23996-3.

Helmi M. Impacts of oral health on life quality metrics: corre-lations with job function, psychological well-being, self-perception, and dietary behavior. Front Oral Health 2025; 6: 1586868. DOI: 10.3389/froh.2025.1586868.

Lekić M, Daković D, Kovačević V, Čutović T, Ilić I, Ilić M. Testing of the Serbian version of the Oral Health Impact Profile-14 (OHIP-14) questionnaire among professional members of the Serbian Armed Forces. Vojnosanit Pregl 2021; 78(12): 1257–62. DOI: 10.2298/VSP200121049L.

World Medical Association. World Medical Association Declara-tion of Helsinki: ethical principles for medical research involv-ing human subjects. JAMA 2013; 310(20): 2191–4. DOI: 10.1001/jama.2013.281053.

Daković D, Lekić M, Bokonjić D, Lazić Z, Čutović T, Mladenović R. Evaluation of periodontal status and treatment needs of the Serbian military forces population. Vojnosanit Pregl 2021; 78(9): 911–8. DOI: 10.2298/VSP191125010D.

Kovačević V, Milosavljević M, Rančić N, Daković D. Assessment of the periodontal health and community periodontal index in the Army of Serbia. Vojnosanit Pregl 2015; 72(11): 953–60. DOI: 10.2298/VSP140812105K.

Nyvad B, Baelum V. Nyvad criteria for caries lesion activity and severity assessment: a validated approach for clinical man-agement and research. Caries Res 2018; 52(5): 397–405. DOI: 10.1159/000480522.

Ayan G, Dayı B. Evaluation of plaque index, gingival index and oral health-related quality of life in obese patients. Od-ovtos Int J Dent Sci 2023; 25(1): 166–78. DOI: 10.15517/ijds.2022.52533.

Popovac A, Kuzmanović Pfićer J, Stančić I, Milić Lemić A, Petričević N, Peršić Kiršić S, et al. Psychometric properties of the five-item ultrashort Oral Health Impact Profile (OHIP-5) in the Serbian cultural environment: a cross-sectional study. J Clin Med 2025; 14(22): 7909. DOI: 10.3390/jcm14227909.

Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Van-denbroucke JP; STROBE Initiative. The Strengthening the Re-porting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61(4): 344–9. DOI: 10.1016/j.jclinepi.2007.11.008.

Nyvad B, Machiulskiene V, Baelum V. Reliability of a new caries diagnostic system differentiating between active and inactive caries lesions. Caries Res 1999; 33(4): 252–60. DOI: 10.1159/000016526.

World Health Organization. Oral health surveys: basic methods - 5th edition [Internet]. Geneva: WHO; 2013 [accessed 2026 Apr 15; cited 2026 Apr 24]. Available from: https://www.who.int/publications/i/item/9789241548649

Silness J, Löe H. Periodontal disease in pregnancy II. Correla-tion between oral hygiene and periodontal condition. Acta Odontol Scand 1964; 22(1): 121–35. DOI: 10.3109/00016356408993968.

Löe H, Silness J. Periodontal disease in pregnancy I. Prevalence and severity. Acta Odontol Scand 1963; 21(6): 533–51. DOI: 10.3109/00016356309011240.

Slade GD, Spencer AJ. Development and evaluation of the oral health impact profile. Community Dent Health 1994; 11(1): 3–11.

Stančić I, Sojić LT, Jelenković A. Adaptation of Oral Health Im-pact Profile (OHIP-14) index for measuring impact of oral health on quality of life in the elderly to the Serbian language. Vojnosanit Pregl 2009; 66(7): 511–5. DOI: 10.2298/VSP0907511S.

Couto P, Pereira PA, Nunes M, Mendes RA. Validation of a Por-tuguese version of the Oral Health Impact Profile adapted to people with mild intellectual disabilities (OHIP-14-MID-PT). PLoS One 2018; 13(6): e0198840. DOI: 10.1371/journal.pone.0198840.

Kovačević I, Barac I, Major Poljak K, Čandrlić S, Čandrlić M. As-sessing the oral-health-related quality of life in patients with dental prosthetics: a cross-sectional study from Eastern Croa-tia. Oral 2025; 5(1): 10. DOI: 10.3390/oral5010010.

Reissmann DR. Methodological considerations when measuring oral health-related quality of life. J Oral Rehabil 2021; 48(3): 233–45. DOI: 10.1111/joor.12983.

Riva F, Seoane M, Reichenheim ME, Tsakos G, Celeste RK. Adult oral health-related quality of life instruments: a systematic re-view. Community Dent Oral Epidemiol 2022; 50(5): 333–8. DOI: 10.1111/cdoe.12689.

Techapiroontong S, Chuenjitwongsa S, Limpuangthip N. Determi-nants of removable partial denture success in patients’ per-spectives. J Dent 2025; 163: 106145. DOI: 10.1016/j.jdent.2025.106145.

Tanasić IV, Tihaček Šojić LJĐ, Milić Lemić AM. Prevalence and clinical effects of certain therapy concepts among partially edentulous Serbian elderly. J Prosthodont 2015; 24(8): 610–4. DOI: 10.1111/jopr.12261.

Dula LJ, Kelmendi TZ, Shala K, Staka G, Pustina-Krasniqi T, Kosumi S. Attachment-retained versus clasp-retained remova-ble partial dentures: effects of retention on patient satisfac-tion. Eur J Dent 2025; 19(3): 823–34. DOI: 10.1055/s-0044-1795122.

Rodriguez K. The role of prosthodontics in enhancing quality of life. Periodon Prosthodon 2024; 10: 24.

Teng CJ, Lin SC, Chen JH, Chen Y, Kuo HC, Ho PS. The associ-ation between denture self-satisfaction rates and OHRQoL: a follow-up study. BMC Oral Health 2020; 20(1): 140. DOI: 10.1186/s12903-020-01119-1.

Ayala-Luis J, Johansson V, Sampogna F, Axtelius B, Söderfeldt B. A multivariable analysis of patient dental satisfaction and oral health-related quality-of-life. A cross-sectional study based on DVSS and OHIP-14. Acta Odontol Scand 2014; 72(3): 187–93. DOI: 10.3109/00016357.2012.762987.

Efeoğlu NH, Başer Ü. Evaluation of the impact of different stages of periodontitis on quality of life with Oral Health Im-pact Profile – 14 (OHIP-14): a systematic review. J Clin Pract Res 2025; 47(3): 227–34. DOI: 10.14744/cpr.2025.99232.

Klarić Puđa I, Goršeta K, Jurić H, Soldo M, Marks LAM, Majstorović M. A Cohort Study on the Impact of Oral Health on the Quality of Life of Adolescents and Young Adults. Clin Pract 2025; 15(4): 76. DOI: 10.3390/clinpract15040076.

Öçbe M, Çelebi E, Öçbe ÇB. An overlooked connection: oral health status in patients with chronic diseases. BMC Oral Health 2025; 25(1): 314. DOI: 10.1186/s12903-025-05673-4.

Ceylan Şen S, Saraç Atagün Ö, Ustaoğlu G, Yildiz ZH. Assess-ment of oral health-related quality of life and its association with periodontal status in geriatric patients. BMC Oral Health 2025; 26(1): 15. DOI: 10.1186/s12903-025-07432-x.

Collins JR, Rivas-Tumanyan S, Santosh ABR, Boneta AE. Perio-dontal Health Knowledge and Oral Health-Related Quality of Life in Caribbean Adults. Oral Health Prev Dent 2024; 22: 9–22. DOI: 10.3290/j.ohpd.b4836035.