Oral mucosal lesions in denture wearers

doi:10.1111/j.1741‐2358.2009.00289.x
Oral mucosal lesions in denture wearers Objective: To determine the prevalence of oral mucosal lesions (OMLs) and denture‐related mucosal lesions (DMLs) in denture wearers and to co‐relate the prevalence with age, gender, type of denture and any systemic conditions. Materials and methods: Dental records of 380 denture wearers were retrospectively reviewed for OMLs and DMLs. Results: We found 45% of the denture wearers had DMLs and 60.8% had OMLs not related to denture wearing. Although the prevalence of DMLs was higher in complete denture wearers than in partial denture wearers (49% vs. 42.2%), this difference was not significant. The most common DMLs were traumatic ulcer (19.5%) and denture‐induced stomatitis (18.1%). When analysed by type, traumatic ulcer, denture hyperplasia, frictional keratosis and candidiasis were more common in complete denture wearers, whereas denture‐induced stomatitis was more common in partial denture wearers. Frictional keratosis was more common in men than in women. The prevalence of OMLs not related to denture wearing was higher in complete denture wearers than in partial denture wearers, and the most common OML was fissured tongue (27.6%). No association between DMLs and systemic conditions or xerostomic drugs was noted. Conclusion: No differences in the prevalence of DMLs in association with denture type were found. The prevalence of OMLs not related to denture wearing was higher in complete denture wearers than in partial denture wearers. This difference was affected by age, and the data were similar to the findings observed in the elderly.     

Income-related inequalities in denture-wearing by Europeans aged 50 and above

doi: 10.1111/j.1741‐2358.2011.00590.x
Income‐related inequalities in denture‐wearing by Europeans aged 50 and above Background: Despite its importance for the planning of future treatment needs and an optimised allocation of health care resources, only little is known about socio‐economic inequalities in denture‐wearing by late middle‐aged and elderly generations. Objectives: To describe income‐related inequalities in denture‐wearing by elderly populations residing in different European countries. Material and methods: Data from the Survey of Health, Ageing and Retirement in Europe (SHARE Wave 2) were used to assess income‐related inequalities in denture‐wearing by means of Concentration Indices (CI) for populations aged 50+ from 14 different European countries. Results: We could identify a significant disproportionate concentration of denture‐wearing amongst the poor elderly populations in Denmark (CI = ?0.3534, corresponding to the highest level of inequality), Sweden (CI = ?0.3479), Switzerland (CI = ?0.2013), Greece (CI = ?0.1953), the Netherlands (CI = ?0.1413), France (CI = ?0.1339), Austria (CI = ?0.0974), Czech Republic (CI = ?0.0959), Belgium (CI = ?0.0947), Germany (CI = ?0.0762), Ireland (CI = ?0.0575) and Spain (CI = ?0.0482, corresponding to the lowest level of pro‐poor inequality). Poland became evident as the only country in which individuals from the upper end of the income scale wear more dentures than their peers from the lower end of the income scale (CI = 0.0379). No significant income‐related inequalities were observable in Italy. Conclusions: There is considerable income‐related inequality in denture‐wearing by several elderly populations in Europe. Future resource planning for prosthetic care should, thus, specifically distinguish between the treatment needs of different socio‐economic groups within elderly populations.     

General health, dental status and perceived dental treatment needs of an elderly population in Istanbul

doi: 10.1111/j.1741‐2358.2010.00363.x
General health, dental status and perceived dental treatment needs of an elderly population in Istanbul Background: Comprehensive data on the oral health status and dental treatment needs of the elderly population in Turkey are deficient. Objectives: This pilot study determined the general and dental health status, perceived medical and dental treatment needs of an elderly population dwelling in residential homes in Istanbul. Method: Subjects at three different residential homes, namely one belonging to the state and two supported by foundations in Istanbul (N=121, female: 63 and male: 58) were involved in this study. A detailed questionnaire was prepared and dental examinations were conducted. Information was collected related to age, education levels, financial status, current physical functional status, general health, mental health, previous dental history, current dental status, oral hygiene practices and denture hygiene of these elderly people. The prevalence of edentulism, the presence and type of dental prostheses, dental and denture status and denture cleanliness were further evaluated. Results: The three most prevalent reported general health problems were associated with genito‐urinary problems (24%) followed by cardiovascular (18%) and respiratory problems (14%) varying significantly between genders, with males suffering more from cardiovascular problems than females (p < 0.05). Females showed significantly higher gastrointestinal and orthopaedic problems than males (p < 0.05). Females were more frequently edentulous than males but denture hygiene was significantly better in females than in males (p < 0.05). Brushing frequency did not significantly increase denture hygiene (p = 0.6). More than one‐third of the subjects had not been to the dentist within the previous 5–10 years, mainly due to lack of demand, followed by the cost of the dental care and fear. More than two‐thirds of denture‐wearing subjects wore their dentures only during eating. Conclusions: There was significant perceived dental treatment and care need for the sample population of elderly studied.     

Complete denture wearing and fractures among edentulous patients treated in university clinics

doi: 10.1111/j.1741‐2358.2011.00551.x
Complete denture wearing and fractures among edentulous patients treated in university clinics Objective: The prevalence of wearing and fracture of complete dentures was evaluated among edentulous patients treated in two dental schools in Brazil. Background: Acceptance and wearing of complete dentures are related to adaptive behaviour of edentulous patients. However, one reason that could interfere with the wearing dentures is their potential to fracture, which is still a common complication in denture rehabilitation practice. Material and methods: Two hundred and twenty‐four edentulous patients rehabilitated with complete dentures from 2000 to 2005 in Araçatuba and Araraquara Dental School, University of State of São Paulo, were assessed in 2006 and 2007 to answer a questionnaire about wearing and fracture of their dentures. Statistical analysis were performed using Epi Info software and chi‐squared test to compare maxillary and mandibular data (α = 0.05). Results: Almost 26% of the patients did not wear their dentures, and among the remainder, the majority wore the maxillary denture. About 30% of the dentures were fractured, with higher prevalence in the maxillary arch (p = 0.003). Conclusions: Discontinuation of wearing dentures was quite high, especially considering the treatment which was carried out in university clinics. Prevalence of fractures was also high, greater for the maxillary denture, and was one of the main reasons for non‐wearing of complete dentures.     

Denture contamination by yeasts in the elderly

Objectives: The aim of this study was to investigate yeast carriage in healthy denture wearers by swabbing and to evaluate the effect of denture hygiene habits. Materials and methods: Denture wearers (n = 87) without evidence of denture stomatitis or any other oral disease were investigated by separately swabbing the fitting surface of the upper denture and the corresponding palatal mucosa in contact with the appliance. In a group of volunteers, a gel without any active compound was spread on the palatal side of the denture once in every morning for 2 weeks. Results: Screening showed Candida colonisation of upper prosthesis in 75.9% of individuals. The most frequent species isolated were Candida albicans (77.9% of the positive cultures), Candida glabrata (44.1%) and Candida tropicalis (19.1%). Carriage of more than one yeast species was found in 48.5% of the contaminated dentures. There was a statistically significant association between denture contamination and palatal mucosa colonisation (chi‐squared test: p < 0.0001). Repeated swabbings after 1 week as well as during a weekly follow‐up for 1 month confirmed the denture contamination and its degree of severity. A daily gel application produced a yeast‐count decrease to 10% of the initial value after 2 weeks (chi‐squared test: p = 0.0134 and p = 0.2841 for prosthesis and palatal mucosa, respectively). Conclusion: This study documented the reliability of oral swabbing when investigating yeast carriage in healthy denture wearers. Moreover, just a diagnostic tool, sampling upper dentures for Candida could be the opportunity to verify the patient’s compliance to hygiene advice.     

The prevalence of denture stomatitis and its predisposing conditions in an older Greek population

doi:10.1111/j.1741‐2358.2009.00359.x
The prevalence of denture stomatitis and its predisposing conditions in an older Greek population Background: Pathology related to complete denture‐wearing will remain an important issue because of an increase in the ageing population. Objective: To investigate the prevalence and the risk factors for denture‐related stomatitis in the edentulous maxilla of older patients with a maxillary complete denture. Material and methods: One hundred and six patients treated in the Department of Prosthodontics of the Athens Dental School were interviewed and clinically examined. The results were analysed using chi‐square tests and multiple logistic regression. Results: Denture stomatitis was recorded in 39.6% of the sample (pinpoint hyperaemia: 17%, diffuse erythema: 16%, papillary hyperplasia: 6.6%). Chi‐square tests recorded significant associations between denture stomatitis and the continuous use of dentures (particularly the diffuse erythema type), the increased duration of denture experience and the poor retention of the maxillary denture. Other significant associations were recorded between the increased age of the current denture and pinpoint hyperaemia, and the reduced frequency of denture cleaning and papillary hyperplasia. Multiple logistic analysis revealed that the most important risk factor for denture stomatitis was the continuous use of the denture. Conclusion: The prevalence of denture stomatitis was high in denture users. Although many predisposing conditions were recorded, the most important risk factor was the continuous use of the denture. Therefore, appropriate advice on denture maintenance should be provided.     

Factors affecting the distribution and prevalence of oral mucosal lesions in complete denture wearers

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2009.00351.x
Factors affecting the distribution and prevalence of oral mucosal lesions in complete denture wearers Objective: To determine the frequency of the oral lesions related to gender, age, the length of time of denture usage, education level and economic status. Methods: The 153 patients with old complete dentures (CD) were asked to participate in the investigation. The subjects (76 male and 77 female) were 37–85 years of age with a mean age of 61.8 ± 9.8 years. Education, economic status and age factors were estimated in subgroups. The data obtained were evaluated by one‐way anova , Mann–Whitney U‐test, Kruskal–Wallis test, Student’s t‐test and chi‐squared test. The level of statistical significance was set at p < 0.05. Results: The patients who had denture stomatitis and traumatic ulcers were statistically significantly older than the ones who did not have these lesions (p < 0.05). Based on the length of denture usage, patients who had a flabby ridge, fibrous inflammatory hyperplasia, traumatic ulcers (p < 0.01) and denture stomatitis (p < 0.05) were using their dentures statistically significantly longer than the ones who had healthy tissues. Conclusions: The CD wearers should be advised to visit their dentist regularly to prevent oral mucosal lesions due to the changing supporting tissues during the length of denture usage and to improve their quality of life.     

Exploring the quality of life after denture-wearing within elders in Kaohsiung

doi: 10.1111/j.1741‐2358.2012.00614.x
Exploring the quality of life after denture‐wearing within elders in Kaohsiung Objective: The objective of the research is to investigate whether the elderly people’s quality of life get improved after denture wearing. Material and methods: About 1600 elderly persons, over 65 years old, were sampled as the research target. The overall response rate was 71.62%. The tool of research is a structural questionnaire Oral Health Impact Profile (OHIP) that was used to measure the oral health–related quality of life. Individual’s satisfaction of denture wearing divides into three groups: edentulous individuals who are satisfied with denture wearing, edentulous individuals who are not satisfied with denture wearing and dentulous individuals. Results: The result shows the eight variables, which are oral health condition, frequency of snacks‐eating, age, frequency in participation in social activities, instrumental activities of daily living (IADL), vision, satisfaction with life and physical functions, have significant influence on total OHIP score. Conclusions: Although being edentulous, if the elderly are satisfied with their denture, the quality of life can be maintained and not affected by oral health problems. It is suggested that the further researches can include more relevant factors when in a discussion on the oral health–related quality of life, especially, the subjective perception of individual’s feeling.     

Wood and bark anatomy of the African species of Gnetum

Quantitative and qualitative data are given for the two African species of Gnetum ( Gnetum section Gnetum subsection Micrognemones ). These species are lianoid and lack the fibre-tracheids of G. gnemon but have about the same vessel element and tracheid length as in that species. Vessel diameter is related to stem age and organography. Tori are clearly present in tracheary elements of the African Gnetum species, a first report for the genus. In these two species, origin of the lateral meristem, which produces vascular tissue and cambia, can be traced directly and indirecdy to cortical parenchyma. A second kind of meristematic action, newly reported for Gnetum, is produced by proliferation of axial parenchyma, fragmenting secondary xylem. Both presence of tori and site of origin of lateral meristematic activity in Gnetum contrast with corresponding conditions in Welwitschia.     

Prevalence of temporomandibular disorders in a population of complete denture wearers

doi: 10.1111/j.1741‐2358.2011.00574.x
Prevalence of temporomandibular disorders in a population of complete denture wearers Background: Complete tooth loss among the elderly is still frequent in developing countries and the incidence of temporomandibular disorders (TMD) is a common finding in complete denture wearers. Objectives: The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) in a population of complete denture wearers. Materials and Methods: The data were collected by four examiners for the diagnosis of use and need for complete dentures followed by the World Health Organization standards and interviews for TMD signs and symptoms evaluation. Exploratory variables included demographic, socio‐economic status and TMD prevalence. Results: The prevalence of TMD among denture wearers was 55.12%. Chi‐squared test showed no statistical difference between subjects with or without TMD for gender, geographical location and skin colour (p < 0.05). The number of subjects with TMD increased as the period of complete denture wear increased, although no statistical difference between groups were found (p < 0.05). Conclusions: There is a need of educational programmes aiming at the importance of health care and periodical change of a complete denture, and strategies with a preventive approach to quality general dental care.     

Denture-related stomatitis managed with tissue conditioner and hard autopolymerising reline material

doi: 10.1111/j.1741–2358.2010.00398.x
Denture related stomatitis managed with tissue conditioner and hard autopolymerising reline material. Objective: To compare the response of denture‐related stomatitis (DS) under management with a tissue conditioner (TC) and autopolymerising hard reline material (AHRM). Background data: Denture‐related stomatitis affects up to 75% of denture wearers; not wearing the denture at night, using TC or prescribing topical or systemic antifungal agents could reduce its incidence. Materials and methods: This was a double‐blind study consisting of 44 participants with DS who wear denture; they were randomly divided into two unmatched groups according to the material used for the management of DS. The TC was replaced weekly, and the AHRM was placed at the beginning of the study and was not changed for 4 weeks. A dentist performed an initial and a weekly clinical diagnosis for DS; the clinical situation was recorded by means of photographs for each week. Results: Both TC and AHRM were effective in the management of DS. Significant differences were found in the DS resolution time (p < 0.001), taking longer for the TC. Conclusions: Both the tissue conditioner and AHRM are effective for the management of DS, but AHRM requires less time for recovery and as a result fewer appointments are required for the patient.     

Effect of ill-fitting dentures on the swallowing duration in patients using polygraphy

doi: 10.1111/j.1741‐2358.2011.00536.x Effect of ill‐fitting dentures on the swallowing duration in patients using polygraphy Background: Surface electromyography (SEMG) has been widely used in the recent years to study swallowing physiology, offering a valid and reliable tool for identifying normal swallowing. The goal of our study was to assess the contribution of denture fitness in the age‐related increase of swallowing duration. Methods: Twenty denture wearers and 20 dentate individuals were analysed using SEMG and a computerised kinesiography of mandibular movement. Three spontaneous saliva swallowings were recorded for each patient with both their old and new prostheses. Three spontaneous saliva swallowings were recorded for each dentate person in two different recording sessions. Results: Old prosthesis mean swallowing time was 1.84 (SD ± 0.85) seconds while the new well‐fitting prostheses needed a 1.28 (SD ± 0.55) (p = 0.0009) swallowing time. The difference in swallowing time was significant (p = 0.01) between dentate subjects and individuals wearing an old prosthesis. No significant difference was found between dentate subjects and the same prosthesis wearers when a new well‐fitting prosthesis was worn. Conclusion: Data presented in this work suggest that part of the increased duration of swallowing showed by elderly and healthy people is because of incorrect an dental prosthesis. Prolongation of swallowing duration in the elderly population could be reconsidered in the light of the quality of dental device worn by the aged population.     

The relationships between oral status, physical and mental health, nutritional status and diet type in elderly Japanese women with dementia

Objectives: To suggest methods for maintaining an adequate nutritional status for elderly patients with dementia by evaluating the relationships between oral status, physical and mental health, and feeding conditions. Background: Feeding difficulties in dementia patients are related to food intake, and failure to eat may be associated with weight loss in long‐term care facilities. The relationship between compromised oral function and diet is still unclear. Materials and methods: A cross‐sectional study of 94 elderly women with dementia (mean age 89.6 ± 5.6 years) from a nursing home was undertaken to investigate their oral, physical and mental and nutritional status. Results: There were significant differences in serum albumin (p = 0.0284), N‐ADL (p = 0.0005), NM scale (p = 0.0004) and HDS‐R (p = 0.0004) between denture wearers and non‐denture wearers. However, there were no significant differences in body mass index between denture wearers and non‐denture wearers. Conclusion: A suitable type of diet and assistance with feeding could maintain the nutritional status of elderly patients with dementia if they are still feeding themselves. The nutritional support team will benefit from the participation of a dentist.     

Major Increase in Prevalence of Overweight and Obesity between 1987 and 2001 among Danish Adults

Objective: The aim of the study was to examine the secular trends in the prevalence of obesity (BMI ≥ 30.0 kg/m²) and overweight (25.0 ≤ BMI < 30.0 kg/m²) in Danish adults between 1987 and 2001. Research Methods and Procedures: The study included self‐reported weight and height of 10, 094 men and 9897 women 16 to 98 years old, collected in a series of seven independent cross‐sectional surveys. Prevalence and changes in prevalence of obesity and overweight stratified by sex and age groups were determined Results: The prevalence of obesity more than doubled between 1987 and 2001, in men from 5.6% to 11.8% [odds ratio (OR) = 2.3, 95% confidence interval (CI) = 1.9 to 2.8, p < 0.0001] and in women from 5.4% to 12.5% (OR = 2.6, 95% CI = 2.1 to 3.2, p < 0.0001), with the largest increase among the 16‐ to 29‐year‐old subjects (men, from 0.8% to 7.5%, OR = 10.2, 95% CI = 4.1 to 25.3, p < 0.0001; women, from 1.4% to 9.0% OR = 7.0, 95% CI = 3.5 to 14.1, p < 0.0001). Between 1987 and 2001, the prevalence of overweight increased from 34% to 40% in men and from 17% to 27% in women. Discussion: The prevalence of overweight and obesity in Denmark has increased substantially between 1987 and 2001, particularly among young adults, a development that resembles that of other countries. There is clearly a need for early preventive efforts in childhood to limit the number of obesity‐related complications in young adults.     

Oral health status in a group of the elderly population residing at home

doi: 10.1111/j.1741‐2358.2011.00556.x Oral health status in a group of the elderly population residing at home Objectives: To determine the oral health status and treatment needs of subjects aged 65 years and older residing in different districts of Ankara. Materials and methods: A total of 1300 patients, 751 females and 549 males, age 65 and over with a mean age of 72.8 ± 6.34 were included in this study. The subjects were visited at home and toothbrushing habits, visiting the dentist, tooth loss, denture needs were questioned and body mass index values were recorded. Results: 52.5% of the subjects were completely edentulous, 83.3% subjects reported wearing a removable denture. Females had a higher total tooth loss frequency when compared to males (p < 0.05). Total tooth loss between 65 and 69 ages was 47.3%, and increased to 62.4% among those aged 75 and over (p < 0.05). 16.2% of the subjects had not visited a dentist in the last 10 years, and only 3% visited a dentist for control check‐ups; no gender‐based difference was observed as to the frequency of dental visits (P > 0.05). No significant relationship was found between tooth loss and BMI values (P > 0.05). 46.3% of the subjects had chewing problems. Conclusions: The subjects included in this study showed high tooth loss frequency and poor oral hygiene habits. Education regarding maintenance of oral hygiene and regular dental check up should be stressed for the elderly.     

Complete denture hygiene and nocturnal wearing habits among patients attending the Prosthodontic Department in a Dental University in Brazil

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2010.00369.x Complete denture hygiene and nocturnal wearing habits among patients attending the Prosthodontic Department in a Dental University in Brazil Objective: The aim of this study was to evaluate the overnight wearing and cleaning habits of complete denture wearers. Background: Successful complete denture treatment can be achieved when the patients are motivated and aware of appropriate denture wear and hygiene. Materials and methods: A sample of 224 complete denture wearers (162 women) aged 37–89 years was studied. Inclusion criteria comprised edentulous subjects who had received their new complete dentures between 2000 and 2005 in the Dental Clinic of the Araçatuba and Araraquara Dental School, São Paulo State University. Ethical approval was sought and granted. Subjects were interviewed using questions related to overnight denture wearing and denture cleaning habits. Possible statistical relationships among some of items were analysed by the chi‐square test at 5% significance level. Results: Of the patients, 55.8% removed their dentures during the overnight period and 88% did this every day. Among them, 66.4% removed both dentures. Most of the patients used brushing with toothpaste (105 patients – 46.87%) as a cleaning method. More than a half of the subjects (63.4%) showed biofilm and calculus on their dentures. Conclusion: The patients need instructions and motivation concerning denture hygienic and denture removal overnight.     

Examination of denture-cleaning methods based on the quantity of microorganisms adhering to a denture

doi: 10.1111/j.1741‐2358.2011.00461.x Examination of denture‐cleaning methods based on the quantity of microorganisms adhering to a denture Objectives: To investigate effective denture‐cleaning methods, we examined the relationships between the quantity of microorganisms adhering to dentures and the use of a denture brush and the frequency of use of a denture cleanser. Subjects and Methods: Denture plaque was collected from the mucosal surface of the examined dentures, which were 142 and 80 upper and lower complete dentures, respectively, worn by 96 outpatients (mean age: 71.9 years) of a university hospital and 41 nursing home residents (mean age: 84.8 years). The collected microorganisms were counted in terms of isolated representative colonies that were cultured and identified using standard methods. The use of a denture brush, the frequency of use, and the type and soaking time of denture cleansers as denture‐cleaning methods were surveyed. Results: The quantity of microorganisms was significantly lower in dentures of denture brush users than in those of non‐users in the outpatients (p < 0.01, Mann–Whitney U test). The quantity of microorganisms was significantly lower in the dentures of outpatients who used a denture cleanser daily or 3–4 times a week than in those who used one once or less per month and in the dentures of nursing home residents who used one daily than in those who used one at other frequencies (p < 0.05, Kruskal–Wallis test, followed by Dunn’s Multiple Comparison test). Conclusion: Within the limitations of this study, it was concluded that the use of a denture brush and daily use of denture cleanser should be recommended to complete dentures wearers as denture‐cleaning methods that effectively reduce the quantity of microorganisms adhering to dentures.     

Self-reported oral hygiene habits among institutionalised elderly and their relationship to the condition of oral tissues in Taubaté, Brazil

Objectives: To record self‐reported hygiene habits, examine the oral conditions of a sample group of institutionalised elderly, and examine possible relationships between these habits and conditions. Design: Cross‐sectional. Setting: All the institutions for the elderly in Taubaté, Brazil. Subjects: The entire population of these institutionalised elderly people (n = 553). Intervention: The subjects were interviewed and underwent an oral examination. Main outcome measures: Oral hygiene habits, oral conditions and statistical relationships between habits and oral conditions were recorded. Results: The average age of the subjects who knew their age (n = 364) was 74.9 years (±12.9), and 64.7% of the sample group were females. Denture‐related stomatitis was found in 19.5%, impaired manual dexterity in 40%, dry mouth sensation in 36.3%, difficulty in performing oral hygiene in 20%, no oral hygiene‐related orientation in 54.1%, no periodic oral examinations in 59.5%, and no tongue cleaning in 68.3% was declared. Among dentate subjects, 73.3% had periodontal disease, 54.7% had caries, 26% reported no toothbrushing, and 7.3% reported flossing. Of the denture wearers, 7% did not brush their dentures. Denture‐related stomatitis showed a statistical relationship with impaired manual dexterity (p = 0.012) and an inverse statistical relationship with denture brushing frequency (p = 0.006). Periodontal disease showed an inverse relationship to flossing (p < 0.001) and tongue cleaning (p = 0.0026). Caries showed an inverse relationship with tooth‐brushing (p = 0.043), flossing (0.022), proper oral hygiene orientation (p = 0.041) and periodical check‐ups (p = 0.007). Conclusion: Oral hygiene practices in this sample group were found to be inadequate, and statistically significant relationships were verified between the lack of good oral hygiene practices and the deleterious oral conditions.