The masticatory handicap of wearing removable dentures in elderly men

Objective: This study aimed at describing the masticatory handicap of wearing removable dentures measured by some masticatory tests and the intake of hard and soft foods. Materials and methods: The subjects were participants in a comprehensive health examination of 67–68‐year‐old men living in Malmö, Sweden. Four hundred eighty‐three men took part in a clinical oral examination which recorded the number of teeth and removable dentures. One hundred and one had complete dentures in both jaws and 131 had removable partial dentures in different combinations. Masticatory tests used almonds to record the number of stokes to the first swallow, and two‐coloured chewing gums for recording bolus kneading and shaping. A nutritionist paid a home visit to assess dietary habits including the consumption of hard and soft foods. The data could be split into groups of different tooth and denture situations which were large enough to enable statistical analysis to be carried out. The results of a regression analysis of the group with different numbers of natural teeth (NT) and no removable dentures could be used as a reference for correlation with the masticatory capacity of removable denture wearers. Results: Number of strokes to the first swallow revealed no masticatory limitations of wearing removable dentures, while chewing gum colour‐mixing and shaping revealed more differentiated impairments equivalent to the function of five to 16 teeth in a remaining natural dentition. Hard food intake for the removable denture groups was comparable to 17–19 NT. Soft food intake was not influenced by denture wearing. In a ranking of oral conditions, those with more than 24 NT had the highest test values for all tests, and those with complete sets of dentures the lowest except for the number of strokes to the first swallow of an almond. Conclusion: Removable denture wearing can be regarded as a handicap when measured with objective masticatory tests using chewing gum and the intake of hard foods. The number of chewing strokes to the first swallow of an almond and the intake of soft foods is not affected by the wearing of removable dentures.     

Validation of communication between elderly denture wearers and dentists: a questionnaire on satisfaction with complete dentures using semi-structured interviews

Objectives: To validate a semi‐structured interview (SSI) for communication between complete denture wearers and dentists. Design: A SSI using a questionnaire with eight questions on satisfaction with complete dentures (CD): covering function, aesthetics and comfort. The first seven questions used a five‐point Likert scale and the last was dichotomous. Two dentists, carefully trained in the use of the structured questionnaire, administered the SSI. Setting: A Greek Department of Prosthetic Dentistry. Subjects: A consecutive sample of 78 CD wearers took part in the study. All subjects presented with complaints from their dentures. Intervention: All participants and their dentures underwent clinical examination. Results: The method showed good reliability, verified by the Cronbach alpha (0.86). Both dentists used the questionnaire produced very similar results. (Wilcoxon test 61–99%). Further, the association of the answers with respect to the five‐point Likert scale was very high; all gamma coefficients were statistically significant except for pain and discomfort from the upper CD (CDU). Conclusions: This method of communication between patients and dentists is reliable and can be used to give good repeatability for qualitatively assessing satisfaction with CD. It can be valuable for clinical use and for extending the study of denture quality to establish outcome measures based on the subjective criteria of satisfaction.     

A comparison of patient satisfaction between treatment with conventional complete dentures and overdentures in the elderly: a literature review

doi:10.1111/j.1741‐2358.2009.00299.x
A comparison of patient satisfaction between treatment with conventional complete dentures and overdentures in the elderly: a literature review Background: It has been stated that mandibular overdentures are more satisfactory than conventional dentures, but problems relating to the use of retrospective ratings, lack of control group and sequential provision of treatment may compromise the findings. Objective: To establish a comparison between treatment with conventional complete dentures and implant‐retained overdentures in elderly patients by conducting a literature review. Materials and methods: A search of English language peer‐review literature was completed using Medline up to 2008 focusing on evidence‐based research. Randomised clinical trials (RCTs) and longitudinal prospective studies were favoured in the review, using a general hierarchical classification. Articles that did not focus exclusively on the comparison of patient satisfaction between complete dentures and overdentures were excluded from further evaluation. The last search was conducted in February 2008. Key terms included quality of life, patient satisfaction, edentulism, complete denture and overdenture. Results: Among the 90 articles found in the initial search, 27 met the inclusion criteria. This included 18 RCTs and eight prospective and one cohort study. Most of the articles stated superiority of the mandibular implant‐retained overdenture therapy over the conventional complete denture regarding patient satisfaction and quality of life. Conclusion: Even with implant treatment presenting higher patient satisfaction and improvement of quality of life, it was not possible to establish a direct comparison between the studies due to differences in adopted methodologies.     

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.     

Adding denture cleanser to microwave disinfection regimen to reduce the irradiation time and the exposure of dentures to high temperatures

Background: The microwave energy is an efficient disinfection method; however, it can generate high temperatures that can result in distortion of the dentures. objectives: To evaluate whether the addition of an enzymatic cleanser to microwave disinfection regimen would disinfect dentures with shorter irradiation time. Materials and methods: Seven resin discs colonized with Candida albicans biofilm were placed on the palatal surface of sterile dentures to be randomly assigned to the following treatments: immersion in distilled water for 3 min with 0 (DW), 1 (DW + M1), 2 (DW + M2), or 3 min (DW + M3) of microwave irradiation; or immersion in denture cleanser for 3 min with 0 (DC), 1 (DC + M1), 2 (DC + M2) or 3 min (DC + M3) of irradiation. After the treatments, the viable cells were counted by a blinded examiner. The temperature was measured immediately after irradiation. The data were analyzed by ANOVA and Tukey post hoc tests (α = 0.05). Results: No viable cells were found after DC + M2, DC + M3, and DW + M3 treatments, of which DC + M2 achieved the lowest temperature. No significant difference was found between the effectiveness of DW, DW + M1 and DC treatments (p > 0.05). Conclusion: Within the limits of this study, the association of a denture cleanser and microwave energy is efficient to disinfect dentures in lower irradiation time and temperature.     

Effects of home and office care denture reliners on maxillary complete dentures

doi:10.1111/j.1741‐2358.2009.00308.x
Effects of home and office care denture reliners on maxillary complete dentures Objectives: The aim of this study was to evaluate the effects of office (OR) and home (HR) care temporary denture reliners on satisfaction and functional outcomes in maxillary complete denture wearers. Methods: Thirty‐four maxillary edentulous patients received application of either OR or HR to their maxillary complete dentures. Patient’s ratings on satisfaction and functional aspects were measured on a 100‐mm visual analogue scale at 4 days post‐application. Associations between baseline ratings and improvement were also assessed. Results: There were no significant differences between the two groups in satisfaction ratings or in the functional outcomes. The OR group showed a significant improvement in mastication and retention, whereas the HR group exhibited a significant improvement in general satisfaction and mastication. Improvement was negatively associated with baseline ratings of speech, ease of cleaning, stability and retention in the OR groups and across all variables, except ease of cleaning, in the HR group. Conclusion: When used correctly, home care denture therapy can be as effective as office applied temporary liner in improving satisfaction with problematic maxillary dentures.     

The effect of denture quality attributes on satisfaction and eating difficulties

Objectives: The development of a measure, with complimentary normative and perceived needs, for the investigation of functional impairment of individual patients and the investigation of the physical causative bases of impairment. Subjects: A consecutive sample of 119 complete denture (CD) wearers attending a Greek department of prosthetic dentistry took part in the study. All subjects presented with some complaint(s) of their dentures. Method: Functional assessment of dentures (FAD) criteria and structured questionnaires were used covering denture satisfaction (DS) and food difficulties with CDs. The questions used a five‐point Likert scale. Results: The results showed that there were statistically significant associations between satisfaction from dentures and eating specified foods. Statistically significant associations were also found between denture qualities and movement of upper dentures and difficulty eating specified foods, but not with an open question on the difficulty of eating unspecified foods. Conclusions: This study successfully validated a suitable model for the combined evaluation of denture quality with clear diagnostic criteria and closed questions on DS and perceived difficulties when eating specified foods. This could predict the need for treatment, monitor the impact of care and provide a feasible measure to meet the need of everyday clinical situations.     

Prevalence of removable partial dentures users treated at the Aracatuba Dental School-UNESP

doi: 10.1111/j.1741‐2358.2012.00653.x
Prevalence of removable partial dentures users treated at the Aracatuba Dental School – UNESP Objectives: The aim of this study was to evaluate the frequency of removable partial dentures (RPD) at the Aracatuba Dental School. Methods: The study was conducted by analysing 412 clinical history of patients attended at the RPD clinics in the period from 2000 to 2007. Results: 412 charts were analysed: 148 (35.9%) men and 264 (64.1%) women. The mean age was 53.8 years (men) and 52.4 years (women). A total of 556 dentures were made; of these, 233 (41.90%) were maxillary and 323 (58.09%) were mandibular dentures. The most frequent Kennedy classification found was Class III (maxilla) and Class I (mandible). In the maxilla, 55% (126) of the major connectors were of the anterior–posterior palatal bar, while in the mandible, 64% (202) were the lingual bar. As regards the claps, 401 were circumferential and 318 were bar claps. Conclusion: The mean age of the patients was 52.9 years with higher prevalence of female patients; the most frequent Kennedy’s classification was Class I in mandible and Class III in maxilla; the most common major connector was anterior–posterior palatal bar for maxilla and lingual bar for mandible; the circumferential clasps were the most common retainer used in both jaws.     

Effect of oral hygiene education and motivation on removable partial denture wearers: longitudinal study

Objectives: The purpose of this study was to determine the effect of two different preventive oral hygiene education and motivation programmes on the plaque and gingival index, as well as denture hygiene of patients provided with removable partial denture (RPD) during a 12‐month follow‐up. Material and methods: A total of 53 partially edentulous patients were recruited for this study. The presence or absence of plaque and gingival bleeding by gentle probing was scored on all tooth surfaces at the preliminary visit. The plaque and gingival indexes were measured using the Löe index. Following treatment, the patients were randomly divided into three groups. In Control Group I, subjects were instructed to continue their personal oral hygiene routine. In Group II, participants were given verbal instructions and a self‐educational manual on oral hygiene without illustrations. In Group III, oral hygiene guidance was delivered using a combination of verbal instructions and a self‐teaching manual. To evaluate the effect of the different modes of instruction, the presence or absence of plaque and gingival bleeding was scored on all tooth surfaces (day zero examination) and re‐examined 7, 15 and 30 days, 3, 6 and 12 months following RPD placement. The state of denture hygiene was evaluated 7, 15 and 30 days and 3, 6 and 12 months following rehabilitation. Parametric statistics was applied to dental plaque and gingival indexes. For accumulation of plaque and calculus on the RPD, non‐parametric statistic was applied. Results: The frequency of plaque found during the preliminary visit was higher than that found in the other periods. With regard to gingival index, significant difference was found between the preliminary visit examination and other periods. There was a significant difference in the plaque accumulation on the denture surface between groups I and III. Conclusion: The different methods of oral hygiene instruction used in this study indicate that the type of education was not of significant importance.     

Zirconia-based dental crown to support a removable partial denture: a three-dimensional finite element analysis using contact elements and micro-CT data

Veneer fracture is the most common complication in zirconia-based restorations. The aim of this study was to evaluate the mechanical behavior of a zirconia-based crown in a lower canine tooth supporting removable partial denture (RPD) prosthesis, varying the bond quality of the veneer/coping interface. Microtomography (μCT) data of an extracted left lower canine were used to build the finite element model (M) varying the core material (gold core – M_Au; zirconia core – M_Zi) and the quality of the veneer/core interface (complete bonded – M_Zi; incomplete bonded – M_Zi-NL). The incomplete bonding condition was only applied for zirconia coping by using contact elements (Target/Contact) with 0.3 frictional coefficients. Stress fields were obtained using Ansys Workbench 10.0. The loading condition (L = 1 N) was vertically applied at the base of the RPD prosthesis metallic support towards the dental apex. Maximum principal (σ_max) and von Mises equivalent (σ_vM) stresses were obtained. The σ_max (MPa) for the bonded condition was similar between gold and zirconia cores (M_Au, 0.42; M_Zi, 0.40). The incomplete bonded condition (M_Zi-NL) raised σ_max in the veneer up to 800% (3.23 MPa) in contrast to the bonded condition. The peak of σ_vM increased up to 270% in the M_Zi-NL. The incomplete bond condition increasing the stress in the veneer/zirconia interface.     

Evaluation of stain removal and inhibition properties of eight denture cleansers: an in vitro study

Gerodontology 2012; doi: 10.1111/j.1741‐2358.2011.00522.x
Evaluation of stain removal and inhibition properties of eight denture cleansers: an in vitro study Objectives: To determine the ability of eight denture cleansers to remove and inhibit tea‐stain build‐up on acrylic resin. Materials and methods: In the stain removal study, Perspex^® (cast heat polymerised resin) specimens previously soaked in saliva were stained using multiple exposures of chlorhexidine and tea solutions. Specimens were exposed for 1 min to one of the eight denture cleansers for five cycles, washed and dried and their optical density read on a uv/vis spectrophotometer at 295 nm. In the stain inhibition study, clear specimens were exposed to saliva followed by cleansers then tea solution, for five cycles. The build‐up of stain at each cycle was measured, and differences in optical densities from baseline were calculated. Results: All denture cleansers were significantly more effective than water in removing stain (p < 0.05). There were significant differences in cleaning ability between cleansers (p < 0.001), Dentural^® and Kleenite^® were particularly effective. The stain inhibition experiment showed that most cleansers were significantly more effective than water in inhibiting stain (p < 0.05). There were significant differences in inhibition ability between cleansers (p < 0.01). Kleenite^® and Equate were particularly effective. Conclusions: All denture cleansers had a capacity to remove stain and most had an inhibitory effect on staining. Kleenite^® was particularly effective in controlling stain formation.     

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.     

Elderly complete denture wearers: a social approach to tooth loss

doi: 10.1111/j.1741‐2358.2011.00550.x Elderly complete denture wearers: a social approach to tooth loss Objectives: To correlate emotional reactions to tooth loss with denture satisfaction attributes in elderly complete denture wearers. Background: Total tooth loss is a serious life event, and poor oral health has an impact on daily life. Edentulism treated by rehabilitation with dentures can have a positive effect on patients’ self‐image and social behaviour. Methods: A group of 80 edentulous subjects undergoing routine prosthetic care in a Greek Department of Prosthetic Dentistry were interviewed using two structured questionnaires. The first questionnaire explored reactions to tooth loss, whereas the second measured their subjective experience of complete dentures. The responses to both questionnaires were compared using the statistical package spss v.17. Results: The results showed significant correlation between aspects of tooth loss experience and complete denture satisfaction. Despite the fact that a substantial proportion of patients were satisfied with their complete dentures, some patients experienced increased social and psychological problems related to their edentulousness and the wearing of complete dentures. The aesthetic and functional aspects of complete dentures affected both patients’ social behaviour and self‐confidence. Conclusions: Total tooth loss was not only reflected in patient’s social behaviour and self‐image, but it had a complex and multifaceted impact on satisfaction from complete dentures.     

可摘局部义齿戴入后义齿区微生态的改变

可摘局部义齿是口腔活动修复中运用最久最为广泛的一种修复方式,其通过卡环的固位,基托的稳定,连接体的连接,可以使人工牙在患者缺牙间隙发挥相应的咀嚼功能。但是,可摘局部义齿作为一个外源性的异物戴入患者口内后,由于其理化性质与口腔正常环境差别极大,并且占据了口腔中的天然间隙,势必会导致口腔内环境的相应改变。口腔微生物依附于口腔内环境,与宿主共生。当口腔内环境变化时,口腔微生态也会产生相关的变化。研究可摘局部义齿戴入后口腔内微生态的变化可以使我们更好地评估可摘局部义齿的适应证,并指导我们新义齿的设计及开发方向。目前相关研究已相当充分,本文就可摘局部义齿戴入后,口腔微生态的变化作一简单综述。     

Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among elderly edentulous patients: satisfaction and quality of life

Objectives: The aim of this study was to compare the satisfaction and the quality of life in an elderly population using either mandibular conventional dentures or implant‐retained overdentures. Materials and methods: A total of 34 patients were divided into two groups: group I – complete dentures users; group II – users of upper complete dentures opposed by implant‐retained overdentures. The subjects were submitted to a questionnaire based on Oral Health Impact Profile and oral health related quality of life to evaluate their satisfaction levels and quality of life with their prostheses. Data were evaluated using a non‐parametric statistical analysis (Fischer test) with significant difference at α = 0.05. Results: There were no significant differences between the groups in relation to comfort, aesthetics, chewing ability, overall satisfaction, pain, functional, phonetic, social, and psychological limitations (p > 0.05). Comparing the stability of mandibular dentures, group II presented the better results (p < 0.05). Conclusion: Although the stability of the mandibular implant‐retained overdenture was enhanced compared to a conventional denture, the quality of life and satisfaction levels were similar for both the groups.     

Affective state and acceptance of dentures in elderly patients

Objective : To examine the relationship between the affective state and acceptance of dentures by elderly patients. Setting : Dental Outpatient clinics and a residential home for the elderly. Bialystok, Poland. Design : Cross sectional survey of denture wearers. Subjects : One hundred and forty one patients between the ages of 60–94. Intervention : A semi-structured interview, which focused on the patient's self-evaluation of their affective state, and a clinical examination. Results : There was a trend for the negative affects (irritability, boredom, anger, loneliness, helplessness) to relate to denture intolerance and for the positive affects (joy, peace, usefulness) to relate to denture acceptance. Conclusions : Anger related significantly t o intolerance of upper and lower dentures. The relationship of age and gender to the acceptance of dentures in the present sample was not significant.     

Patients' experiences with partial dentures: a qualitative study

Objective: The aim of the study was to gain insight into people's experiences of being given and using partial dentures. Methods: In‐depth semi‐structured interviews were carried out with 23 people of varied age, social background and denture wearing experience in Tayside, Scotland. Participants were encouraged to discuss how they came to have partial dentures, their day‐to‐day denture use and their interactions with dentists. The interview data were systematically coded using key theme headings, and summary charts were constructed to facilitate analysis. Results: The initial decision that a partial denture was needed was generally difficult to accept. People perceived the main benefits of partial dentures to be improved appearance and confidence, but experienced a variety of difficulties with their dentures and often coped with these by only wearing them on social occasions. Participants had not always told their dentists about the difficulties they experienced. Barriers to seeking help with denture problems included financial constraints, previous experience of rushed appointments or poor communication from dentists and a perceived lack of entitlement to help when partial dentures were issued free. Conclusions: Partial dentures can be difficult to cope with. People experience a range of difficulties in wearing them, not all of which have been discussed with dentists. Informative and supportive communication when partial dentures are first needed, and subsequently, can improve the quality of patients’ experiences and may help promote effective use and appropriate help‐seeking by partial denture wearers.     

Partial edentulism and removable partial denture design in a dental school population: a survey in Greece

Gerodontology 2011; doi: 10.1111/j.1741‐2358.2010.00382.x Partial edentulism and removable partial denture design in a dental school population: a survey in Greece Objectives: To investigate the pattern of partial edentulism and the most frequent designs of cobalt‐chromium removable partial dentures (RPDs), constructed at the Dental School of Athens, Greece. Methods and materials: Five hundred and fifty‐three patients, between 42 and 81 years old, mostly males, treated by undergraduate dental students, were included. The survey was based on visual evaluation of master casts and work authorisation to dental technicians. Aspects examined were: Kennedy Classification, modification areas, major connectors, clasping, placement of rest seats and indirect retention. Results: Kennedy Class I was the most common encountered in the maxilla (50.5%) and in the mandible (70%). The most frequent major connectors were the lingual bar (92.6%) and the U‐shaped palatal strap (54%). The most common clasp was the Roach (69.2%) in Class I and Class II. In Class III and IV, the most common was the occlusally approaching clasp (55% and 70%). The most frequent location of the rest was mesial of abutment teeth. On the average, 39.5% of Class I RPDs and 58.6% of Class II RPDs had indirect retainers. Conclusion: A combination of the two major philosophies of RPD design (biomechanical and hygienic) was evident in the RPDs examined in our study.     

Knowledge of prosthodontic treatment among denture-wearers and non-denture-wearers attending a dental institute in India: a survey report

Objective: Knowledge of subjects regarding prosthodontic treatment may play a role in their acceptance of the prostheses. The purpose of this survey was to assess the knowledge of prosthodontic treatment among the denture‐wearers and non‐denture‐wearers reporting to the Institute of Dental Sciences, Belgaum. Methods: A self‐designed closed‐ended questionnaire containing 14 questions was designed. Four‐hundred and nineteen subjects aged between 25 and 65 years were surveyed over a period of 2 months. Collected data were statistically analysed using chi‐squared test at a significance level of p < 0.05. Results: From the 419 subjects surveyed, 140 subjects (33.4%) were dentate and 279 subjects (66.6%) were edentulous either in the maxillary, mandibular or both arches. Among the 279 edentulous subjects, 143 (51.3%) did not use any kind of prosthesis. There was a statistically significant difference in knowledge regarding the replacement of teeth by artificial means, the number of visits required for the provision of a complete denture, problems with dentures among subjects using and not using them (p < 0.001) whereas no significant difference was found among the subjects regarding aesthetics with dentures and socializing with friends. Conclusion: Attempts should be made to raise the level of knowledge of both denture‐wearers and non‐denture‐wearers reporting to the Institute for any dental treatment.