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.     

下颌起排法全口排牙临床效果研究

目的:研究通过比较不同的排牙方式制作的全口义齿对咀嚼次数、咀嚼效率以及患者的主观感受的影响。方法:78例无牙颌患者按照牙槽嵴高度分为正常组和低平组,正常组有患者32例,低平组有患者46例,每组分别戴用上颌起排法和下颌起排法制作的全口义齿,比较咀嚼次数、咀嚼效率和满意度的差别。结果:在戴用上颌起排法制作的全口义齿时,正常组的咀嚼次数高于低平组,差异具有统计学意义(t=3.60,P0.05);戴用下颌起排法制作的全口义齿后,低平组的咀嚼次数高于采用上颌起排法的全口义齿,差异具有统计学意义(t=4.41,P0.05);在戴用上颌起排法制作的全口义齿中,正常组的咀嚼效率高于低平组,差异具有统计学意义(t=5.72,P0.05);而在戴用下颌起排法制作的全口义齿后,低平组的咀嚼效率高于采用上颌起排法的全口义齿,差异具有统计学意义(t=7.16,P0.05)。正常组认为使用下颌起排法制作全口义齿咀嚼能力、稳固感好于上颌起排法,差异均具有统计学意义(P0.05);低平组认为使用下颌起排法制作全口义齿咀嚼能力、稳固感和舒适感好于上颌起排法,差异均具有统计学意义(P0.05)。结论:对于牙槽嵴低平无牙颌患者使用下颌起排法制作的全口义齿,能够有效地增强咀嚼效率,提高义齿的稳定性。     

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.     

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.     

Should edentulous patients be constrained to removable complete dentures? The use of dental implants to improve the quality of life for edentulous patients

doi:10.1111/j.1741‐2358.2009.00294.x
Should edentulous patients be constrained to removable complete dentures? The use of dental implants to improve the quality of life for edentulous patients Background: Nowadays, there is some speculation among dental educators that the need for complete dentures will significantly decrease in the future and that training in their provision should be removed from the dental curriculum. Objective: To sensitise the reader to the functional shortcomings of complete denture therapy in the edentulous patient and present restorative options including implants to improve edentulous quality of life in these patients. Methods: Information retrieval followed a systematic approach using PubMed. English articles published from 1964 to 2008, in which the masticatory performance of patients with implant‐supported dentures was assessed by objective methods and compared with performance with conventional dentures, were included. Results: National epidemiological survey data suggested that the adult population in need of one or two complete dentures will increase from 35.4 million adults in 2000 to 37.9 million adults in 2020. Clinical studies have showed that the ratings of general satisfaction were significantly better in the patients treated with implant overdentures post‐delivery compared with the complete denture users. In addition, the implant group gave significantly higher ratings on comfort, stability and ability to chew. Furthermore, patients who received mandibular implant overdentures had significantly fewer oral health‐related quality of life problems than did the conventional group. Conclusion: Implant‐supported dentures including either complete overdentures or a hybrid prosthesis significantly improve the quality of life for edentulous patients compared with conventional removable complete dentures. Therefore, the contemporary dental practitioner should consider other options as well as conventional removable complete dentures to restore edentulous patients.     

The efficacy of a topical gel with triester glycerol oxide in denture-related mucosal injuries

doi: 10.1111/j.1741‐2358.2011.00549.x
The efficacy of a topical gel with triester glycerol oxide in denture‐related mucosal injuries Objective: The efficacy of a topical gel with triester glycerol oxide for treating ulcerations related to new complete dentures was studied and compared with a placebo gel. Materials and methods: Fifty edentulous patients were enrolled in this double‐blind clinical study. All subjects received new maxillary and mandibular complete dentures and were recalled 1, 3 and 7 days after denture placement. Twenty‐five subjects received topical gel with triester glycerol oxide (TGO), and 25 subjects received topical gel without TGO. At each visit, pain and discomfort with the new dentures was assessed, and at the last visit, healing of ulcerations was also graded by a clinician. Subjects also graded the gel’s taste, smell and ease of use. Results: Specifically, there was no statistically significant difference in ulcer healing (p > 0.05), ratings of smell, taste and ease of use (p > 0.05) or pain and discomfort scores (p > 0.05). However, within‐group differences were observed in pain and discomfort scores between follow‐up sessions (p = 0.01 for all comparisons). Conclusion: Clinically, TGO gel is not effective in the treatment of mucosal injuries occurring following placement of complete dentures.     

Fracture resistance of maxillary complete dentures subjected to long-term water immersion

doi: 10.1111/j.1741‐2358.2012.00616.x Fracture resistance of maxillary complete dentures subjected to long‐term water immersion Objective: This study investigated the fracture resistance of maxillary acrylic resin complete dentures subjected to long‐term water immersion. Materials and Methods: Maxillary acrylic resin complete dentures were fabricated from five denture base resins. Half of the dentures were stored in water for 50 h, and the other half were kept in water for 180 days before testing. Ten specimens were fabricated per group. The flexural load at the proportional limit (FL‐PL) of the dentures was tested. Results: A two‐way anova revealed a significant difference in FL‐PL because of the denture base material variable. There were no significant differences in FL‐PL because of the effect of water immersion and the interaction between the effect of water immersion and the denture base material. The FL‐PLs of the dentures fabricated with the two conventional heat‐processed resins, the pour‐type autopolymerizing resin and the microwave energy‐processed resin were not significantly different from each other; they were significantly higher than the light‐activated resin in regard to their FL‐PL. Conclusion: The FL‐PLs of the maxillary acrylic resin complete dentures did not change after long‐tern water immersion, and the FL‐PL of the denture fabricated from the light‐activated resin was lower than those of the other materials.     

Influence of psychological factors on the acceptance of complete dentures

Objectives: To assess the influence of psychological factors on the acceptance of complete dentures in a population wearing dentures judged to be clinically satisfactory. Design: Subjects were asked to complete personality profiles and also to rate their dentures using a denture satisfaction questionnaire. Setting: The survey was conducted in the prosthetics clinic of a teaching hospital. Subjects: Patients were selected from those who had new complete dentures constructed in the department within the previous two years. Intervention and main outcome measures : The personality inventory was a self‐administered questionnaire comprising 240 items covering the five domains of personality. Denture satisfaction was scored on a nine item scale with four Likert type responses to each. Results: A group of 16% consistently complained about their dentures. Statistical analysis showed that personality factors especially Neuroticism had a significant relationship with denture satisfaction. Conclusion: Psychological factors significantly influence denture satisfaction and profiles may provide useful in predicting potential difficult denture wearers.     

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.     

Edentulous patients' knowledge of dental hygiene and care of prostheses

Objective: The aim of this study was to analyse denture users’ oral care habits with regard to the use of their prostheses. Background: Rehabilitative treatment is only successful when patients are motivated and aware of correct prosthesis use and hygiene. Materials and methods: Questionnaires were distributed to 150 complete denture users at the Federal University of Bahia School of Dentistry, the Esmeralda Natividade Health Center, the Bahian Science Development Foundation and a Salvador nursing home. The questionnaire included information on gender, age, length of prosthesis use, cleaning methods and materials, etc. The data were analysed using EpiInfo version 6 software. The chi‐squared test was used for statistical analysis, with a significance level of 5%. Results: Questionnaire results showed that 78% of the subjects, with an average age of 67.3 years, had used the same complete denture for over 5 years. 64% slept with their prostheses and 44% removed them from the mouth only for cleaning. None of the patients interviewed knew anything about brushes designed specifically for complete dentures. 37.3% had a restricted diet and 44% believed that a complete denture would last for more than 10 years. Conclusion: Within the limitations of this study, it was concluded that the edentulous patients surveyed had limited awareness of prosthetic hygiene and long‐term oral care despite extended periods of denture use.     

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.     

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.     

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.     

Self-reported denture hygiene of a sample of edentulous attendees at a University dental clinic and the relationship to the condition of the oral tissues

Objectives: This article aims to evaluate the habits of hygiene and usage of a sample group of Brazilian wearers of complete dentures. Design: This study has a cross‐sectional design. Setting: It was performed in the dental clinic of the University of Mogi das Cruzes. Subjects: A sample group of 236 complete denture wearers was selected. Intervention: The individuals were interviewed and clinically examined. Main outcome measures: Most commonly used hygiene habits were assessed and recorded. Possible relationships between habits and oral conditions were also assessed. Results: Dental treatment was sought by 43.6% 10 years after their last dental appointment, 77.5% declared they had been given no instructions regarding the hygiene of their dentures, only 22.9% said they had been instructed about oral hygiene, and 91.9% stated they had not been told to return for periodical review visits. Denture stomatitis was found in 42.4%, although 89% of these patients presented with no symptoms; 98.7% of the group brushed their dentures; 27.1% regularly immersed their dentures in chemical products; 26.3% removed their dentures overnight. A positive relationship was observed between the lack of recommendations regarding oral and denture cleansing and the presence of denture‐related stomatitis and hyperplasia. Family income and periodicity of visits to the dentist were also found to be related. Conclusion: Mechanical cleaning is the most prevalent method of hygiene. Self‐reported lack of guidance to oral care was statistically related to inflammatory oral conditions. Future research is necessary to clarify possible causal role between these factors.     

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.     

Maxillary complete denture movement during chewing in mandibular removable partial denture wearers

Objectives: To evaluate the pattern of maxillary complete denture movement during chewing for free‐end removable partial dentures (RPD) wearers, compared to maxillary and mandibular complete denture wearers. Materials and methods: Eighteen edentulous participants (group I) and 10 volunteers with bilateral posterior edentulous mandibles (group II) comprised the sample. Measures of mean denture movement and its variability were obtained by a kinesiographic instrument K6‐I Diagnostic System, during the mastication of bread and a polysulphide block. Data were analysed using two‐way anova (α = 0.05). Results: Upper movement during chewing was significantly lower for group II, regardless of the test food. The test food did not influence the vertical or lateral position of the denture bases, but more anterior dislocation was found when polysulphide blocks were chewed. Group II presented lower intra‐individual variability for the vertical axis. Vertical displacement was also more precise with bread as a test food. Conclusion: It can be concluded that mandibular free‐end RPD wearers show smaller and more precise movements than mandibular complete denture wearers.     

The oral health‐related quality of life in edentulous patients treated with Conventional complete dentures

Objective: To compare the oral health‐related quality of life (OHRQoL) between patients with both maxillary and mandibular complete denture and those with either the maxillary or the mandibular complete denture. Background: Satisfaction of denture wearers can be estimated using the OHRQoL questionnaires like the OHIP‐EDENT and the Geriatric Oral Health Assessment Index (GOHAI). Methods: Two questionnaires were used to compare the OHRQoL between edentulous patients who had conventional removable complete denture on both jaws and those who had on either one of the jaws. Result: The age of the participants ranged from 42 to 75 years, with the mean age of 58 ± 8.12 years. The mean OHIP‐EDENT scores were significantly high among those who wore conventional dentures in both jaws (54.12 ± 5.21), compared with the participants who only had denture either on upper or lower jaw (46.52 ± 7.35). It was noticed that the mean GOHAI score was significantly lower (p < 0.05) among participants who had conventional denture on both upper and lower jaw (28.25 ± 3.67), as compared to those who had conventional denture only on one arch (35.12 ± 2.11). Conclusion: Patients with complete dentures in both jaw (Group I) were less satisfied than patients with single complete denture (Group II). The result obtained in this study shows dissatisfaction with conventional dentures among edentulous patients.     

The influence of age and denture wear on the size of edentulous structures

Objectives : This study was designed to evaluate the influence of age and denture use on the size of arches and residual ridges in edentulous patients. Design : At two nursing homes, maxillary and mandibular stone casts of 302 fully edentulous patients were utilized to measure the size of the arches and residual ridges, according to age and use of complete dentures. Age cohorts were divided into three groups; 60–69, 70–79, and 80–89 years old. Two hundred and forty‐nine denture wearers used complete dentures for at least 2 years before examinations. Fifty‐three non‐denture users had never worn removable prostheses. Chi‐square analysis (p<0.05) was used to establish the possible relations between the linear values and the size indexes of the ridges and arches and the two examined parameters: age and denture wear. Results : Young old patients possessed edentulous structures that were not significantly larger than elderly old patients in both the maxilla and the mandible. Non‐denture users had significantly bigger arches and ridges in both edentulous jaws than denture users. Conclusions : Young old, non‐denture users tended to have bigger residual edentulous tissues compared to elderly old patients who used complete dentures.