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.     

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.     

Evaluation of satisfaction with masticatory efficiency of new conventional complete dentures in edentulous patients--a survey

doi: 10.1111/j.1741‐2358.2012.00634.x Evaluation of satisfaction with Masticatory efficiency of new conventional complete dentures in edentulous patients. A survey Background: Knowing how patients really feel after treatment is, very often, as relevant as the success rate of the conventional dentures and it can even be the measurement of masticatory function. Aim and objectives: This questionnaire survey aimed to analyse the satisfaction level and masticatory efficiency of patients treated with conventional complete dentures. Design and setting: Thirty edentulous patients were considered in the study. Satisfaction level and masticatory efficiency were analysed based on specific questionnaires for edentulous patients and by a likert rating scale from 0 to 5, at three moments: Prior to treatment (edentulous period), after the insertion of the new dentures and at 30–45 days follow‐up. Materials and methods: Thirty patients including 12 male and 18 female patients (mean age 65 years), who voluntarily came for the services. T‐test was applied at three different levels. Results: The rehabilitation with conventional complete dentures produced an improvement (p < 0.05) in satisfaction level and masticatory efficiency. Conclusion: Thus, those patients who were edentulous previously and dissatisfied with their masticatory ability showed improvement after receiving a new set of conventional complete dentures.     

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.     

Accelerated rehabilitation of an edentulous patient with an implant retained dental prosthesis: a case report

This case report details the successful rehabilitation of an edentulous patient using a complete upper prosthesis and a lower implant retained overdenture. The provision of care was split between a specialist centre and a primary care setting. This approach reduced inconvenience to the patient. Modern surgical and prosthodontic techniques also reduced the total delivery time. After initial consultation a new set of complete dentures was prescribed with changes in design to the originals. The patient was also planned for placement of two mandibular implants to stabilise and retain the mandibular denture. The first line of treatment involved provision of a new set of dentures constructed by the patient's general dental practitioner. Dental implants were then placed in a specialist centre and the patient returned to the dental practice for attachment of the lower denture to the dental implants. The benefits and success of mandibular implant retained dentures are well documented. With delivery of the overdenture, the patient reported increased satisfaction with his prostheses which allowed him to eat a greater range of foods and enabled him to feel confident when speaking and socialising.     

A study to compare the oral health impact profile and satisfaction before and after having replacement complete dentures constructed by either the copy or the conventional technique

Aims: To assess the oral health impact profile (OHIP) on edentulous subjects who needed to have their dentures replaced either by a copy technique or a conventional technique, and to determine whether any change in the subjects’ assessment of their original and replacement dentures impacted on oral health related quality of life parameters. Background: The OHIP is an instrument used to measure subjects’ perceptions of the social impact of oral disorders on their well being. Changes in the OHIP may occur when subjects need to have their complete dentures replaced. Furthermore, it is possible that the method by which the dentures are constructed may impact on this. Methods: A total of 65 edentulous subjects were studied. Thirty‐three subjects had their dentures constructed by a copy technique and 32 by a conventional technique. Subjects completed the OHIP‐14 questionnaires before and after being provided with a set of replacement complete dentures. They also assessed specific features of the upper and lower dentures. Responses were recorded on a Likert scale. Results: For many subjects, the responses in the before treatment questionnaires were at the lower end of the Likert scale, indicating that there were no major impacts on oral health related quality of life parameters. There were no major differences between the copy denture subjects and the conventional denture subjects in relation to the change in OHIP scores before and after treatment. Generally subjects expressed improved satisfaction with the new lower denture. However, for the copy denture group there were significant improvements for all seven assessments compared with only five out of seven assessments for subjects in the conventional group. Conclusion: For these groups of edentulous subjects, although they may need dentures to be replaced after a period of wear, this does not necessarily have significant impacts on oral health related quality of life parameters. It seems likely that this is the main reason why the provision of new dentures by either a copying or conventional technique did not result in major changes to the OHIP.     

Care Needs of the Elderly Treated at a Dental School1

Increased longevity and recently intensified emphasis on gerodontology mandate that dental students'exposure to clinical care of the elderly be enhanced. The extent to which individual students can be exposed to geriatric dental care depends on the availability of elderly patients to dental school clinics and the treatment needs of these patients. The purposes of this study were (1) to determine the dental treatment needs of geriatric patients who seek care at a dental school, and (2) to ascertain if differences exist between the needs of older versus relatively young geriatric patients. Data collected on 128 elderly patients during a three month period indicate that 57% of the aged were either edentulous at examination or treatment planned to become edentulous and receive two full dentures. The remaining 43% were treatment planned to remain dentulous and receive therapies other than full upper and lower dentures. More older geriatric patients required full dentures than their younger cohorts. More young elderly required prophylaxes, scalings, root planing therapy, dental restorations, and partial dentures. Additional to their denture requirements, aged patients appear to have sufficient non-prosthetic needs to allow for meaningful gerodontic experience by students.     

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.     

Elders with implant overdentures: a 22-year clinical report

doi: 10.1111/j.1741‐2358.2012.00628.x Elders with implant overdentures: a 22‐year clinical report Objective: To report on the long‐term survival and prosthodontic maintenance of two edentulous adults with mandibular overdentures supported by hydroxyapatite (HA)‐coated implants. Background: Mandibular implant overdentures are a successful treatment option with positive impact on the quality of life of elderly edentulous adults. Long‐term survival of the implants requires continued rigorous prosthodontic maintenance. Clinical report: Two elderly edentulous adults with mandibular overdentures supported by 2 HA‐coated implants were presented for prosthodontic rehabilitation after 22 years of placement. The implants were osseo‐integrated and surviving at presentation based on accepted criteria. The mandibular implant overdentures suffered recurrent loss of retention and stability. Prosthodontic treatment involving the replacement of defective attachment systems and construction of new sets of mandibular implant overdentures opposing complete maxillary dentures is presented. Conclusion: The long‐term survival of mandibular 2‐implant overdentures requires continued prosthodontic maintenance. A conservative approach in the rehabilitation of two older edentulous adults with mandibular 2‐implant overdentures was described including proper selection of attachment systems.     

Does prosthodontic rehabilitation change the eating patterns among completely edentulous patients?

doi: 10.1111/j.1741‐2358.2010.00404.x Does prosthodontic rehabilitation change the eating patterns among completely edentulous patients? Objective: Nutrition is compromised in completely edentulous individuals. As there is limited literature available on the nutritional health of the elderly in the Indian population, the present study was undertaken to assess these changes before and 1 month after placement of complete dentures in a dental hospital in Indore, Madhya Pradesh, India. Materials and methods: The 10‐item closed‐ended questionnaire was completed by the investigator who interviewed the subjects (n = 35) before placement of complete dentures and 1 month later. Results: A statistically significant difference was found for having an illness or condition that led to a change in the type and/or amount of food eaten (p = 0.013); eating few fruits, vegetables, or milk products (p = 0.005) and having oral problems that made it difficult to eat (p = 0.003). Conclusions: Prosthodontic rehabilitation improved the eating pattern with increased intake of fruits, vegetables and milk products.     

下颌种植覆盖义齿的生物力学研究进展

口腔生物力学是用生物力学的概念和方法,研究口腔医学中的有关基础性科学问题、解决口腔医学中的临床实际问题、发展口腔临床技术的一门学科。在口腔正畸学、修复学、种植学及口腔颌面外科学等领域存在着大量的生物力学问题,生物力学已成为口腔医学的基础科学之一。传统全口义齿修复常常会出现固位稳定差、咀嚼效率低、患者有疼痛感、适应时间长等情况,很大程度上不能满足患者的修复要求。种植覆盖义齿对于下颌牙槽嵴严重吸收的患者,效果尤为明显。种植覆盖义齿是义齿与种植体之间以不同的附着体作为连接,形成患者可以自行摘戴的种植体支持的覆盖义齿修复。下颌种植覆盖义齿因其能有效地提高下半口义齿的固位性和稳定性、显著提高了患者的咀嚼效率,目前已成为修复下颌牙槽骨严重吸收的无牙颌患者的有效修复方法。本文针对下颌种植覆盖义齿的生物力学研究进展作一综述。     

Age-related satisfaction with complete dentures,desire for improvement and attitudes to implant treatment

In the edentulous lower jaw implant stabilised dentures have proved clinically so successful that the indication for this treatment is now being discussed more often with geriatric patients. The aim of this study of edentate subjects was to determine the age-relation of the demand for denture improvement, the risks and feasibility of implant treatment. Sixty four complete denture wearers aged from 42 to 84 years took part in the study. A questionnaire was used to determine the subjective demand for denture improvement. For 33 subjects implants seemed possible. For these patients fear and scepticism concerning implant treatment were specified and quantified. Impaired general health was the most frequent absolute contra-indication for implants; the local oral prerequisites tended to be slightly less favourable in elderly. Older patients were more satisfied with poorly fitting dentures and were less prepared to take trouble to achieve denture improvement. Although scepticism concerning implant treatment was not age-related, patients who were keen for an improvement of their dentures were significantly younger and less sceptical about implants.     

A study to compare the oral health impact profile and satisfaction before and after having replacement complete dentures in England and Scotland

Objective: To assess the oral health impact profile (OHIP) on edentulous subjects in Scotland and England who needed to have their dentures replaced, and to determine whether any change in the subjects’ assessment of their original and replacement dentures impacted on oral health related quality of life parameters. Background: The loss of all teeth may impact on functional activities. The OHIP is an instrument used to measure subjects’ perception of the social impact of oral disorders on their well being. Methods: A total of 58 edentulous subjects were studied. Subjects completed the OHIP‐14 questionnaires before and after being provided with a set of replacement complete dentures. They also assessed specific features of the upper and lower dentures. Responses were recorded on a Likert scale. Results: For many subjects, the responses in the before treatment questionnaires were at the lower end of the Likert scale, indicating that there were no major impacts on oral health related quality of life parameters. There were significant improvements in four of the 14 OHIP parameters assessed after treatment. With the new dentures, subjects expressed improved satisfaction, particularly for the lower prosthesis. There were no major differences between the responses of the subjects in Scotland and England. Conclusion: For this group of edentulous subjects, although they may need dentures to be replaced after a period of wear, this does not necessarily have significant social impacts. For this reason the provision of new dentures did not result in major changes to the OHIP.     

Electromyographic evaluation of masseter and anterior temporalis muscles in rest position of edentulous patients with temporomandibular disorders, before and after using complete dentures with sliding plates

Objectives: This study was performed with the purpose of investigating electromyographic (EMG) activity of the anterior temporalis and masseter muscles in edentulous individuals with temporomandibular disorder (TMD), before and after using sliding plates on complete dentures in the mandibular rest position. Background: Edentulous patients may present TMD, which is characterised by pain in temporomandibular joints, masticatory and neck muscles, uncoordinated and limited mandible movements, joint sounds and an altered occlusal relationship. It is imperative to offer treatment in order to re‐establish stomatognathic system structures before submitting the individual to any definitive restorative treatment. Materials and methods: The patients were edentulous for at least 10 years. EMG recordings were made before the insertion of the dentures (0 months) and also after using the sliding plates at the fourth month, 9th month and 12th month, using computerised electromyography K6‐I/ EMG Light Channel Surface. EMG evaluations of the muscles were performed under the following clinical conditions: rest position with dentures (R1), rest position without dentures (R2), rest position with dentures post‐activity (chewing) (R3), rest position without dentures post‐activity (chewing) (R4). Results: All patients obtained remission of muscular fatigue and reduced pain in stomatognathic system structures. Temporalis muscle showed significant increase in EMG activity compared with initial values (p < 0.01). Masseter muscles showed significantly lower mean values (p < 0.01) compared with initial values. Conclusion: The sliding plates allowed the process of neuromuscular deprogramming, contributing to muscular balance of the masticatory system, and are therefore indicated to be used before the fabrication of definitive complete dentures in patients with TMD.     

Sensory detection of food odour in relation to dental status,gender and age

The aim of this study was to investigate to what extent declining odour perception can be ascribed to dental status and oral hygiene habits, taking into account gender and age. Apparently healthy adults (n=182), ranging from 53 to 93 years (mean age=68.4) were tested. Information about oral hygiene habits (brushing teeth and cleaning dentures) and dental status was obtained by questionnaires. A validated objective procedure was used to measure sensory detection thresholds for isoamylacetate by an ascending method of limits. A significant negative correlation of odour perception with age was shown by the edentulous subjects which might reflect their wider age spread with many subjects over age 75. The evaluation of odour perception as a function of dental status shows no significant difference in odour perception between persons partial denture wearers, with natural teeth only or complete dentures. However, a tendency for lower odour perception was observed among male partial denture wearers, especially those reporting less frequent oral hygiene, which justifies further more detailed study.     

Oral hygiene and the need for treatment of the dependent institutionalised elderly

Objective: To assessing the oral hygiene and treatment needs of a geriatric institution in southern France. Background: For various reasons, the care demand from elderly people is low and difficult to determine, whereas their oral status would need long and complicated treatments. Materials and methods: From 2003 to 2004, a cross‐sectional study of 321 elderly patients was conducted at several geriatric services of Montpellier, France. The clinical evaluation of dental status was recorded together with medical information. Dental and prosthetic hygiene, status of dentures, caries experience, dependence conditions and treatment needs were evaluated. Results: The prevalence of edentulism was 27%, with no gender difference (23% of the men and 29% of the women). Among them, 16.7% (upper jaw) and 18.1% (lower jaw) were totally edentulous with no denture. The mean number of decayed and missing teeth was 3.7 for men and 2.8 for women and 21.5 for men and 21.0 for women, respectively. The mean number of filled teeth was 0.8 for men and 1.3 for women, with no statistical difference according to gender for the three indexes. Most of the subjects needed prostheses (53%), 45.1% extractions and 30.6% conservative treatments. Only 2.4% did not need any treatment. Conclusion: The prevalence of edentulism was relatively low, while the need for prosthodontic rehabilitation, especially for men, was still very high. The dental hygiene was globally inadequate. This evaluation emphasises the care demand and the need for help in oral hygiene procedures for the dependent institutionalised elderly.     

Understanding the psychology of geriatric edentulous patients

doi: 10.1111/j.1741‐2358.2011.00496.x Understanding the psychology of geriatric edentulous patients Objective: This article focuses on understanding our older patients who require complete prosthodontic care. By breaking down the patient psychology to its component parts, it is easier to obtain a clear picture of this special cohort of patients. Considering the increase in number of geriatric edentulous patients, this knowledge will help the dentist serve the geriatric population better. Background: The role of psychology and personality in complete denture treatment is well documented. The geriatric patient who needs complete dentures has a psychological aspect that needs consideration. Although significant, these aspects may sometimes be ignored or considered irrelevant. Materials and methods: A review of relevant literature was carried out to obtain data on the psychology and personality of geriatric, complete denture patients and their behavioural changes. The obtained data was filtered and condensed to provide a short but comprehensive look at the geriatric edentulous patient’s psychology. Conclusion: When handling geriatric edentulous patients, the dentist must be confident of addressing and managing the psychology of these patients. A thorough understanding of the geriatric mental state thus becomes important and significant for the clinician.     

The presence of black-pigmented Gram-negative anaerobes in the oral cavity of edentolous subjects

Abstract The aim of this study was to investigate whether black-pigmented Gram-negative anaerobes are part of the indigenous oral flora of edentulous subjects with or without dentures. Group I consisted of 11 subjects with dentures (mean age 63.6 years, range 52–75) and Group II consisted of 39 subjects with complete dentures in both jaws (mean age 59.3 years, range 37–80). Two microbial samples for microbiological examination were taken from each subject. One of them was from the dorsum of the tongue and the other was from saliva. Black-pigmented Gram-negative anaerobes > 10⁷ cfu/ml were found in both samples. In 50 edentulous subjects, they were found more commonly from tongue (40%) than from saliva (26%). None of the subjects had Porphyromonas gingivalis . There was no statistically significant difference ( P > 0.05) between the presence of black-pigmented Gram-negative anaerobes on tongue and in saliva in the two groups. Our results suggested that high levels of black-pigmented Gram-negative anaerobes may belong to the indigenous oral flora in edentulous mouths with or without dentures.     

A study of the prosthodontic and oral health needs of an ageing psychiatric population

Background: Life expectancy has increased worldwide, with India (having 8% who are senior citizens), falling into the “Greying Country” category. This ageing population constitutes a high‐risk oral health group, vis‐à‐vis impaired manual dexterity, cognitive deterioration and unmet treatment needs, which could be compounded by psychiatric morbidity. Objective: To assess oral health status and prosthodontic need of ageing psychiatric patients. Materials and method: One hundred and twenty‐five patients, aged 50 years or above, admitted to the Department of Geriatric Mental Health, King George’s Medical University, Lucknow, Uttar Pradesh, India, were examined for prosthodontic, oral health status and need, the study population being divided into groups on the basis of Bristol Activities Scale of Daily Living. Results: Depressive symptoms (which increased with age) and psychiatric morbidity were found to be more in females. About 98% of the population showed probing depths of more than 3 mm, with mean number of decayed/missing teeth and inability to maintain oral/denture hygiene (p < 0.001) increasing in higher disability levels. While 91.3% of the population wearing a prosthesis required new dentures, 33.3% of the study population had unfulfilled partial denture need and 28.4% had unfulfilled upper/lower complete denture need. Conclusion: Ageing psychiatric subjects require dental education and treatment to meet their needs.     

Radiographic changes in alveolar bone height on overdenture abutments: a longitudinal study

Objective: Stabilisation of partial dentures is an important part of prosthodontic treatment, particularly in patients with an excessive reduction in alveolar bone supporting their abutment teeth. In these cases, overdenture prostheses are one possible treatment choice. Background: The aim of this study was to evaluate the effects of overdentures on the condition of alveolar bone of the remaining teeth, and to evaluate the overdenture concept in the prosthetic treatment of partially edentulous patients. Materials and methods: The investigation was conducted on 22 patients during observation periods of 6 and 10 years. After preparation, all abutment teeth were provided with either amalgam restorations or gold copings. An overdenture in the lower jaw was fabricated for every patient. A special film holder was used to repeat the X‐ray procedure in every patient in the same manner. The radiographs were evaluated using the grid scale. The alveolar bone level of all remaining teeth was evaluated on dental films by measuring the distance between the root apex and coronal border of the alveolar bone. Results: A statistically significant difference (p < 0.01) was calculated 6 years after delivery stage between distal alveolar bone levels of experimental abutments under overdentures and the remaining teeth of the control group. Alveolar bone of abutment teeth was considerably preserved, particularly in seven patients observed 10 years after provision of their dentures. Conclusion: Within the limitation of this study, the validity of the overdenture treatment in partially edentulous patients is concluded. Good oral hygiene was crucial for the success of treatment with overdentures.