Malodour in denture wearers: an ill-defined problem

Denture plaque has not been studied to the same extent as dental plaque, and although there are many similarities in microbial composition, there are some significant differences. Denture-induced stomatitis is associated with poor denture hygiene, a more acidogenic plaque and the presence of Candida albicans. Obligate Gram-negative anaerobic micro-organisms, although present in denture plaque, have rarely been specifically investigated. Opportunist pathogens including coliforms and staphylococci have been isolated from dentures. Teeth adjacent to partial dentures are more susceptible to caries and periodontal diseases, perhaps due to an increased plaque buildup at the prosthesis/tooth interface. Little work has been published on malodour associated with dentures. The inert material provides a substratum for the plaque biofilm, which encompasses a range of odour-producing species. The microbiology of the tongue in denture wearers has not been specifically studied. Thus the nature, origin and extent of malodour in denture wearers is ill-defined, but many species capable of producing malodorous compounds are present. The wide age and health range presented by denture wearers further confounds investigation. There is a need for further work in the area, both for cosmetic- and health-associated reasons in the increasing elderly population.

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.

[Forms of appearance of decubuti caused by complete upper and lower dentures]

One of the most usual forms of complaint after the insertion of complete dentures is decubitus. It is an ulcer caused by the mechanical harm during the wearing of complete or removable partial dentures. Its size is about that of a lentil. Its shape is usually round or oval but can also be longish in appearance. Its usual colour is grayish white or scarlet. In their research the authors concentrated on the places where these decubiti appear after the insertion of complete dentures. Also, they focused on the question whether new decubiti tend to appear after check-ups and how long the presence of the bedsores last. They took down the particulars of 61 patients (47 women and 14 men) wearing complete upper and lower dentures and of 122 patients with complete upper and lower dentures. The gender and age of the patients and the number of complete upper and lower dentures were also recorded. It is remarkable that 69% of the patients (70% of the women and 64% of the men) appearing at the first check-up turned up at the second one. At the third check-up, 13% of the patients (15% of the women and 7% of the men) showed up. During the first check-up, 87% of the dentures (meaning 106) had to be modified, while during the second one, this rate was 51% (meaning 61 dentures), and during the third one, it was 7% (9 dentures). Thus, the insertion is not the last stage of making complete dentures, for the short-term check-ups are very important phases, as well.

Responses of jawbone to pressure*

OBJECTIVE

To provide a literature review of bone resorption of edentulous jaws focusing on responses to pressure.

BACKGROUND

After the extraction of all teeth in a jaw there is a continuous reduction of the residual ridge. The individual variation of bone resorption is great, and the aetiology is complex and not yet well understood.

MATERIALS AND METHODS

A search of the literature published up to May 2003 on bone resorption and pressure was performed using PubMed/Medline.

RESULTS

Animal studies have demonstrated that excessive and constant pressure induces bone resorption. Recent experimental research has indicated that bone resorption is a pressure-regulated phenomenon with a lower threshold for continuous than for intermittent pressure. Clinical studies have suggested that residual ridge resorption is due more to the effects of denture wearing than to disuse atrophy. However, the results of leaving out dentures at night are not conclusive. Nor does the literature offer any strong evidence for the so-called combination syndrome, which has been described as a result of unfavourable loading. Clinical studies using multivariate analyses indicate that female gender and systemic factors may be of greater importance than oral and denture factors. Implant-supported prostheses have a bone preserving effect rather than the continuing resorption under complete dentures.

CONCLUSIONS

The best way to reduce bone resorption is to avoid total extraction, preserve a few teeth and fabricate overdentures. In edentulous jaws, placement of implant-supported prostheses will lead to less bone loss and may even promote bone growth. To increase our knowledge of residual ridge resorption extended experimental, clinical and statistical methods will be needed, preferably including collaboration between dental and medical researchers.

Denture-related oral mucosal lesions in a Brazilian school of dentistry

The purpose of this study was to survey the frequency of denture-related lesions of the oral mucosa in patients treated at a Brazilian dental school and to determine if the oral lesions were related to age, sex, denture type, length of denture use and denture cleaning methods. The denture-related lesions observed in this study were chronic atrophic candidiasis, chronic hyperplastic candidiasis, denture-induced fibrous inflammatory hyperplasia (FIH), traumatic ulcer, angular cheilitis and flabby ridge. The most frequent lesion, chronic atrophic candidiasis, occurred more frequently in females, in complete maxillary denture wearers, with denture use for 16-20 years. The most common method of cleaning dentures was a toothbrush and toothpaste. These results suggest that dentures can cause a wide range of lesions of the oral mucosa, that could be prevented with follow-up to evaluate dentures and provide instructions on how to maintain oral tissues healthy.

Changes in temporomandibular disorders after treatment with new complete dentures

A total of 250 edentulous patients (118 non-denture and 132 denture wearing) awaiting treatment for new complete dentures were examined for signs and symptoms of temporomandibular disorders. Signs and symptoms of temporomandibular disorder (TMD) were evaluated before prosthetic treatment, 3 months and 3 years after denture insertion by means Helkimo's Anamnestic and Clinical Dysfunction Indices. Before treatment began, patients were observed to have a low prevalence of signs and symptoms of TMD. This prevalence decreased, but was not statistically significant, in the 3 months and 3 years after denture insertion. No statistically significant correlations were found between signs and symptoms of TMD and denture retention, stability, occlusal errors, freeway space, age of present denture, or number of sets of dentures.

[Proliferative mucosal lesions in elderly people]

The aim of this study consisted into the identification of the hyperplasic modifications on the oral mucosa related to the etiological factors implicated into the etiopathogenity. We surveyed 228 patients aged between 65-84 years, with partial or total edentation, with removable dentures. The diagnostic was based on a complex clinical examination and complementary tests. The clinical manifestation forms were very different, determined by local factors, especially prosthetic one. The registration of these lesions demonstrates the main role of the dentist on the prophylactic activity of registration of these lesions and reduction of the etiologic factors.

A review of the functional and psychosocial outcomes of edentulousness treated with complete replacement dentures

Loss of natural teeth has functional and psychosocial consequences that can, in many cases, be rectified with complete replacement dentures. However, the outcome of complete denture therapy is variable, and relies on patient factors, as well as the skill of the clinician and laboratory technician making the dentures. This article reviews recent literature on the outcomes of edentulousness and complete denture therapy.

Comparison between balanced occlusion and canine guidance in complete denture wearers--a clinical, randomized trial

OBJECTIVE

Two occlusal concepts exist for the setup of complete dentures: canine guidance and balanced occlusion. These two schemes were studied in a randomized clinical trial of 22 patients.

METHOD AND MATERIALS

Subjective data were collected using a visual analog scale that described the patients' satisfaction with the esthetic appearance, the ability to chew, the ability to speak, and denture retention. Objective data were collected on the number of denture ulcers, the number of occlusal contacts, and denture retention during eccentric movements. Statistic evaluation was performed with the Friedman test.

RESULTS

Patients assessed canine-guided dentures to be significantly more satisfying in esthetic appearance, mandibular denture retention, and chewing ability. The ability to speak and the retention of maxillary dentures were not influenced by the occlusal concept in the patients' opinion, whereas the examiners found that maxillary canine-guided dentures lost retention more frequently during eccentric movements than balanced dentures. The objective inspection of mandibular denture retention underscores the patients' assessment, showing that the mandibular canine-guided dentures are much more stable during laterotrusive and protrusive movements.

CONCLUSION

Canine guidance can be used successfully in complete denture treatment as it provides better mandibular denture retention, esthetic appearance, and chewing ability.

Complications after treatment with implant-supported fixed prostheses: a retrospective study

PURPOSE

The aim was to retrospectively evaluate the frequencies of different complications, as well as the number of visits to dentists because of such complications, after treatment with implant-supported fixed prostheses.

MATERIALS AND METHODS

The study group comprised 75 patients who had been treated with implant-supported fixed prostheses 3 years earlier. All case records were scrutinized, and notes of complications in association with implants and superstructures were registered.

RESULTS

The most common intervention made was occlusal adjustment/selective grinding of the prostheses. Complications in association with both implants and superstructures were fairly common. The most frequent complication was fractures of the acrylic resin matrix, including artificial acrylic resin teeth. Consultations because of periimplant mucosal inflammation were much more common among women compared to men, while complications that could be attributed to heavy loading tended to be more common in men.

CONCLUSION

Complications with both implants and superstructures are fairly common after treatment with implant-supported fixed prostheses. Regular follow-ups to maintain optimal function in these patients are thus mandatory.

Case report: differential pressure impressions for complete dentures

A method of producing a differential pressure, secondary impression of a lower arch with a sharp bony ridge is described. The use of this technique allows the clinician to dictate where the load is to be borne by the mucosa.

A clinical study to assess the breath protection efficacy of denture adhesive

This randomized and controlled, examiner-blind, 3-period, crossover clinical trial was designed to determine the effect of an experimental denture adhesive, a marketed denture adhesive (European Fixodent( Fresh), or no denture adhesive on the breath odor of 37 adults wearing full maxillary and mandibular dentures. Breath quality was measured at baseline and at 3 and 6 hours after the start of each treatment period via monitoring of volatile sulfur compounds (VSCs) using a halimeter and second-person organoleptic grading. A 48-hour washout phase separated treatment periods. There were no statistically significant differences in VSCs between any of the treatment regimens over 6 hours. Both the denture adhesive treatments were superior in breath quality improvement in organoleptic scores compared to no denture adhesive at 3 and 6 hours (p=0.0001). This research demonstrates the ability of both an experimental and marketed denture adhesive to deliver superior second-person breath benefits relative to no adhesive. The results indicate that Fixodent denture adhesives provide the denture wearer with a noticeable improvement in breath.

Clinical assessment of common patient complaints with complete dentures

The purpose of this study was to investigate relationships between patient complaints with complete dentures and several factors such as age, gender, medical status and denture faults. Six hundred patients who received new dentures were assessed three months after insertion of the dentures. Patient complaints were scored according to their answers to specific questions. Denture quality was recorded by one prosthodontist using a validated classification of aspects of denture quality. No significant relationship was found when age, gender, and medical status were compared with patient complaints. Statistically significant relationships were observed between denture construction faults or the condition of the patient's denture bearing mucosa and patient complaints.

Advances in prosthetic dentistry

Until recently removable prostheses were the only form of treatment for those who had lost all or most of their natural teeth, while for the partially dentate, dentures were perceived as a poor substitute for a fixed restoration, lacking stability and prone to increasing oral disease. Subsequent studies demonstrated the functional benefits of removable partial dentures (RPDs) and how they could be used with minimal oral harm.

A comparison of the cost effectiveness of pressure-indicating materials and their ability to detect pressure areas in complete dentures

Pressure areas on the fitting surfaces of dentures can cause great discomfort and pain to denture wearers if not detected and removed. Pressure-indicating materials are commonly used to detect these areas, and several commercial varieties are available, but these tend to be expensive. The cost effectiveness of these materials has not been investigated, nor has this been linked to their efficacy and ease of use. The aim of this study therefore, was to compare the different pressure-indicating materials available commercially with that of a home-made paste. An assumption of efficacy was made by the number and size of pressure areas revealed, by taking standardised photographs and analysing the images. User friendliness was determined by the time taken to mix, apply and remove the material. Cost was determined by a cost per unit calculation based on the average or minimum quantity required for each material. The results indicated that a home-made paste made of equal quantities of hand lanolin (BP) and zinc oxide powder was not only the most effective, but was also the cheapest, being only 3% of the cost of the most expensive of the materials.

Evaluation of speech in patients rehabilitated with various oral implant-supported prostheses

In the present study, speech function was assessed in edentulous patients wearing fixed or removable dental prostheses supported or not by oral implants. A total of 138 patients participated in the present research. The experimental group (n=113) was divided in 4 subgroups. Subgroup FD/FFPi comprised 22 patients with a maxillary full denture (=FD) and a mandibular fixed full prosthesis on implants (=FFPi). Subgroup FFPi/ND consisted of 27 patients with a maxillary fixed full prosthesis on implants and a natural dentition (=ND) in the mandible. Subgroup FD/ODi included 49 patients wearing a maxillary full denture and a mandibular overdenture on 2 implants (=ODi). Subgroup FFPi/FFPi comprised 15 patients having a fixed full prosthesis on implants in both jaws. The outcome of the logopedic screening of the experimental group was compared with that of a control group of subjects having a natural dentition (ND/ND; n=25). A standard clinical procedure for evaluation of speech was carried out by a speech pathologist. Besides, specific oral and prosthetic parameters were scored in all patients. It was established that one or more pronunciation difficulties occurred in 84% of the patients of the experimental group. This was significantly more than in the control group, where half the number of subjects had some speech deficiencies. No clear influence of specific oral and prosthetic parameters could be identified. From the present results, it could be concluded that in patients rehabilitated with oral implant-supported prostheses speech disorder is more frequently observed than in subjects with a natural dentition.

Identification of complete denture problems: a summary

In this section, guidelines to the diagnosis of complete denture problems are presented in tabular form. Suggestions to the management of these problems are listed.

Fixed or removable implant-supported restorations in the edentulous maxilla: literature review

Among the prosthesis designs used to treat the edentulous maxilla are fixed or removable implant-supported restorations. Since the aesthetic requirements and preoperative situation of each patient varies, controversy exists regarding prostheses' success rates and complications. The purpose of this article is to compare the treatment options and prosthesis designs with their indications and to compare implant and prosthesis success and treatment expense. This objective was accomplished through the review of reports with regard to varying design considerations and factors that influence the decision-making process and treatment outcomes.

[The floating ridge, the thickened arch: a necessary evil?]

Flabby ridge and twofold lips shouldn't exist. As far as removable muco supported prosthesis is concerned, a perfect balanced occlusion respects maximally the integrity of the osseous tissues and the soft covering tissues. Clinical situations responsible for flabby ridge and the twofold lips are described. To prevent these problems, the solution is double: the dentist has to work "lege artis" and the negligence of the patient with dental prosthesis has to be avoided. An immediate treatment is necessary modifying the existing dental prosthesis. Some advice for the manufacturing of the new prosthesis is given.