Denture stomatitis in an elderly edentulous Asian population

Denture stomatitis is a common oral disease in denture wearers. Multiple aetiological and predisposing factors are believed to be responsible for its initiation and progression. The aim of this study was to assess the relationship between denture age, denture hygiene habits, denture wearing and denture cleanliness in an elderly edentulous Asian population. Seventy-five edentulous patients, all wearing maxillary complete dentures were divided into two groups. The test group comprised 36 patients (14 male and 22 female) with Type II denture stomatitis. The control group comprised 39 subjects (14 male and 25 female) with clinically healthy palatal mucosa. A standardized interview and clinical appraisal were carried out. The dye disclosing method was used to assess denture cleanliness and the resultant staining pattern scored. Statistical appraisal between the two groups revealed significant differences in denture hygiene habits (P < 0.05), denture wearing behaviour (P < 0.01) and denture cleanliness (P < 0.01). No significant difference was observed in the age of dentures between the test group and controls (P > 0.05). In the studied Asian edentulous population, a relationship between denture hygiene habits, denture wearing behaviour and denture cleanliness to the presence of denture stomatitis was observed.

Complete dentures--the soft option. An update for general dental practice

Permanent soft linings are frequently used as a 'soft option' blanket treatment for problems such as chronic pain under a lower denture, when it would be more appropriate to diagnose and eliminate any possible precipitating factors. The aim of this article is to provide an update on temporary and permanent soft materials and to give guidance on their indications and limitations of use, together with advice on their maintenance.

Complete dentures in the prosthetic rehabilitation of elderly persons: five different criteria to evaluate the need for replacement

The purpose of this study was to examine the condition and functional properties, as well as adjustment and replacement needs, of 288 complete dentures worn by 144 inhabitants of Helsinki over 75 years old. Five different criteria to evaluate the need for replacement were used: (I) criteria based on Oral Health Surveys-Basic Methods (WHO, 1987); (II) criteria based only on the clinical data collected during the examination; (III) criteria based only on examiners' subjective opinion of the condition of the dentures; (IV) criteria based on clinical data as well as examiners' experience and consultation with the patient; (V) criteria based only on patients' subjective opinion. Depending on the evaluation method used, 10-84% of the dentures were judged to be in need of replacement. Strict objective evaluation methods produced the highest figures for replacement need, and method (I, WHO, 1987) the lowest. The most justifiable replacement percentage (26%) was achieved when the dentist assessed treatment need together with the patient. This study documents the multiple subjective and objective difficulties related to the wearing of complete dentures. The study also highlights the well-recognized importance of regular annual reexaminations for those wearing complete dentures and the assessment of need for adjustment of the dentures. It also demonstrates that successful treatment decisions cannot be made solely on the basis of clinical examination or a dentist's subjective opinion, but should be formulated in close consultation with the patient.

Radiographic findings, ridge resorption, and subjective complaints of complete denture patients

To evaluate the relationship between the complaints of complete denture wearers and alveolar bone resorption as well as the location of mental foramina, 96 patients were interviewed. All subjects had received new dentures at the University of Iowa between August 1985 and July 1990. Panoramic radiographs had been made for all the subjects before dentures were fabricated. The amount of estimated ridge resorption correlated significantly with the number of years females had been edentulous, but no correlation was found in males. The location of the mental foramen in relationship to the crest of residual ridge correlated negatively with the number of years both genders were edentulous. Subjective need for dental treatment, as expressed by "sore gums" or poor or fair chewing ability, were the most frequent complaints among the subjects. These complaints were more often recorded with the subjects who had lost more than 50% of their estimated original ridge height than with those with less than 50% resorption, but this difference was not significant.

[Typical symptoms of methyl acylate sensitivity in wearers of acylate dentures]

Between 1986. and 1995. 150 patients were patch tested who had developed allergic reactions to their prosthesis made from acrylate. Three patients are described, whose history and patch test results confirmed the hypersensitivity to methylmetacrylate. The typical symptoms of acrylate sensitivity are discussed. After the removal of acrylate prosthesis and replacement with polyamide base (Valplast) prosthesis, the symptoms disappeared. Because the number of allergic reactions increases, the authors emphasize the necessity of prescreening in suspected cases of acrylate allergy.

Influence of complete denture renewal on craniomandibular disorders: a 1-year follow-up study

Great individual variation in the signs and symptoms of craniomandibular disorders (CMD) and in the adaptability of the masticatory system is evident among complete denture wearers. The masticatory system of 64 edentulous patients (41 women, 23 men; mean age 59 years, range 41-80 years), who came to the Institute of Dentistry for renewal of their complete dentures, was examined before prosthetic treatment and after a 1-year follow-up period. The degree of CMD was assessed using the anamnestic and clinical dysfunction indices of Helkimo. The results show that few complete denture wearers had severe signs and symptoms of CMD. No statistically significant correlation was noted between CMD and either the duration of edentulousness or the number of sets of dentures.

Eradication of the long-term carriage of methicillin-resistant Staphylococcus aureus in patients wearing dentures: a follow-up of 10 patients

To cure the long-term carriage of methicillin-resistant Staphylococcus aureus (MRSA), eradication treatment was given to 10 patients wearing complete dentures. In addition to multiple body sites, MRSA was cultured from the dentures of six patients. The contaminated dentures were rebased and sterilized with heat in order to prevent recolonization. The patients did not use their dentures during the decolonization therapy. Subsequently, MRSA was eradicated from three of these patients but three others remained MRSA-positive despite at least two courses of combined systemic and topical eradication treatment. These particular patients had persistent stomatitis and their dentures were a poor fit, in poor condition and repeatedly grew MRSA. Eradication treatment was successful in the remaining four patients whose dentures were MRSA-negative. These results confirm that dentures may function as foreign bodies and sustain persistent nasopharyngeal. MRSA colonization. Therefore, we suggest that whenever eradication of MRSA is deemed necessary in cases of nasal, oral or pharyngeal carriage, heat treatment of the dentures should be included. Further comparative studies with larger patient populations are needed to evaluate the contribution of dentures to the long-term carriage of MRSA, as well as to assess the value of denture sterilization during the eradication course.

Oral candidosis in long-term hospital care: comparison of edentulous and dentate subjects

OBJECTIVE

To obtain information on the oral health status of the elderly living in a medicalized, geriatric institution.

DESIGN

A cross-sectional clinical investigation with complementary microbiological studies.

SUBJECTS AND METHODS

A cohort of 233 elderly in one long-term care ward; collection of demographic data; clinical examination to determine dental and prosthetic status and health of the oral mucosae; swabs for detection of mucosal and denture colonization by Candida; paraffin stimulated saliva for detection of colonization by mutans streptococci and lactobacilli.

MAIN OUTCOME MEASURES

Oral and denture hygiene; oral mucosal health; degree of colonization by Candida, mutans streptococci and lactobacilli.

RESULTS

Mean age of the 233 patients was 85.6 +/- 6.9 years; 61% were totally dependent, 62.7% were wearing one or two complete dentures; 19.7% had natural teeth and no denture and 17.6% neither teeth nor denture. Of those wearing dentures 72% had denture stomatitis. Of those with natural teeth 72% were affected by active caries. Yeast counts were significantly correlated with the intensity of the erythema of the palatal mucosa, plaque score of the natural teeth, denture plaque score, and salivary counts of mutans streptococci and lactobacilli.

CONCLUSIONS

High oral yeast counts and frequent prevalence of oral candidosis in elderly subjects living in institutions are associated with poor oral hygiene and neglect of denture care.

[Denture stomatitis: etiology and clinical considerations]

Wearing removable dental prosthesis causes an alteration in the oral microflora. For certain individuals, this new environment is responsible for the development of a particular condition: prosthetic stomatitis. This article reviews the pertinent literature regarding the main predisposing factors causing the disease. It targets the different risk groups and identifies the proposed mechanism for the proliferation of Candida albicans on the palatal side of the prosthesis. Various treatments depending on the severity of the disease are also mentioned.

Effects of improvements of poorly fitting dentures and new dentures on masseter activity during chewing

The effects of four sequential modifications to improve occlusion, vertical dimension, retention, and stability of poorly fitting dentures, and of placing new dentures, on the EMG activity were investigated in 21 denture wearers with a mean age of 67.7 years. Electromyographic recordings of right and left masseter muscles were made while the subjects performed masticatory and swallowing threshold tests and applied static guided forces were measured before and after each modification and at three intervals after the delivery of new dentures. A 2-week adaptation period was allowed for each denture modification. Three- and 12-week adaptation periods were allowed for the new dentures. No significant changes were found in guided static bite force or peak bite force during chewing following any modification or insertion of new dentures. Significant decreases (p < 0.05) from the original poorly fitting denture in preferred side and nonpreferred side muscle activity were found for the preferred side tests with both foods after both the correction of occlusion and 3 mm increase in vertical dimension. Concomitant decreases (p < 0.05) in the masseter closing burst and stroke durations were found and contributed to the reduction in masseter muscle effort. Further reductions (p < 0.01) in masseter closing bursts and stroke durations were observed with new dentures. The results revealed that new dentures or the stabilization of poorly fitting dentures through occlusal correction and restoration of occlusal vertical dimension permits patients to use less muscle effort while chewing and maintaining their initial masticatory performance.

Effects of improvements of poorly fitting dentures and new dentures on patient satisfaction

Clinicians reline or replace dentures to improve occlusion, stability, retention and facial support. They believe that well-fitting dentures will maintain supporting tissues in good health and satisfy patients by improving oral function and self-esteem. In this study, satisfaction of 21 patients with poorly fitting dentures was assessed before and after the dentures were modified to improve occlusion, vertical dimension of occlusion, and retention and stability or the dentures were replaced with new ones. More than 55% of the patients were moderately to fully satisfied with their poorly fitting dentures. Most patients perceived improvements in chewing comfort, chewing ability, eating enjoyment, food choices, security, and speech after each denture modification and with new dentures. The relative importance of the four sequential modifications could not be determined because they were made sequentially and their effects became cumulative. Chewing ability, eating enjoyment, particles under dentures, and food choices were highly correlated with chewing comfort and overall patient satisfaction. The results support the belief of many clinicians that patients benefit from relining of poorly fitting dentures or replacement with new dentures. Improvements in chewing function were perceived by most patients despite the lack of improvement in masticatory performance or masseter muscle activity with modified or new dentures. It is likely that denture wearers perceive chewing ability in terms of chewing comfort rather than ability to comminute food, an objective measure of chewing performance. The latter is not altered markedly by the clinical excellence of dentures.

Histological changes in edentulous oral mucosa under implant-supported overdentures

The microscopic characteristics of the mucosa covering the alveolar ridge that supports a complete denture have long been studied. In this paper, any histological changes in mucosa loaded by a denture before and after a denture has been anchored by implant onto the bone were followed. The results suggest that mechanical loads improve trophism of mucosa, and that fixing a denture to implants leads to a more uniform distribution of loads.

Complete edentulism and denture use for elders in New England

The purpose of this study was to collect information about the oral health of a representative group of elders in the New England states. This study provides the most current descriptive analysis of completely edentulous noninstitutionalized elders to date. In-home examinations and interviews were conducted for a representative sample of elders over 70 years of age. The oral examinations and interviews were conducted by calibrated dentists and trained interviewers, respectively. Of 1156 study participants, 424 (36.7%) were edentulous. Edentulous rates were similar for men and women and were negatively related to levels of education and income. Of the completely edentulous individuals, 89.9% had maxillary and mandibular complete dentures. Most of these dentures (83.2%) were worn during the day. More than one third of the respondents reported wearing one or both of their dentures while sleeping at night. For 77 of the completely edentulous individuals, examination revealed denture irritations, most of which were on the hard palate.

Oral mucosal changes and associated factors among male industrial workers with or without access to subsidized dental care

Oral mucosal changes and associated factors were studied among male industrial workers in southern Finland. Two groups, with or without access to an employer-provided dental benefit scheme, were compared. A multiple-choice questionnaire followed by clinical examinations was completed by 325 (81%) subsidized workers and 174 (69%) controls. In both groups 52% of the subjects had some oral mucosal change, and there were no significant differences between the groups in the location distribution of the changes. Smoking was significantly associated with redness of the oral mucosa (p < 0.001), coating (p < 0.001), and leukoplakia (p < 0.01), whereas denture wearing was associated with ulcers (p < 0.05), hyperplasia (p < 0.001), and redness (p < 0.001). Among denture wearers non-acceptable dentures were significantly associated with hyperplasia (p < 0.001). The subsidized group had better dentures, although this did not significantly benefit their oral mucosal status.

Cytological changes in oral mucosa in denture stomatitis

The cytological patterns associated with the atrophic and hyperplastic forms of denture stomatitis (DS) were studied in 94 patients with DS and 33 controls. Forty percent of patients with DS and 30% of patients in the control group had a positive culture for Candida. When compared to the smears from the control group patients, the smears from patients with DS presented a higher amount of: i) cytological cellular material; ii) fungal cells; iii) cells of the intermediate and parabasal types; iv) cells of the intermediate type with a positive culture for Candida; and v) polymorphonuclear leukocytes, preferentially in association with a positive culture for Candida. Conversely, smears from the control group showed a higher percentage of cells of the superficial type than those of the patients with DS. Although no specific changes in the DS-affected mucosa have been observed by cytology, we consider that this is a useful, easy and inexpensive technique that gives important information about the inflamed mucosa it can be used in the treatment and control of these patients.

Studies of changes in occlusion after the insertion of complete dentures. Part I

The present study aims to investigate changes in the occlusion of complete dentures after their insertion. A total of 85 edentulous patients were provided with new complete dentures. Their individual hinge axes were determined using mechanical axiography and the upper finished dentures were transferred by facebows to Dentatus articulators. The lower dentures were mounted according to an intraoral central bearing point (CBP) registration and equilibrated in terminal hinge position. An articulator specially modified for measurements in the condylar area was used. The differences between the positions of the condylar balls with CBP registration and those after equilibrating the occlusion were determined. On average, 19 days after insertion, 71 patients took part in a follow-up examination. As in the first session, the terminal hinge position was registered with the CBP method using the apex of the Gothic arch. Thus, the positions of the condylar balls immediately after the new registration could be compared with those in equilibrated intercuspation 3 weeks earlier. The differences were found to be 0.5 +/- 0.4 mm (0-2.9 mm) in the three axes (sagittal, coronal and horizontal). They are thought to result from settling into the denture bearing tissues and also from neuromuscular adjustment of the masticatory system. Compulsory remounting of complete dentures after insertion is therefore recommended.

Signs of temporomandibular dysfunction related to edentulousness and complete dentures: an anamnestic study

Symptoms of temporomandibular dysfunction (TMD) are prevalent among elderly individuals with complete dentures. In the agrarian areas of middle Finland it was, as recently as a few decades ago, almost a tradition to extract teeth during young adulthood. Women who today are in post-menopausal age are the last sizable age group in Finland where the problems of edentulousness can be investigated. The purposes of this study were twofold. First, postmenopausal women who are edentulous in the maxilla or totally edentulous were studied to determine if they differ from women with natural teeth in both jaws in terms of subjective TMD symptoms. Second, these subjective symptoms were examined to discover any correlation with duration of edentulousness, age of the dentures, or difficulties in wearing them. The results suggest that for postmenopausal women, clicking noises in the temporomandibular joint and tension in the neck are more common complaints among denture wearers than among those who still have natural teeth. Factors that make the wearing of complete dentures more difficult may also predispose the wearer to TMD symptoms. Duration of edentulousness is not, however, related to the prevalence of anamnestic TMD symptoms.

Denture stomatitis: quantification of interleukin-2 production by mononuclear blood cells cultured with Candida albicans

Denture stomatitis is usually associated with the presence of yeast, particularly Candida albicans, and several bacteria. In this study mononuclear blood cells were grown in the presence of Candida albicans from a single colony, and interleukin-2 production induced in T lymphocytes was measured. Blood cells were from a population of patients with denture stomatitis and a control group of denture wearers without stomatitis. Induction of interleukin-2 production was correlated with factors that condition denture stomatitis, namely, isolation of Candida albicans in selective medium, age of the denture, and diabetes. Concentrations of interleukin-2 in supernatant and serum were also compared. Significant differences in interleukin-2 production were found between patients with denture stomatitis and controls. Statistical analysis demonstrated a significant association between isolation of Candida albicans and elevated interleukin-2 production in cultures from patients with and without denture stomatitis.

Complete denture problem solving: a survey

An investigation was carried out into the problems experienced by 114 referred patients with complete dentures who were considered to be difficult or to have difficult prosthodontic problems. The commonest problems were those of pain and lack of retention, due mainly to occlusal discrepancies and excessive VDO. Treatment was carried out on an individual basis with a large proportion of dentures being remade. However, a small number was satisfied by counselling alone without procedural treatment. A diagnostic denture technique was used for particularly difficult cases. This technique showed that, in two cases, technical prosthodontic inadequacies could definitively be excluded as the problem. The overall success rate for treatment was 80 per cent. Further studies on a larger patient sample are needed so that specific problems can be linked to cause and outcome in a meaningful manner.

Oral health and treatment needs in a non-institutionalized elderly population: experience of a dental school associated geriatric clinic

The purpose of this study is to report oral and dental findings in a population of independent geriatric patients, who were treated at the Geriatric Dental Clinic, School of Dental Medicine, Tel Aviv University. The study group consisted of 221 patients, 31.2% males and 68.8% females. The mean age was 75.3 years. Of the patients, 75% were edentulous. The most frequent complaint was pain associated with wear of dentures, and the most frequent mucosal lesion was traumatic ulcer (51%). Most dentures were of poor quality (77%). The mean denture age was 9.7 years, increasing as the patient's age increased. Denture hygiene was good in 59%, fair in 11% and poor in 30%. The mean number of visits at the Geriatric Clinic was 5.5 per patient.

[Dentures and food selection. A survey in elderly women]

Having complete dentures can have a negative influence on dietary intake and dietary composition, which can lead to an unhealthy situation, particularly for the elderly. In order to get more information on this subject, 86 women between 54 and 74 years old, who were treated at an university clinic, completed questionnaires about their chewing of and preference for various foodstuffs. From the results of this study the dietary intake of dietary fibres, protein and iron appeared to be lower in women with complete dentures. After correction for the total intake of energy these differences disappeared. The former group also indicated that they had more difficulties chewing bread, tough and soft meat, raw vegetables, apples and snacks. No differences were found concerning preference.

Relationship between prosthodontic status, caries, and periodontal disease in a geriatric population

This study evaluated the influence of prosthodontic status on caries a and periodontal disease in a hospitalized population of elderly people. Among the data gathered was information on caries, gingival condition, oral hygiene, plaque accumulation, and factors related to the prevalence, type and quality of the prostheses present. There was no significant association between the type of rehabilitation and the economic, social, or educational variables, but it appeared that removable partial denture wearers had less concern for oral health. Root caries and periodontal diseases were more frequent when the restoration, either fixed or removable, was defective. Th results of this study indicate the importance of oral hygiene instruction and regular recalls among removable partial denture wearers.

Comparative studies on check-bite and central-bearing-point method for the remounting of complete dentures

Thirty-six complete dentures were remounted both with check-bite as well as central-bearing-point (CBP) registration. The mandibular or denture position was registered in the condylar area three times with each method. Two independent operators carried out the registrations. One half of patients had their occlusion equilibrated according to the check-bite registration, the other half in the central-bearing-point position. After individual determination of the hinge axis the upper dentures were mounted by a face-bow transfer into a Dentatus articulator. A total of six registrations was performed and repeatedly compared in the condylar area in three dimensions using a computer supported measuring device. The reproducibility of the check-bite registration was 0.37 +/- 0.33 mm, with a maximum of 1.77 mm. For the central-bearing-point method this was 0.29 +/- 0.26 mm with a maximum of 1.56 mm. The mean difference in condylar position between both methods was 0.66 +/- 0.55 mm with a maximum of 4.02 mm. A third independent operator re-examined 30 of the patients 2-3 weeks after the remounting and evaluated the adaptation to the new dentures. Those patients whose dentures were equilibrated with the central-bearing-point method tended to cope better with their dentures and suffered on average from fewer pressure spots.