Unveiling denture-induced oral lesions: A comprehensive study on classification and pain assessment

BACKGROUND

Denture-induced oral Lesions (DIOLs) often manifests shortly after the placement or adjustment of new or realigned dentures, frequently resulting in severe pain and discomfort.

OBJECTIVES

This study aimed to classify DIOLs placing a particular emphasis on assessing the associated pain.

METHODS

A prospective case study was conducted involving 126 patients who were fitted with a total of 193 dentures of various types at the Hadassah School of Dental Medicine. All patients underwent comprehensive intra-oral examinations within 1-8 weeks following denture delivery, completed symptom questionnaires and had their medical records reviewed. Key variables documented included age, gender, overall health status, denture type, and a detailed description of the DIOLs. The description encompassed factors such as lesion location, shape, colour, size, border characteristics, ulcerative appearance, membrane coverage, 3D morphology (elevated, immersed and flat) and patient-reported Verbal Pain Score (VPS) when touching the DIOLs, when wearing the denture, and when not wearing the denture.

RESULTS

Notably, 25.4% of denture wearers required no adjustments, while 14.4% necessitated more than three revisions. A majority (71.8%) of DIOLs cases were associated with mandibular complete dentures, primarily situated on the alveolar ridge. The mean VPS indicated a pain intensity of 7 ± 2.1, with temporary dentures in both jaws causing the most discomfort. Implant-supported overdentures were particularly painful when placed in the mandible. Additionally, VPS scores were higher among older individuals and those with prior prosthetic experiences. A significant correlation was observed between pain intensity and presence of chronic health condition (0.036).

CONCLUSIONS

This study revealed distinct characteristics of DIOLs and highlighted the multifactorial nature of pain experienced following the development of DIOLs. Insights into the influence of patient and denture characteristics on DIOLs and pain intensity can guide healthcare professionals in optimising patient comfort and satisfaction.

Removable dental prostheses and difficulties with chewing among frail individuals: Results from the Swiss SAPALDIA cohort

Oral healthcare among the frail is an underestimated geriatric care element. While neglected oral health (OH) is a well-established risk factor for frailty, frailty can be a risk factor for subsequent OH problems. The cross-sectional investigation nested into the SAPALDIA sub-cohort of citizens aged 52 years and older, aims to stimulate longitudinal research into aspects that accelerate poor OH among frail individuals. The hypothesis investigated was that (pre-) frail individuals are more likely to have missing teeth replaced with removable dental prostheses (RDP) resulting in difficulties with chewing. The study included 1489 participants undergoing geriatric assessments and oral examination. The main predictor was frailty status (non-frail; pre-frail; frail), based on Fried's frailty phenotype. The main outcomes of interest were non-functional dentition (presence of ≤ 19 natural teeth), presence of any RDP and self-reported difficulties with chewing. Pre-frailty and frailty were not associated with the presence of ≤ 19 natural teeth, but were associated with a higher RDP prevalence. The presence of at least one complete denture (CD) had 1.71 fold and 2.54 folds higher odds among pre-frail and frail, respectively, compared to non-frail individuals. Frail individuals with CD reported chewing difficulties 7.8 times more often than non-frail individuals without CD. The results are in line with the hypothesis that (pre-) frail individuals may be more likely to have tooth loss restored by RDPs. Future longitudinal research needs to assess potential barriers to oral hygiene and fixed dental prostheses among (pre-) frail and to study their oral health-related quality of life.

Relation between the risk factors for the severity of denture stomatitis and quality of life of complete edentulous individuals: a cross-sectional study

OBJECTIVE

To assess the association between risk factors for developing denture stomatitis (DS) and oral health-related quality of life (OHRQoL) in complete denture wearers.

METHODOLOGY

Participants of both sexes, wearing complete dentures, were classified using the modified Newton classification for the absence or the severity of DS and allocated to groups Normal or zero, IA, IB, II, and III. Lifestyle, oral and denture history, and medication use were assessed using specific questionnaires; clinical parameters such as anatomical characteristics of support were evaluated with the Kapur classification; salivary flow (SF) was calculated by the volume of unstimulated saliva per minute; and microbial load was determined by counting colony forming units (CFU) of target microorganisms present in the biofilm collected from dentures and palate. OHIP-EDENT assessed the OHRQoL. Kendall's tau_b and Spearman tests were applied with a significance level of 5%.

RESULTS

184 patients (143 female and 41 male) aged 65.5 ± 6.8 years were evaluated. Positive correlations were found for sex (women; p=0.013, r=0.16), individuals who started to consume alcoholic beverages as a young adult (18-27 years) (p=0.008, r=0.22), CFU of Candida spp. (p<0.001, r=0.27 denture; p<0.001, r=0.31 palate); Candida albicans (p=0.004, r=0.22 denture; p=0.003, r=0.25 palate), and Candida glabrata (p=0.004, r=0.22 denture; p=0.001, r=0.27 palate). Moreover, negative correlations with DS were found for CFU of Staphylococcus spp. (p=0.004, r=-0.20 palate) and enterobacteria (p=0.002, r=-0.24 palate), as well as a negative correlation between SF (p=0.009, r=-0.193) and DS. The CFU of Staphylococcus spp. and enterobacteria on the palate significantly correlated with OHRQoL.

CONCLUSION

Being female, consuming alcoholic beverages as a young adult, CFU of Candida spp., Candida albicans, Candida glabrata, and salivary flow may be the most significant risk factors for DS. The microbial load of Staphylococcus spp. and enterobacteria seems to influence the quality of life for complete denture wearers.

Evaluation of Prosthetic Complications with Metal-Acrylic Resin Implant-Fixed Complete Dentures: A Medium- and Long-Term Retrospective Analysis with Up to 13 Years of Follow-up

PURPOSE

To present prosthetic complications observed in the medium and long term in patients treated with metal-acrylic resin implant-supported fixed complete dentures (MAIFCDs).

MATERIALS AND METHODS

A total of 87 patients who were treated with MAIFCDs were included. Acrylic resin (denture teeth and base) fracture, screw loosening (prosthetic or abutment), screw (prosthetic or abutment), and framework fracture were analyzed for descriptive statistics. Product-limit survival estimates were used for the cumulative no-complication rate (CNCR) of prostheses. All results were assessed using α = .05.

RESULTS

The average observation time was 42.9 months (range: 19 to 153). Of 597 implants, 8 mandibular (44.4%) and 10 maxillary implants (55.6%) failed. In total, 29 patients (33.3%) experienced no complications in an average of 7 years, and 58 patients (66.6%) experienced at least one complication. The average time for the first complication to occur was 23 months (range: 1 to 97 months). The average number of complications was 5.9/patient. Acrylic resin complications were the most frequent, followed by screw loosening, screw fracture, and framework fracture. Of those patients with complications, 9 (16%) had maxillary MAIFCDs with an average of 4 complications. In total, 28 patients (48%) had only mandibular MAIFCDs with an average of 5 complications, and 21 patients (36%) had both arches treated with MAIFCDs with an average of 9 complications. Mandibular MAIFCDPs in women had a higher CNCR compared to maxillary MAIFCDs of both women and men and when both arches of women were treated with MAIFCDs (P < .05).

CONCLUSIONS

The CNCR of MAIFCDs differed depending on the arch treated and sex. Mandibular MAIFCDs in women had a lower complication rate than MAIFCDs in other arch-sex pairs. Acrylic resin related complications were commonly observed as well as prosthetic screw loosening.

Denture Wearing and Malnutrition Risk Among Community-Dwelling Older Adults

Most studies have associated denture wearing with a higher risk of malnutrition and lower nutritional intake in the elderly. As the effect of wearing dentures remains debatable, the aim of this study was to determine if older adults wearing dentures have a higher risk of malnutrition. We recruited 294 Japanese community-dwelling adults aged ≥65 years from two elderly welfare centers in Sapporo. The Mini Nutritional Assessment-Short Form (MNA-SF) was used to assess their nutritional status. Their demographic characteristics, eating habits, and health status were assessed using a questionnaire. Moreover, salt-impregnated taste paper and bioelectrical impedance analysis were used to obtain salt taste sensitivity and body composition (body mass index and protein mass). The mean age of older adults was 75.8 ± 5.8 years and 71.1% were women. We found that 74.1% of the older adults wore dentures. The proportion of the whole population with a risk of malnutrition was 23.5%. Multivariate analysis revealed that partial denture wearing could be protective against the risk of malnutrition. In this study, we found more partial denture wearers with normal nutritional conditions and cooking by themselves than non-denture-wearing older adults. Furthermore, complete denture wearers were eating significantly less meats or fish every day. This study suggests that using partial dentures to replace the lost teeth to meet the dietary needs of the elderly is critical to maintaining a healthy nutritional status. Moreover, it also indicates the importance of providing education to older adults who wear complete dentures.

Risk factors for mandibular bone resorption in complete denture wearers

This study aimed to evaluate the impact of factors related to the patient (age, sex, bruxism, and general health) or prosthesis (use of old dentures, duration of denture wear, and nocturnal wear) on the mandibular ridge resorption rate (RRR) of complete denture (CD) wearers. This retrospective cohort study was composed of edentulous patients who sought prosthodontic treatment for maxillary and mandibular CDs. The mandibular RRR was estimated based on panoramic radiographs (n = 120) obtained at the time of the clinical examination. The total height of the alveolar process was considered to be 3 times the distance from the inferior border of the mandible to the lower border of the mental foramen. Radiographic measurements were performed by 1 calibrated examiner. Data were collected from dental records related to the patient or prosthesis. Data were evaluated by 1-way analysis of variance or Student t test at a significance level of 5%. Of the factors evaluated, age (P ∼ 0.000), previous use of CDs (P ∼ 0.000), and bruxism history (P = 0.003) were statistically significant for the mandibular RRR. The RRR was greater among patients older than 60 years, those who had been wearing old CDs, and those who reported bruxism. Thus, the study results showed the negative influence of advanced age, use of old dentures, and bruxism on mandibular RRR.

Evaluation of the treatment of halitosis with photodynamic therapy in older patients with complete denture: Protocol for a randomized, controlled trial

BACKGROUND

Halitosis is the term used to define an unpleasant odor emanating from the mouth. However, no studies have evaluated the causes and treatment of halitosis in the population of older adults with denture.

METHODS

A randomized, controlled trial is proposed. The patients will be divided into 2 groups: G1: older adults who wear complete dentures and will be treated with tongue scraper (n = 20); G2 older adults who wear complete dentures and will be treated with PDT (n = 20). If the halitosis persists, the participants will be submitted to hygiene procedures for the mucosa and dentures. The evaluation of halitosis will be made before and after treatments, with OralChroma. If the halitosis is solved, the participants will return after 1 week for an additional evaluation. Oral Health Impact Profile (OHIP-14) will be administered by a calibrated examiner on the day the patient history is taken (baseline) and 1 week after treatment for halitosis.

DISCUSSION

This protocol will determine the effectiveness of photodynamic therapy regarding the reduction of halitosis in older adults with complete denture.

TRIAL REGISTRATION

This protocol was registered in ClinicalTrial.gov, under number NCT03960983. It was first posted and last updated in May 23, 2019. https://clinicaltrials.gov/ct2/show/NCT03960983.

The patient general satisfaction of mandibular single-implant overdentures and conventional complete dentures: Study protocol for a randomized crossover trial

BACKGROUND

Mandibular overdentures retained by a single implant placed in the midline of edentulous mandible have been reported to be more comfortable and function better than complete dentures. Although single-implant overdentures are still more costly than conventional complete dentures, there are a few studies which investigated whether mandibular single-implant overdentures are superior to complete dentures when patient general satisfaction is compared. The aim of this study is to assess patient general satisfaction with mandibular single-implant overdentures and complete dentures.

METHODS

This study is a randomized crossover trial to compare mandibular single-implant overdentures and complete dentures in edentulous individuals. Participant recruitment is ongoing at the time of this submission. Twenty-two participants will be recruited. New mandibular complete dentures will be fabricated. A single implant will be placed in the midline of the edentulous mandible. The mucosal surface of the complete denture around the implant will be relieved for 3 months. The participants will then be randomly allocated into 2 groups according to the order of the interventions; group 1 will receive single-implant overdentures first and will wear them for 2 months, followed by complete dentures for 2 months. Group 2 will receive the same treatments in a reverse order. After experiencing the 2 interventions, the participants will choose one of the mandibular prostheses, and yearly follow-up visits are planned for 5 years. The primary outcome of this trial is patient ratings of general satisfaction on 100 mm visual analog scales. Assessments of the prostheses and oral health-related quality of life will also be recorded as patient-reported outcomes. The secondary outcomes are cost and time for treatment. Masticatory efficiency and cognitive capacity will also be recorded. Furthermore, qualitative research will be performed to investigate the factors associated with success of these mandibular denture types. Clinical outcomes, such as implant survival rate, marginal bone loss, and prosthodontic complications, will also be recorded.

DISCUSSION

The results of this randomized crossover trial will clarify whether mandibular single implants and overdentures for edentulous individuals provide better patient general satisfaction when compared to conventional complete dentures.

TRIAL REGISTRATION

This clinical trial was registered at the University Hospital Medical Information Network (UMIN) Center (UMIN000017883).

A case with tumor of left parotid gland and denture stomatitis

The article discuss the case of an edentulous patient presented to the dental clinic for pain and burning sensation of oral mucosa and diagnosed subsequently with oxyphilic adenoma. A 58-year-old patient, with maxillary edentulism, treated with complete denture, presented to the Clinic of Prosthetic Dentistry of the Faculty of Dental Medicine, University of Medicine and Pharmacy of Craiova, Romania, for pain of oral mucosa and bad stability of denture. The diagnosis of erythematous denture stomatitis as consequence of salivary flow reduction was establish after patient's clinical examination, and by unstimulated sialometry. Clinical exam suggested hyposalivation could be a consequence of a tumor situated at the level of the left parotid gland. The echography confirmed the diagnosis of left parotid gland tumor. The tumor was surgical removed and histopathological exam confirmed oxyphilic adenoma. Education of patient for wearing new denture while maintaining a strict oral hygiene and dealing with low salivary flow was the treatment for denture stomatitis. General dentist has an important role in finding and diagnosing patients with systemic diseases, especially salivary tumors.

The effect of nocturnal wear of complete dentures on sleep and oral health related quality of life: study protocol for a randomized controlled trial

BACKGROUND

Edentulism and sleep disturbance are chronic conditions that are common in older people and have serious adverse consequences for their functioning and quality of life. Edentulism can disturb sleep through the alteration of the craniofacial structure and surrounding soft tissue. However, the effect of prosthetic rehabilitation of edentulism on sleep quality is still not well understood. The objectives of this study are to test whether nocturnal denture wear affects sleep quality, daytime sleepiness, and the oral health related quality of life of edentate older people with moderate to severe sleep apnea, and to identify modifiers of effect of nocturnal denture wear.

METHODS/DESIGN

We will carry out a single-blind randomized cross-over trial. Seventy edentate older people with moderate to severe obstructive sleep apnea will be enrolled. The study participants will be assigned to wear and not wear their dentures on alternate periods of 30 days. The outcome measures will be sleep quality (assessed by portable polysomnography), daytime sleepiness (assessed by the Epworth Sleepiness Scale), and oral health related quality of life (assessed by validated questionnaire). A number of characteristics (sociodemographic, oropharyngeal morphology, oral and prosthesis characteristics, and perceived general health quality of life) will be assessed by means of clinical examination, 3D imaging of the craniofacial structure, and validated questionnaires at baseline. Linear mixed effects regression models for repeated measures will be fitted to test the study hypotheses. The main analyses will be based on the intention-to-treat principle. To assess the robustness of the findings to potential incomplete adherence, sensitivity analyses will be conducted while applying the per-protocol principle.

DISCUSSION

This practice-relevant evidence could represent a preventive approach to improve sleep characteristics of the older population and improve their well-being and quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01868295.

Complete dentures revisited

The aim of the article is to assist practitioners in the diagnosis and management of complete denture problems by addressing the problems from a theoretical viewpoint and in a clinically diagnostic way.

CLINICAL RELEVANCE

To assist practitioners and undergraduates to understand the clinical basis of complete denture prosthodontics.

Not chewing food among the Thai elderly with complete denture

OBJECTIVE

The study aims to investigate the use of a complete denture in terms of not chewing food and determining the strength of association between not chewing food and several potential risk factors among the Thai elderly.

MATERIAL AND METHOD

Under the support of the "Khao Aroi" or "Delicious Rice" or "Dental Implant" Project of Institute of Dentistry, Department of Medical Services, Ministry of Public Health, and in co-operation with the Ministry of Science and Technology during 2007-2011, a cross-sectional survey by multi-stage cluster sampling was conducted in 2008, in 21 provinces, 87 hospitals, with 2,676 Thai elderly. The sample was drawn from a sampling frame of 58,043 target Thai people aged 60 years and over under the Dental Prosthesis Service Campaign (DPSC) project during 2005 and 2007. All Thai elderly, who received a complete denture from the DPSC project at least three months prior were surveyed from May to October 2008 through questionnaires. Data were analyzed by a set of descriptive analyses and binary logistic regression models.

RESULTS

Not chewing food among the Thai elderly, after receiving a complete denture, was 12.5%, quite a bit more effective than ordinary work. Nontaluck found 38% for the proportion not wearing dentures in the 30-baht health care program. This finding is confirmed by the work of Dalodom et al that the use of dentures by Thai elderly was 93% in the DPSC project. The important risk factors that influenced not to chew food were satisfaction with dentures, patients satisfaction with the denture fitting and care, while controlling the amount of dentures, respectively.

CONCLUSION

Satisfaction of patients with their dentures, good oral health care in fitting denture work, and good communication between dentists and patients are important keys affecting the use of dentures.

A survey of complete denture patients experiencing difficulties with their prostheses

OBJECTIVE

The objective of this study was to investigate the problems faced by patients having complete dentures and the cleanliness of dentures by the patients.

MATERIALS AND METHODS

This cross-sectional study is done with a sample of 178 patients having complete prosthesis since 1 year. A self-administered structured questionnaire pretested through a pilot survey was used in the study. The data were analyzed using the SPSS version 16.0. The Student's t-test, ANOVA and post hoc test were used as test of significance.

RESULTS

Mastication discomfort and looseness of denture were the most common complaints followed by lack of retention (35.4%), bad breath (29.8%), tongue restriction (26.4%) and food accumulation (24.7%). There was a significant relationship of complaints with age groups (p=0.00).

CLINICAL SIGNIFICANCE

This study concluded that most of the patients were present with complaints due to dentures. So, dental professionals should pay serious attention to their patients for subjective acceptable result of the dentures and also advice them to properly maintain hygiene of dentures.

Risk Assessment-Based Individualized Treatment (RABIT): a comprehensive approach to dental patient recall

Patient recall should be a tool to support prevention, allow early intervention, and ensure long-term dental health. Although the concept of patient-customized recall intervals has increased in popularity, recommendations vary significantly. Concepts of risk assessment-derived recalls are described in the literature separately for caries, periodontal disease, and edentulism, but no published guidelines exist for creating patient-centered recall systems that integrate all risks. Further, no recommendations exist regarding oral cancer risk assessment and recall intervals. The evidence shows that recall intervals of less than twelve months do not impact stage and tumor size at diagnosis although increasing this interval may significantly affect the outcome. The typical approach to recall scheduling is that the interval before the next oral health review should be chosen when no further treatment is indicated or on completion of a specific treatment journey. This article advocates a modified approach that supports individualized risk-based recall schedules not only after active therapy is completed but also during the course of treatment. The design of individualized recall schedules would address a patient's risk for caries and periodontal disease and the need to perform periodic oral cancer screenings. Evidence is also presented regarding the timing of recalls for edentulous patients. This article describes design principles for a Risk Assessment-Based Individualized Treatment (RABIT) system, presents an example of an electronic health record (EHR) recall module implemented at one dental school, and identifies barriers to implementation. As EHRs become more prevalent in dental practice, it is expected that the software industry and the profession will collaborate to include RABIT-like concepts in software management packages.

Prevalence of temporomandibular disorders' signs and symptoms and chewing ability in patients with prosthodontic prostheses

This study aimed to determine the prevalence of temporomandibular disorders among patients wearing dental prostheses including complete and fixed partial dentures and to evaluate the chewing ability of those patients. Questionnaire and clinical examinations were used to assess those objectives. Fifty six percent of all examined subjects exhibited at least one sign or symptom of temporomandibular disorders while 8.0% bad moderate symptoms and 10% had severe symptoms. Patients with fixed partial dentures had a significantly higher prevalence of temporomandibular disorders signs than both complete dentures and dentate. The fixed partial denture group and dentate group exhibited significantly higher chewing ability than did the complete denture group. Therefore, the type of prosthesis correlated significantly with chewing ability.

Oral complaints of denture-wearing elderly people living in two nursing homes in Istanbul, Turkey

AIM

The aim of this study was to observe and determine oral complaints of people aged 55 years or older, living in two nursing homes in Istanbul, Turkey, and their satisfaction with their complete or partial dentures by means of a simple questionnaire.

METHODS

Two old people's homes (one public and one private) in the district of Uskudar in Istanbul agreed to take part in this study. All residents who were available were invited to answer a piloted nine-point questionnaire with questions on age, gender, physical problems, eating, and communication, aesthetic denture wearing and psychological problems. The questions were asked in person by one investigator. The resulting data were entered into SPSS version 15.

RESULTS

Out of a total of 210 residents, 130 (61.9%) took part in the study, of whom 53% (n=71) of residents were living in the private nursing home and 60% (n=81) were female. One hundred and five (80%) were denture wearers. More than half of the residents (59%, n=79) were over 75 years old. Problems were mostly seen in older ages, especially those over 75 years old, over 60% of whom reported problems for all the variables listed in the questionnaire. Women were more aware of halitosis than men.

CONCLUSIONS

The results of this study confirm those of previous studies and suggest that elderly people with dentures, and particularly complete dentures, frequently complain of a wide range of problems including: eating, social interaction and communication and these problems have a detrimental influence on their quality of life.

Microwave denture disinfection versus nystatin in treating patients with well-controlled type 2 diabetes and denture stomatitis: a randomized clinical trial

PURPOSE

The aim of this randomized clinical trial was to compare the effectiveness of microwave denture disinfection and nystatin in the treatment of well-controlled type 2 diabetic patients with denture stomatitis in terms of microbiologic and clinical outcomes.

MATERIALS AND METHOD

Diabetic patients wearing maxillary complete dentures with denture stomatitis (n = 40) were divided into two groups: NYS (patients treated with topical nystatin 4 times/day for 14 days) and MW (patients who had their dentures microwaved [650 W for 3 minutes] 3 times/week for 14 days). Mycologic samples were taken from the palates and dentures of the patients for quantification and identification of Candida, and standardized photographs of the palates were taken for clinical analysis. Evaluations were repeated at baseline, the end of treatment (day 14), and throughout follow-up (days 30, 60, and 90). Microbiologic data were evaluated by analysis of variance using a random effects statistical model, Tukey post hoc test, and chi-square test (α = .05). Clinical results were analyzed using Mann-Whitney and Fisher exact tests (α = .05).

RESULTS

Both treatments were considered successful in reducing the clinical signs of denture stomatitis and significantly reduced the values of colony-forming units/mL from the palates and dentures at days 14 and 30. In addition, 40% of treated patients were cured by the end of treatment. No significant differences in the microbiologic and clinical outcomes were revealed between the two groups (P > .05). C albicans was the most predominant species isolated (P < .01), followed by C tropicalis and C glabrata.

CONCLUSION

Denture microwave disinfection was as effective as nystatin for the treatment of diabetic patients with denture stomatitis.

[Oral kinesiology and the quality of life]

In a comparative study, the influence of oral health on the quality of life was investigated for people with temporomandibular pain, people with tooth wear and people with complete dentures. To this end, the study made use of the Oral Health Impact Profile. Both the total score and the scores on 4 of the 7 domains of the Oral Health Impact Profile were significantly higher in the research group with temporomandibular pain than in the research groups with tooth wear and complete dentures. These results suggest that among people with temporomandibular pain the influence of oral health on the quality of life is more negative than among people with tooth wear and among people with complete dentures. This result can probably be linked with the general finding that patients with temporomandibular pain bear a relatively high psycho-social burden.

Some dogmas related to prosthodontics, temporomandibular disorders and occlusion

It is the aim of this paper to give a few examples of dogmas related to prosthodontics and oral implants and to discuss the controversial role of occlusion in the aetiology of temporomandibular disorders. New knowledge is developing at a rapidly increasing rate in dentistry, as in other areas of society. Our lecturers at university taught us many useful things. But, as time goes by, what is still relevant? Some methods are so well established that they deserve to be called dogmas. It is implied that a dogma is not supported by strong evidence, even though it has existed and been practised for a long time. In the era of evidence-based dentistry it is appropriate to scrutinize such issues. A review of the current literature indicates that conflicting opinions exist concerning a number of common procedures in clinical dentistry, mainly due to a scarcity of good studies with unambiguous results. There is therefore a need for more high-quality clinical research in attempting to reach the goal of evidence-based clinical practice. The dental community should take an active part in this process.

Oral allergies to dental materials

Oral allergies represent a pathological entity not well known nor diagnosed by dental health professionals. The purpose of this work is to present an information relative to the multidisciplinary steps to be done to solve allergy problems. Three clinical examples of contact oral allergies (to mercury, or gold, or methacrylates) are presented, as to illustrate signs and symptoms of an oral allergy to the more frequent dental materials implied.We discuss the problem of oral allergies from what is known from the scientific literature. We stress the importance of a multidisciplinary approach to take into account patients with an oral allergy, with participation of specialists from dental and dermatologic fields.

Demographics of implant placement and complications of a patient subgroup in a dental hospital population

STATEMENT OF PROBLEM

Little has been reported about the demographics of implant placement in the Irish population and the complications that occur. This is important in terms of service planning and providing patient information.

PURPOSE

The purpose of this study was to construct a database of patients who had implants placed in the Dublin Dental School et Hospital from 2000 to 2006. Also, we wanted to compare the complications that occurred in patients who had overdentures to those with a fixed prosthesis.

METHODS

Hospital records were searched for all patients who had implants placed over a seven-year period and we recorded demographic information, as well as details of the implant site, implant type and restoration. Patients who had four or more implants placed for an implant-supported overdenture or fixed prosthesis were invited to attend for a clinical examination.

RESULTS

A total of 1,111 implants were placed in 452 patients over the study period--half of the implants supported single crowns, while the other half supported mainly overdentures and full arch fixed prostheses, with few fixed partial dentures. The 40- to 60-year-olds had the greatest number of implants placed of any age group and most implants were placed in the anterior region. Patients with implant-supported overdentures recorded more complications (52%) compared to those with fixed prostheses (32%). The most common complications associated with both treatments were gingival inflammation and peri-implant mucositis. Overdentures additionally had a significant number of retentive clip fractures.

CONCLUSIONS

Implant-supported overdentures and fixed prostheses were both clinically successful. However, patients and clinicians should be aware that soft tissue and mechanical complications are common.

Comparative evaluation of ketoconazole tablet and topical ketoconazole 2% in orabase in treatment of Candida-infected denture stomatitis

AIM

Denture stomatitis is a common and recurring problem of denture wearers. Ketoconazole tablet is one of the antimycotic drugs that often has been used to treat this condition, but systemic use of this drug has some adverse effects that frequently lead to unfavorable compliance and treatment failure. This study was designed to compare the efficacy of topical ketoconazole 2% in orabase and ketoconazole tablet.

METHODS AND MATERIALS

Thirty patients with denture stomatitis (positive culture) were divided into two groups. The first group received ketoconazole tablet (orally used 200 mg per day) for 14 days and the second group received 2% topical ketoconazole in orabase applied twice daily on the mucosal denture surface. Candida cultures were taken from the palatal mucosa before and on days 7 and 14 after commencement of the therapy. The mean of colonies before and 7 and 14 days after medication were calculated. One-way ANOVA and paired t-test were used for data analysis (alpha=0.05).

RESULTS

The mean of colonies number before receiving medication in the tablet and topical application groups were 454 and 441 respectively. The mean of colonies number after receiving medication in tablet and topical application group were 137 and 176 (on the seventh day) and 122 and 96 (on the 14th day), respectively; there was no significant difference between the two groups after medication (p=0.18).

CONCLUSION

Topical ketoconazole 2% in orabase can be useful in managing denture stomatitis. This topical medication has fewer side effects, whereas systemic administration of ketoconazole tablet is associated with some complications.

CLINICAL SIGNIFICANCE

The application of topical ketoconazole 2% in orabase ointment can be considered in the treatment of denture stomatitis and has comparable efficacy with the ketoconazole tablet.

Joint sounds in complete denture wearers. Literature review

Long-term denture wearers can present with prosthesis instability, reduced occlusal vertical dimension and incorrect positioning of the jaw. This can lead to muscular changes and joint vibration. This study presents the main considerations related to joint vibrations in partially or totally edentulous patients. Occlusal treatment improves the disc-condyle relationship in the mandibular fossa. Furthermore, a detailed clinical exam and anamnesis must be performed to identify the dysfunction and its etiology, so that appropriate treatment can be provided.

[Does the combination syndrome exist? A case report]

This case report documents the prosthetic rehabilitation of a patient showing the typical features of combination syndrome. This case documentation gives a general overview of the suspected development and the prevalence of this "syndrome". A treatment option should be shown by the example of a patient from the starting situation until the prosthetic therapy by means of a complete maxillary denture and an implant-supported mandibular overdenture rigidly retained with a milled bar.

[Etiopathogenesis of complication caused by removable full dentures]

The goal of the research was to study the complications caused by removable dentures. For these reason 890 patients were investigated. It was found that the pathologic changes in oral cavity are the results of: poor quality of denture, unfavorable condition before and after prosthesis. The factors responsible in the development of complications after orthopedic treatment were identified: living conditions, quality and toxicity of dentures materials. The received results give an ability to determine the common disturbance in the maxillo-facial system and use adequate methods and remedies to avoid complications caused by removable orthopedic construction.

The prevalence of temporomandibular disorders among two different denture-wearing populations

AIM

The aim of this clinicostatistical study was to profile the complete denture wearers of two different populations, to determine any possible relationship between the prevalence of temporomandibular disorders (TMDs) and factors involved in complete denture wearing and to compare this prevalence between the groups.

MATERIALS AND METHODS

Denture wearers who attended the clinics of the Dental School and Hospital, University of Bristol, U.K. (group A) and the Dental School, University of Athens, Greece (group B), were examined. An approximately equal number of patients; 115 for group A and 136 for group B, were selected. The examination included: (a) a history record with reference to sex, age, years of complete denture experience, sets of dentures used, age of the current dentures, time period of every day denture wearing, any difficulties on opening the mouth, and/or pain at the temporomandibular joint (TMJ) region and (b) a craniomandibular clinical examination in relation to midline deviation, pain and sounds from the joints, pain in the related muscles and inspection of the vertical dimension of occlusion. Data collected were analyzed using the chi-square test.

RESULTS

Denture wearers of group A were older, presented with greater experience in complete denture wearing, used more sets of dentures, most wore dentures exhibiting decreased vertical dimension of occlusion and wore their dentures only in the day time. The TMDs prevalence was not statistically significantly different between A and B groups (34.8% and 41.2% respectively). In group B the TMDs prevalence was greater in females. There was a decreasing TMDs prevalence with increasing age. Neither of the groups showed significant TMDs prevalence in relation to the denture experience, the number of dentures used, the age of the present denture nor the vertical dimension of occlusion. Group B showed a decreasing TMDs prevalence in relation to continuous denture wearing.

CONCLUSIONS

This clinicostatistical study showed that two different population groups of complete denture wearers who presented with different profiles have similar prevalence of TMDs.

Correct complete denture rehabilitation, a chance for recovering abused tissues

The prosthodontic treatment must provide for the edentulous patients bio-functional prosthetic restorations, bio-prophylactic for the surrounding tissues. In this aim, an edentulous patient must be submitted to a methodical clinical examination in order to establish the quality of hard and soft tissues, which will indicate the degree of difficulty of the prosthetic treatment. Additional investigation as a microbiologic examination and cephalometric radiographs can be useful in a modern investigation. In our daily practice, we are rarely confronted with a normal morphology of the denture bearing oral structures. The problem of managing abused tissues in a patient with morphologic abnormalities due to faulty prostheses is sometimes difficult to solve. Preventing the deterioration of oral status must be a condition in providing a chance for the success of the following rehabilitations, mainly in the situation when the complete edentulousness succeeds in a young or middle age patient.

[An edentulous case with articulation disorder and severe bone resorption]

PATIENT

A 71-year-old man complained of articulation disorder caused by poor retention of the upper and lower complete dentures. Both maxillary and mandibular residual ridges showed severe resorption. The dentures had short base borders and poor retentions, and were sway with mandibular functional movement. First, I planned to improve the retention and mandibular position of his dentures by repairing his dentures. When I confirmed to make a good retention and an appropriate mandibular position, I started to make new dentures, and then set them.

DISCUSSION

Evaluation before and after treatment showed recovery of articular function. The new denture, which has suitable tongue space, made the tongue movement area during speaking wider. This might result from the patient acclimatizing to a new condition.

CONCLUSION

New dentures showing stable retention and good articular function were not sway during functioning or articulation, and the patients articulation became clear.

Prevalence and risk factors associated with denture-related stomatitis in healthy subjects attending a dental teaching hospital in North Jordan

There is scant information regarding the prevalence of denture-related stomatitis (DRS) in Jordan.

AIMS

The aims of this study were to investigate the prevalence of DRS in a group of healthy Jordanian subjects wearing removable complete dentures, and to investigate for the factors that may be associated with this infection.

MATERIALS AND METHODS

A total of 300 complete denture patients attending a dental teaching centre in North Jordan for replacement dentures were examined thoroughly for the presence of DRS. Demographic data, including denture-wearing habits, duration of denture usage and smoking, were also obtained. Oral mucosal tissues were examined for signs of denture trauma. Dentures were assessed for plaque accumulation.

RESULTS

Of the 300 subjects examined, 175 were male and 125 were female. The overall prevalence of DRS in males and females was 52% (157/300). Increased plaque deposits (plaque indices 2 and 3) were significantly more prevalent in subjects with severe forms of DRS (p<0.01). Dentures that were more than 20 years old were located in the group of subjects with grade 2 and 3 infections. A total of 86% of patients with DRS complained of denture trauma compared to 10% of subjects with healthy mucosa, and 87% of the DRS group wore dentures continuously day and night. A total of 70% of subjects with grade 3 DRS were heavy smokers (more than 15 cigarettes/day).

CONCLUSION

Local factors studied contributed significantly to the development of DRS in healthy subjects and are important factors to be considered in the pathogenesis of this infection.

Assessment of oral status and oro-pharyngeal candidosis in elderly in short-term hospital care

OBJECTIVES

To evaluate prevalence of oral candidosis and predisposing conditions in hospitalized elderly patients.

DESIGN

We examined 104 elder patients recently hospitalized in two geriatric hospitals for shortterm hospital care.

METHODS

Information was collected on patients' sex, age, mental and physical disabilities, smoking habits, medical prescriptions, oral pathologies, denture wearing, oral hygiene habits and oral hygiene level. Quality of existing dentures was evaluated. Oral mucosae were examined for clinical signs suggesting oral candidosis. Semiquantitative cultures of Candida were carried out to confirm the clinical diagnosis.

RESULTS

The diagnosis of oral candidosis was confirmed in 18/54 patients showing clinical signs of oral candidosis. Confirmed oral candidosis was associated with the presence of other infections, proteo-caloric denutrition, ongoing antibiotic therapy, and denture wearing. Dentures in patients with confirmed oral candidosis at poorer technical quality of the acrylic surface in contact with the underlying mucosa.

CONCLUSION

The wearing of removable dentures is a major predisposing factor for oro-pharyngeal candidosis of elderly patients in short-term hospital care. Appropriate oral and denture hygiene measures as well as denture wearing habits should be introduced or maintained to prevent this infection.

Addressing problems in complete dentures

The authors have compiled a set of solutions to the most common issues influencing the success of complete denture cases. A brief review and discussion of occlusal vertical dimension is presented, followed by a troubleshooting guide to problems such as inadequate retention and stability, discomfort, and other problems affecting treatment outcome.

Clinical study on the correlation between psychogenic dental prosthesis incompatibility, oral stereognosis, and the psychologic diagnostic tools SCL-90-R and CES-D

PURPOSE

The objective of this study was to use an oral stereognosis test to evaluate possible intraoral/sensorimotor causes in patients with a psychologic diagnosis of psychogenic prosthesis incompatibility, and to evaluate possible correlations between oral stereognosis and the psychologic diagnostic tools Symptom Checklist-90-R (SCL-90-R) and Center of Epidemiological Studies Depression Scale (CES-D).

MATERIALS AND METHODS

The study cohort comprised 83 patients with complete dentures fabricated according to a standardized protocol. Twelve patients diagnosed with psychogenic prosthesis incompatibility (11 women, 1 man) using the SCL-90-R and CES-D scales in a previous study and a group of 24 randomly selected control subjects (14 women, 10 men) underwent an oral stereognosis test with 10 neutral-tasting plastic test specimens with a maximum edge length of 8 mm in 2 test cycles.

RESULTS

The results revealed no significant differences in oral stereognostic ability between patients with diagnosed psychogenic dental prosthesis incompatibility and the control patients. The patients in the test group expressed clear dissatisfaction with their dentures. No correlation was found between oral stereognostic ability and the SCL-90-R or CES-D values.

CONCLUSIONS

This study is the first to use oral stereognosis tests for patients with psychologically diagnosed psychogenic dental prosthesis incompatibility. The diagnosis of psychogenic prosthesis incompatibility by the SCL-90-R and CES-D scales is affirmed by the lack of correlations between the functional/anatomic aspects of oral stereognostic ability, psychologic diagnostic tools, and the clinical picture of psychogenic prosthesis incompatibility. Thus, psychogenic prosthesis incompatibility can be classified more explicitly as a psychosomatic disorder.

The role of candida in inflammatory papillary hyperplasia of the palate

The objective of this study was to investigate the expression by immunohistochemistry of the major basement membrane (BM) components (laminin, collagen type IV, fibronectin) in specimens from the palatal mucosa lesions of patients with complete dentures and diagnosis of inflammatory papillary hyperplasia of the palate (IPHP). Furthermore to evaluate the potential role of candidal infection in patients with IPHP. Biopsies of palatal mucosa were obtained from patients with IPHP, generally healthy/orally healthy patients with dentures, and healthy subjects. Immunohistochemical studies performed with specific antibodies to BM proteins. Scrapings and swaps of oral lesions from all patients and control groups were taken from the palate, and Candida species colonization was assessed with mycology tests. Immunohistochemical expression of BM components revealed thin linear staining in the BM of healthy palatal mucosa. In IPHP discontinuities or disruptions in BM were observed at the interface between epithelium and the underlying connective tissue in the areas of severe inflammatory response. Our findings suggest an interaction between the expression of BM components and Candida involvement in the development of IPHP, a disorder involving inflammatory reaction and modification of soft tissues.

Relationship between Candida and nocturnal denture wear: quantitative study

The purpose of this study was to evaluate the relationship between Candida and denture wear during the night. Twenty-four edentulous volunteers were randomly divided into two groups. Group I (GI, n = 11) was composed of volunteers who wore their complete dentures day and night and Group II (GII, n = 13) was composed of volunteers who wore their complete dentures only during the day. Three examination periods were performed for both groups. In GI, the first examination (A) was carried out after overnight denture wearing. Subsequent examinations were conducted after one (B) and seven nights (C) without denture use during sleep. In GII, the first (A) was done without previous use during sleep, and the following were carried out after one (B) and seven nights (C) of overnight denture wearing. Total unstimulated saliva was collected in a sterile container and cultured in duplicate inside Petri dishes. The values of colony forming units (CFU mL(-1) +/- s.d.) were obtained: GI A - 10.1 x 10(3) +/- 1.2 x 10(4), B - 2.0 x 10(3) +/- 2.6 x 10(3), and C - 2.6 x 10(3) +/- 5.9 x 10(3) and GII: A - 0.4 x 10(3) +/- 0.6 x 10(3), B - 9.4 x 10(3) +/- 17.7 x 10(3) and C - 6.3 x 10(3) +/- 15.3 x 10(3). The mean counts for Candida sp. were expressed as log (CFU + 1) mL(-1) and statistical significance of differences among groups was tested by anova (alpha = 0.05). Multiple comparisons were performed according to Bonferroni test and indicated significant differences between A-B and A-C, but not between B and C for both groups. It was concluded that there is a significant relationship between continuous denture wear and Candida sp.

Frequency and location of traumatic ulcerations following placement of complete dentures

PURPOSE

To determine the location of mucosal injuries that appear following placement of complete dentures, as well as the number of adjustments necessary to achieve patient comfort. The frequency of mucosal injuries in female and male patients and their connection with clinical anatomic features were also investigated.

MATERIALS AND METHODS

Sixty-one completely edentulous healthy patients who wore dentures (47 women and 14 men) took part in the study; 122 newly fabricated complete maxillary and mandibular dentures were investigated. All patients were seen for a 1-week adjustment appointment. Areas where signs of denture-induced mucosal injuries appeared were marked on an anatomic illustration. The follow-up period was in 1-week increments as deemed necessary by the patient. Associations between variables were analyzed with analysis of variance. Results were recorded as mean + SD. Statistical significance was set at P < or = .05.

RESULTS

Eighty-seven percent of the dentures required adjustment at week 1, 50% at week 2, and only 7% at week 3. No patients required a further visit. Most frequently injured maxillary areas were the vestibular sulcus (41%), maxillary tuberosity (21%), and hamular notch (12%). In the mandible, the most frequently injured areas were the retromylohyoid area (17%), lingual sulcus (14%), and vestibular sulcus (13%). Denture-induced irritations were detected in a higher ratio in the mandible (P < .001), especially in male denture wearers at the first adjustment (P < .05). Men had a higher ratio of lesions at the region of the maxillary vestibular sulcus between the labial and buccal frenum and at the mandibular vestibular sulcus of the buccal shelf region (P < .001).

CONCLUSIONS

Denture-induced irritations appeared most often in the vestibular sulcus of the maxilla and mandible, indicating that it is necessary to evaluate the area of the facial seal of the prosthesis by applying a medium- or a heavy-pressure indicator paste to the borders, and to make adjustments at the delivery stage and subsequent adjustment appointments. Denture placement must not be the final patient-clinician encounter when treating with complete dentures. Denture adjustments are very important clinical phases of denture fabrication and essential in patient care.

Postprandial whole-body protein metabolism after a meat meal is influenced by chewing efficiency in elderly subjects

BACKGROUND

The rate of protein digestion affects protein utilization in elderly subjects. Although meat is a widely consumed protein source, little is known of its digestion rate and how it can be affected by the chewing capacity of elderly subjects.

OBJECTIVES

We used a [1-(13)C]leucine balance with a single-meal protocol to assess the absorption rate of meat protein and to estimate the utilization of meat protein in elderly subjects with different chewing efficiency.

DESIGN

Twenty elderly volunteers aged 60-75 y were involved in the study. Ten of them had healthy natural dentition, and the other 10 were edentulous and wore complete dentures. Whole-body fluxes of leucine, before and after the meal (120 g beef meat), were measured with the use of a [1-(13)C]leucine intravenous infusion.

RESULTS

A rapid increase in plasma aminoacidemia and plasma leucine entry rate was observed after meat intake in dentate subjects. In complete denture wearers the increase in leucine entry rate was delayed (P<0.05), and the amount of leucine appearing in peripheral blood during the whole postprandial period was lower than in dentate subjects (P<0.01). Postprandial whole-body protein synthesis was lower in denture wearers than in dentate subjects (30% compared with 48% of leucine intake, respectively; P<0.05).

CONCLUSION

Meat proteins could be classified as fast digested proteins. However, this property depends on the chewing capacity of elderly subjects. This study showed that meat protein utilization for protein synthesis can be impaired by a decrease in the chewing efficiency of elderly subjects.

A comparison of oral health related quality of life between complete and partial removable denture-wearing older adults in Korea

The purpose of this study was to compare the oral health related quality of life (OHRQoL) between older Korean adults with complete and partial removable dentures using oral health impact profile (OHIP). A pool of 4250 Korean older adults was identified by random stratification by area from the sample cohort of Korean National Survey of Oral Health in the year of 2000. Out of the potential pool, 445 subjects with removable partial dentures (RPDs) or complete dentures (CDs) agreed to be interviewed by telephone. Each question in the survey was about how frequently each event was experienced during the past 12 months. To analyse the association between OHIP scores and removable denture status, bivariable analysis and multiple linear regression analysis were used. RPD users showed higher scores on eight items than CD users. They were 'breath stale', 'food catching', 'sensitive teeth', 'toothache', 'tense', 'unable to brush teeth', 'less tolerant to family members' and 'irritable with others'. RPD users might be associated with higher scores of functional limitation, physical pain and psychological discomfort than CD users. RPD users had slight tendency to be associated with higher OHIP-49 score than CD users, but it was not statistically significant. The findings of the present study confirm that there is no general OHRQoL difference between RPD and CD users. But in the items and subscales of OHIP, RPD users might experience more impaired OHRQoL than CD users.

Dental care of patients with autoimmune vesiculobullous diseases: case reports and literature review

Dental management of patients with autoimmune vesiculobullous disorders is complicated because of prominent involvement of oral mucosa, increased risk of oral disease, and difficulty in rendering dental care. Although these diseases are relatively uncommon, dental practitioners should be familiar with the oral sequelae of these conditions and their management. Pemphigus vulgaris, cicatricial pemphigoid, and epidermolysis bullosa represent the most common autoimmune oral vesiculobullous diseases. This case-illustrated review summarizes the pathogenesis, diagnostic features, and natural history of oral vesiculobullous disorders, placing an emphasis on the treatment and prevention of associated oral disease aimed at maintaining a healthy, functional dentition.

Correlation between adhesion, enzyme production, and susceptibility to fluconazole in Candida albicans obtained from denture wearers

OBJECTIVE

The aim of this study was to assess the contribution and the correlation between the virulence factors of Candida albicans in denture stomatitis.

STUDY DESIGN

Thirty C. albicans strains obtained from the oral cavity of patients with denture stomatitis and 30 C. albicans obtained from the oral cavity of denture wearers with normal palatal mucosa were compared for adhesion ability to buccal epithelial cells (BEC), reduction in adhesion after exposure to fluconazole, and enzyme production. The correlation between these virulence factors was assessed by Pearson's correlation coefficient.

RESULTS

C. albicans obtained from denture stomatitis patients were more adherent to BEC and higher enzyme producers than those obtained from healthy patients. Our results demonstrated that exposure to fluconazole reduces C. albicans adherence to BEC. This study could also provide evidence of correlation between virulence factors.

CONCLUSION

Our results suggest that adhesion and enzyme production could be factors that, along with predisposing conditions related to the host, determine if an individual will develop disease or remain as a healthy carrier and confirm that fluconazole has an impact on the adherence ability and enzyme production in C. albicans.

[Case of complete denture with improvement of facial aspect through the recovery of the mandibular position]

PATIENT

This is a clinical case report of esthetic and masticatory impairment due to a mandibular protrusion during occlusion. The patient was a complete edentulous subject who complained about esthetic and matiscatory disturbance. First of all, treatment dentures were done, in order to improve the mandible position and recover the facial aspect. Objective evaluations were carried out to compare the improvements achieved after the insertion of the new dentures.

DISCUSSION

The treatment dentures were used to improve patient's mandible position as well as vertical dimension. Once the facial appearance was recovered as a result of an appropriate mandible position, a reduction of the angle formed between the FH plane and the A-B plane from 87 to 83 was recognized after the insertion of the new dentures through the analysis of lateral cephalograms. It indicates that the mandible's position changed to backward position resulting in an improvement of the facial aspect.

CONCLUSION

In the present clinical case report, not only subjective evaluation for appropriate mandible position and vertical dimension, but also including objective evaluation methods allowed us to evaluate and compare objectively the patient's pre and post operative condition.

Prevalence of temporomandibular disorder signs in patients with complete versus partial dentures

OBJECTIVES

To determine the prevalence of signs of a temporomandibular disorder (TMD) in completely edentulous patients wearing upper and lower complete dentures (CD) and to compare this to the prevalence of signs in partially edentulous patients wearing upper and lower clasp-retained acrylic removable partial dentures (RPD).

MATERIALS AND METHODS

A questionnaire and a clinical examination were used to assess 200 patients. One hundred of these were complete denture wearers being treated for the provision of replacement CD. The other 100 patients were partially edentulous patients, who had RPD replacing upper and lower partially missing teeth and their supporting structures.

RESULTS

It was shown that there was a statistically significant difference between the two groups regarding the presence of temporomandibular signs. Partially edentulous patients wearing upper and lower RPD had a significantly higher prevalence of TMD signs than edentulous patients wearing CD (36% compared to 17%). They also exhibited significantly (P<0.04) more signs of joint tenderness (18%) on clinical examination compared to (5%) only in the CD-wearing patients. Tenderness upon palpation in the periauricular region was the most common site reported in both groups.

CONCLUSIONS

The partially edentulous patients (wearing RPD) exhibited more TMD signs when compared with the CD-wearing patients. Significantly, more partially edentulous patients had joint tenderness (P<0.04) than did CD-wearing patients. The masseter muscle most commonly demonstrated muscle tenderness.

Antimicrobial activity of monocaprin: a monoglyceride with potential use as a denture disinfectant

Monocaprin is a 1-monoglyceride of capric acid that has antimicrobial activity against enveloped viruses, certain bacteria, and the yeast Candida albicans. Solutions containing monocaprin were formulated and tested in vitro against a number of micro-organisms, including species found in the oral cavity and common pathogenic species. The antimicrobial activity of monocaprin was tested with strains growing on a surface as well as in the planktonic phase. Micro-organisms tested were: Streptococcus mutans, Candida albicans, Lactobacillus sp., Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. Two sets of dilutions were prepared for each test strain; one to be inoculated with the micro-organism growing in the planktonic phase and the other with the same strain growing on a filter paper disk. Control solutions were also prepared to find out if any of the excipients were affecting the microbicidal effect of monocaprin. Test strains growing on the filter paper surface were less sensitive to monocaprin than the same strain growing in its planktonic phase. C. albicans was the micro-organism that was most sensitive to monocaprin, but S. mutans also showed appreciable sensitivity. The indication that monocaprin may have potential as a topical agent against Candida was tested in an open study of denture disinfection in 32 patients attending a geriatric daycare centre. A significant, but short-term, reduction in counts of Candida on the fitting surface of full dentures was observed.

Construction faults associated with complete denture wearers' complaints

Edentulism is considered a poor health outcome and may compromise the quality of life. Although the number of adults losing their natural teeth is diminishing, there are still large numbers of edentulous adults in the population. A retrospective study was conducted with information derived from literature (from 1984 till 2004) about the patients who experienced ongoing difficulties with new complete dentures, to determine possible underlying causes. Relationships were observed when denture construction or design faults were compared with patient complaints and the advised solution of the problem. CONCLUSION. This study suggests that in most instances, complete denture patients present with complaints only when there is real design fault. Clinician must carefully evaluate the denture for faults in denture base extension and horizontal and vertical jaw relationships.

Cephalometric evaluation of maxillomandibular relationships in patients wearing complete dentures: a pilot study

The purpose of this study was to evaluate the changes in vertical and sagittal maxillomandibular relationship of the patients who had been wearing dentures for an extensive period. Fifteen edentulous patients (seven men and eight women; mean age 63.5 years) who had worn dentures for six to 16 years (mean 10 years) were selected for this study. New prostheses were fabricated by conventional methods, and the patients were evaluated cephalometrically before and after the new prosthesis. The results were compared by Wilcoxon signed rank test (P < .05). Results indicated that a prognathic mandible and a pseudo Class III relationship with a reduced occlusal vertical dimension became a normal Class I maxillomandibular relation when the new prosthesis was inserted. A better facial profile was achieved.

A 2-year study of Candida-associated denture stomatitis treatment in aged care subjects

OBJECTIVE

To test the efficacy of two methods of treatment for denture stomatitis in aged care institutions.

BACKGROUND DATA

Candida-associated denture stomatitis has been associated with a lack of denture hygiene.

MATERIALS AND METHODS

Sixty subjects with denture stomatitis were randomly divided into three groups: sodium hypochlorite denture soak, microwaving and control. Both methods of treatment were carried out on a nightly basis for 1 week, excepting the control group. Standardised photographs of the palate and microbial samples of palate, upper and lower dentures were taken before and after treatment.

RESULTS

Both hypochlorite and microwave irradiation significantly reduced the numbers of Candida and aerobic bacteria on both dentures and both methods significantly reduced Candida on the palate. However, palatal aerobic bacteria were not significantly reduced by either method and the controls showed insignificant changes at all three sites for both Candida and aerobes.

CONCLUSION

While both methods of denture disinfection were successful, except for the counts of palatal aerobic bacteria, three independent observers of the clinical photographs had difficulty in identifying the controls but were more successful with the treatments. The raters also showed that there was no difference between both methods of disinfection and this agreed with the microbiological analysis.

Fluconazole and/or hexetidine for management of oral candidiasis associated with denture-induced stomatitis

OBJECTIVE

The aim of the present study was to compare the influence of fluconazole capsules and/or hexetidine mouthrinses for the management of oral candidiasis associated with denture stomatitis. DESIGN RELEVANT: Sixty-one patients (ages 43-76 years, mean: 61) admitted to the Department of Oral Surgery and Medicine and diagnosed as suffering from oral candidiasis associated with denture stomatitis by microbiological examination were involved.

MATERIALS AND METHODS

Patients in group 1 (n = 21) were given only fluconazole capsules (Zolax 50 mg once a day), those in group 2 (n = 18) were given only hexetidine mouthrinses (Heksoral 0.1%, twice daily), whereas those in group 3 (n = 22) were given both fluconazole capsules and hexetidine mouthrinses for 14 days. The yeast colonies of the saliva samples were counted and calculated as the number of colony forming units per milliliter. The presence of yeasts in the lesion and denture samples were evaluated as present/absent according to their growth on cultures. Candida albicans was identified by means of germ tube analysis.

RESULTS

Patients in groups 1, 2 and 3 had a statistically significant decrease in the amount of C. albicans in saliva, lesions and dentures after treatment, when compared with pretreatment results (P < 0.05). Candida albicans counts in saliva, lesion and denture after treatment detected no statistically significant difference when the three groups were compared.

CONCLUSION

Of the three study groups, group 2, where hexetidine was the only medication prescribed, was found to be superior on account of fewer potential complications. We conclude that dentists should employ a more conservative intervention with oral mouthrinses rather than risk adverse effects and complications of systemic drugs for the management of oral candidiasis.

The impact of cigarette/tobacco smoking on oral candidosis: an overview

Smoking is associated with a variety of changes in the oral cavity. Cigarette smoke has effects on saliva, oral commensal bacteria and fungi, mainly Candida, which causes oral candidosis, the most common opportunistic fungal infection in man. How cigarette smoke affects oral Candida is still controversial. This brief overview is an attempt to address the clinical findings on the relationship between smoking and oral candidosis and possible mechanisms of pathogenicity.

Period between Completion of Radiation Therapy and Prosthetic Rehabilitation in Edentulous Patients: A Retrospective Study

PURPOSE

The primary purposes of this study were: (1) to describe the number and types of complications patients had before and after insertion of a removable prosthesis (i.e., denture) following radiation therapy to the head and neck and (2) to investigate whether the time between radiation therapy and denture insertion might contribute to those complications.

MATERIALS AND METHODS

This research evaluated edentulous patients and those who were rendered edentulous as a result of their cancer treatment. After obtaining institutional approval following HIPAA regulations, a total of 349 charts were identified: 152 patients from Houston Veterans Administration Medical Center (HVAMC) and 197 patients from M. D. Anderson Cancer Center (MDACC). A total of 190 patients met the inclusion criteria with data available for review.

RESULTS

No significant differences were found in any of the comparisons made, except when comparing complications that occurred after the dentures were inserted and the amount of time it took for prosthetic rehabilitation. The majority of patients had no complications. The patients who received their dentures in 180 days or less had the same number of complications when compared with those patients who received their dentures in 181 to 365 days and those who had to wait longer than a year for prosthetic rehabilitation. Patients with more pre-insertion complications tended to have delayed prosthetic rehabilitation. Those patients who had complications both before and after denture insertion tended to have bilateral dosing of their radiation treatment. Patients who had received radiation therapy were 1.7 times more likely to have post-prosthesis insertion complications. The majority of patients who experienced complications before and after denture insertion had greater than 5000 cGy.

CONCLUSIONS

The numbers of complications reviewed in this retrospective analysis were considerably fewer than the number expected. There appears to be no difference in the number of pre- and post-insertion complications as a function of the time delay from oral surgical procedure to start of radiation treatment (10 to 21 days vs. 22 days or more).

Impact of dry mouth on oral symptoms and function in removable denture wearers in Japan

OBJECTIVE

The purpose of this study was to determine the association of dry mouth with oral symptoms and function, such as denture instability, discomfort, soreness in denture-bearing tissue, and dissatisfaction with chewing, tasting, or speaking in removable denture wearers.

STUDY DESIGN

The subjects were 493 removable denture wearers with a mean age of 67.3 years. Perception of oral dryness was measured by a questionnaire. A multiple logistic regression analysis was used to determine the effect of the dry mouth on oral symptoms and function after controlling for age and gender.

RESULTS

Oral dryness during eating was related to dissatisfaction with chewing (odds ratio, 10.5; P < .001) and speaking (odds ratio, 3.5; P < .05) and overall dissatisfaction (odds ratio, 6.3; P < .01) in complete denture wearers. Feeling of dry mouth was likely to be associated with soreness in denture-bearing tissues in both complete and removable partial denture wearers.

CONCLUSIONS

There was a significant association of the perception of dry mouth among a group of denture wearers with oral symptoms and function.