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ORAL LESIONS IN ASSOCIATION WITH REMOVABLE DENTURE WEARERS

H. BILHAN, T. SULUN , O. KUTAY*

*Department of Removable Prosthodontics, Istanbul University , Turkey

Abstract 

The aim of this study was to investigate the prevalence and etiology of oral lesions related with several individual parameters of removable denture wearers such as the type of the denture, patient age, denture age, denture hygiene and continuous (24 hour) denture wearing. A total of 274 patients wearing removable dentures with an average age of 61.2 ± 10.3 (118 male, 156 female) were included in our study group. All patients are examined and interviewed for individual parameters and oral lesions are recorded when existed. 184 patients (67.2 %) were wearing complete and 27 patients were wearing partial dentures in both jaws. 48 patients were wearing a combination of complete(C) and partial(P) dentures (38 C/P and 10 P/C dentures). The average denture age was 9.8 ± 7.9 years. The relationship between DRS and denture age and patient age was analyzed by using Whitney-Mann-U test. The relationship between other denture related factors and DRS was investigated by the use of Chi-square test. Although a pronounced number of DRS cases (55 cases, 74.3 %) showed Candida albicans growth, there was no statistical significance recorded for the relation to candidal colonization. Several epidemiological facts related with denture stomatitis can not be manuplated such as gender, age of patients, the type and localization of dentures are factors. However, denture wearing habits can be easily changed which can help to reduce the prevalence of denture stomatitis. Patient motivation on hygiene and periodic controls seems to be a valuable measure to prevent DRS. The results showed that DRS was the most frequently encountered lesion among removable denture wearers and its prevalence was 55.8%. Association of DRS was found significantly higher with female gender, denture age, continous denture wearing, inconvenient denture hygiene and maxillary complete dentures.

Introduction

It has been suggested that the use of removable dentures is a predisposing factor for denture related stomatitis (DRS) (Budtz-Jorgensen, 1981). It is yet to be questioned, whether DRS is caused by denture wearing alone or it is associated with increasing age and the accompanying factors of aging such as worsened general health or increased medication. While some of the investigators explain the prevalence of DRS with the rising age of patients (Moskona & Kaplan, 1992) others found no relationship (Wolff et al., 1991; Kulak & Arikan, 1993; Nevalainen et al., 1997). Some studies have even recorded that DRS occurs less frequently with increasing age of the patient (Nyquist, 1952; Love et al., 1967). Results of research dealing with individual parameters of removable denture wearers, such as denture age (Hoad-Reddick, 1989; Moskona & Kaplan, 1992), denture hygiene (Budtz-Jorgensen & Bertram, 1970; Hoad-Reddick et al., 1990; Fenlon et al., 1998) and continuous use of dentures (Jeganathan et al., 1997; Fenlon et al., 1998) showed a positive correlation with DRS. Additionally, some investigators indicated that DRS are more prevalent in complete denture wearers than in partial denture wearers. (Love et al., 1967; Mikkonen et al., 1984; Nevalainen et al., 1997).

Material and Methods

363 edentulous and partially dentate patients attending the Department of Removable Prosthodontics of Istanbul University, for a new denture, have been examined and interviewed.

The patients age, gender, existence of a denture actually being used, denture age, frequency and method of denture cleaning and dental history were recorded. Clinical examination was performed always by the same investigator for standardization reasons. The type of dentures, presence and localization of denture induced lesions such as ulceration, stomatitis, angular cheilitis, inflammatory papillary hyperplasia, epulis fissuratum, flabby ridge, and the cleanliness of the dentures was noted.

In the case of DRS, the erythema was scored by using Newton 's classification index (1962):

1- Slight inflammation (Localized slight hyperaemia)

2- Moderate inflammation (generalized erythema)

3- Severe inflammation (Diffuse and papillary hyperplasia) For DRS cases, additionally a mycological test for Candida albicans was made.

Mycological testing:

Conclusions:

1) The most commonly encountered denture related oral lesion in denture wearing patients was denture related stomatitis (DRS).  

2) Denture related stomatitis is in significant association with both denture age and continous denture wearing.  

3) The results of our study showed a higher predisposition to denture related stomatitis in females. 

4) The results indicated a significant relationship between denture related stomatitis and denture cleanliness.  

5) A significant number of DRS cases were encountered especially among patients wearing maxillary complete dentures. This finding was usually reported in similar investigative studies (Mikkonen et al., 1984; Nevalainen et al., 1997). This fact can possibly be explained by the greater area which is covered by the denture base, and prevented from contacting saliva.  

6) Epidemiological facts about DRS, such as gender, age of patients, the type and localization of dentures are factors, which are not possible to manipulate, whereas denture-wearing habits can be easily changed and thus the prevalence of DRS dramatically reduced. Future studies should concentrate on patient information and motivation on hygiene, for prophylactic purposes.

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