Factors associated with the non-wear of mandibular dentures in the Brazilian public primary health care.

This study investigated factors that affect the use of complete conventional mandibular dentures (CCMD) by patients of the Brazilian Public Health Service. For this, two hundred and thirty one subjects who received CCMD in the Primary Health Care of the Public Health Service in Belo Horizonte - Brazil were evaluated and divided in Group 1 - irregular/non-wear; Group 2 - regular wear. Multivariate logistic regression analysis was used to create predictive models for CCMD non-wear and included socio-demographic and biological variables, technical quality of CCMD, and user satisfaction. The prevalence of CCMD non-wear was 41.10%. The mean score of CCMD quality was 54.97 (0-100). Not wearing the CCMD was significantly associated with user satisfaction and technical quality (p < 0.05). The lack of retention of the CCMD was the most important factor in the evaluation of satisfaction and quality. The final predictive model (specificity = 92.65%; AROC = 0.8759) for not wearing the CCMD retained the variables CCMD stability (OR = 0.888; 95%CI = 0.827-0.954), freeway space (OR = 0.916; 95%CI = 0.860-0.976), satisfaction with speech (OR = 0.694; 95%CI = 0.612-0.786), and irregular CCMD edges (OR = 3.185; 95%CI = 1.478-6.864). Socio-demographic and biological variables were not associated with patients not wearing the CCMD, whereas technical quality and user satisfaction were strongly associated.

Factors associated with the non-wear of mandibular dentures in the Brazilian public primary health care

Abstract This study investigated factors that affect the use of complete conventional mandibular dentures (CCMD) by patients of the Brazilian Public Health Service. For this, two hundred and thirty one subjects who received CCMD in the Primary Health Care of the Public Health Service in Belo Horizonte - Brazil were evaluated and divided in Group 1 - irregular/non-wear; Group 2 - regular wear. Multivariate logistic regression analysis was used to create predictive models for CCMD non-wear and included socio-demographic and biological variables, technical quality of CCMD, and user satisfaction. The prevalence of CCMD non-wear was 41.10%. The mean score of CCMD quality was 54.97 (0-100). Not wearing the CCMD was significantly associated with user satisfaction and technical quality (p < 0.05). The lack of retention of the CCMD was the most important factor in the evaluation of satisfaction and quality. The final predictive model (specificity = 92.65%; AROC = 0.8759) for not wearing the CCMD retained the variables CCMD stability (OR = 0.888; 95%CI = 0.827-0.954), freeway space (OR = 0.916; 95%CI = 0.860-0.976), satisfaction with speech (OR = 0.694; 95%CI = 0.612-0.786), and irregular CCMD edges (OR = 3.185; 95%CI = 1.478-6.864). Socio-demographic and biological variables were not associated with patients not wearing the CCMD, whereas technical quality and user satisfaction were strongly associated.

Incidence of peri-implant mucositis and peri-implantitis in edentulous patients with an implant-retained mandibular overdenture during a 10-year follow-up period.

OBJECTIVES: The aim of this sub-analysis of two prospective studies was to assess the incidence of peri-implant mucositis and peri-implantitis in fully edentulous patients with an implant-retained mandibular overdenture during a 10-year follow-up period. MATERIAL AND METHODS: One hundred and fifty edentulous patients with two endosseous implants to support a mandibular overdenture were available from two prospective studies. Clinical and radiographic parameters were assessed at 5 and 10 years of functional loading. Incidence of peri-implant mucositis and peri-implantitis were calculated at implant level and patient level following the Consensus of the Seventh European Workshop on Periodontology on peri-implant diseases. RESULTS: Incidence of peri-implant mucositis at patient level was 51.9% after 5 years of evaluation and 57.0% after 10 years. Incidence of peri-implantitis at patient level was 16.9% after 5 years of evaluation and 29.7% after 10 years. CONCLUSION: Peri-implant mucositis and peri-implantitis do occur in totally edentulous patients and incidence numbers are high.

Association between prosthetic factors and temporomandibular disorders in complete denture wearers.

OBJECTIVE: The purpose of this study was to investigate the prevalence of temporomandibular disorders (TMD) in denture wearers and the association between prosthetic factors and this condition. BACKGROUND: There is no consensus about the relationship between prosthetic factors and TMD among denture wearers. MATERIALS AND METHODS: The sample was composed of 92 patients wearing both maxillary and mandibular complete dentures. The Research Diagnostic Criteria for TMD (RDC/TMD) were adopted for patient examination. Objective evaluation of denture quality was determined by analysis of retention and stability of mandibular denture, interocclusal distance, articulation and occlusion. Association between denture quality and TMD diagnosis was analysed using chi-square and Fisher's exact tests. RESULTS: 37.4% of the patients presented TMD. Denture quality was not significantly associated with the presence of TMD: mandibular retention (p = 0.466); mandibular stability (p = 0.466); interocclusal distance (p = 0.328); centric relation (p = 0.175); and balanced occlusion (p = 0.56). CONCLUSION: Within the scope of this case-controlled cross-sectional study, no robust association between prosthetic factors and TMD was found.

Xerostomia in complete denture wearers: prevalence, clinical findings and impact on oral functions.

OBJECTIVES: To investigate the prevalence of dry mouth in a select sample of edentulous Jordanian older population wearing complete dentures and to evaluate its impact on oral functions. BACKGROUND: The prevalence and impact of Xerostomia as a cofactor in causing denture problems in Jordanians have not been previously investigated. MATERIALS AND METHODS: This study included 455 participants (253 men and 202 women). Perception of dry mouth was measured by a pilot-tested questionnaire. Xerostomic status was confirmed clinically. Complete denture function was also assessed. RESULTS: One hundred and thirty six subjects (29.9%) had reported a subjective feeling of dry mouth with a prevalence of 24.9% in men (n = 63) and 36.1% in women (n = 73) (p < 0.01). 136 of the 145 subjects with satisfactory dentures showed one or more signs suggestive of Xerostomia. The majority of xerostomic participants with different sets of complete dentures were dissatisfied with oral functions (p < 0.05). There was a significant association between dry mouth and increasing age, female gender and smoking status (p < 0.05). CONCLUSION: Among complete denture wearers, Xerostomia is significantly more prevalent in women and associated with increased age and smoking. Xerostomia adversely affects oral functions and overall satisfaction with dentures.

Factors associated with missing teeth in the Brazilian elderly institutionalised population.

OBJECTIVE: Identify factors associated with missing teeth in the elderly institutionalised population in Brazil. METHODOLOGY: Cross-sectional study of elderly institutionalised Brazilians with 1192 subjects. A questionnaire was applied as well as an epidemiological survey of oral health conditions in accordance with WHO. Factorial analysis was carried out with variables related to missing teeth, as well as the Fisher's exact test, chi-squared test and multiple logistic regression. RESULTS: Mean age was 76.3 (± 9.8), 53.5% (638) of subjects were women and 717 (60.2) were dependent. Mean of Decayed Missing and Filled Teeth Index (DMFT index) was 29.4 (± 4.9). The subjects that did not use upper and lower dentures were 61.5% (732) and 79.2% (944), respectively. Median number of missing teeth per person was 27.88 (± 6.8) with a mean of 4 (± 6.6) teeth present and 2.4 (± 4.5) caries-free teeth. Factors associated with missing teeth following multivariate analysis were: age, sex, self-assessment of oral health, access to health services, type of institution and area of the country. CONCLUSIONS: High level of tooth loss and low level of rehabilitation demonstrate precarious oral health. It is therefore necessary to improve institutional access mechanisms to public health facilities for the institutionalised elderly.

Survival analysis of mandibular complete dentures with acrylic-based resilient liners.

OBJECTIVE: The purpose of this long-term randomised controlled trial was to compare the longevity of dentures constructed using a conventional acrylic resin (CAR) to that of dentures constructed using an acrylic-based resilient liner (ARL). MATERIALS AND METHODS: The follow-up study was essentially carried out by annual telephone calls to each of the 67 participants. The Kaplan-Meier method and life-table analysis were used for univariate analyses. The Cox proportional-hazards test was used as a final model for statistically adjusting predictor variables such as sex, clinician type, mandibular denture type and age at denture delivery. RESULTS: The denture type was likely to affect the survival time of the dentures, while the sex and clinician type were not. The group using acrylic-based resilient denture liners had twice the risk of having shorter denture-survival times than those using conventional acrylic resin dentures. Younger participants were likely to have a reduced risk of having shorter denture-survival times than older participants. CONCLUSION: We conclude that mandibular complete dentures constructed using ARL are twice as likely as dentures constructed using CAR to have shorter denture survival times, mainly because of material deterioration.

The oral health status of special olympics athletes in Belgium.

OBJECTIVES: To describe and evaluate the oral condition and oral treatment needs of the participants of the Special Olympics Special Smiles program organised in Belgium in 2008. DESIGN: A cross-sectional study where the data were collected through interviews and clinical examinations. PARTICIPANTS: 687 Belgian Special Smiles athletes participated, mean age 33 years. RESULTS: More than 70% had at least one missing tooth. Distinct signs of gingivitis and visible caries experience were observed in 44% and 22% of dentate athletes respectively. Dutch-speaking athletes were less likely to present with untreated caries (OR: 0.46; 95% CI: 0.31-0.68) or with gingivitis (OR: 0.51; 95% CI: 0.37-0.71) compared to their French-speaking colleagues. Signs of past injury were identified in 12% of athletes. Of those athletes with an edentulous mandible, only 53% presented with a removable denture; 73% of athletes missing some maxillary anterior teeth and 30% of those missing all anterior teeth had no prosthetic replacement in the maxilla. Nearly two fifths of athletes were referred for treatment: in 12% of athletes dental treatment was considered urgent. CONCLUSION: The results suggest that there is a tremendous unmet need for dental treatment in the Belgian Special Smiles population, with French-speaking athletes in greatest need. Improvements in data collection should be encouraged for example. more detailed screening methods (e.g. caries screening including enamel lesions, full periodontal examination) and questionnaires (e.g. inclusion of questions related to dietary habits, dental attendance). In this way barriers to optimal oral health (care) in this population could be further explored, attempts made to reduce them and so reduce health inequalities.

The prevalence of denture stomatitis and its predisposing conditions in an older Greek population.

BACKGROUND: Pathology related to complete denture-wearing will remain an important issue because of an increase in the ageing population. OBJECTIVE: To investigate the prevalence and the risk factors for denture-related stomatitis in the edentulous maxilla of older patients with a maxillary complete denture. MATERIAL AND METHODS: One hundred and six patients treated in the Department of Prosthodontics of the Athens Dental School were interviewed and clinically examined. The results were analysed using chi-square tests and multiple logistic regression. RESULTS: Denture stomatitis was recorded in 39.6% of the sample (pinpoint hyperaemia: 17%, diffuse erythema: 16%, papillary hyperplasia: 6.6%). Chi-square tests recorded significant associations between denture stomatitis and the continuous use of dentures (particularly the diffuse erythema type), the increased duration of denture experience and the poor retention of the maxillary denture. Other significant associations were recorded between the increased age of the current denture and pinpoint hyperaemia, and the reduced frequency of denture cleaning and papillary hyperplasia. Multiple logistic analysis revealed that the most important risk factor for denture stomatitis was the continuous use of the denture. CONCLUSION: The prevalence of denture stomatitis was high in denture users. Although many predisposing conditions were recorded, the most important risk factor was the continuous use of the denture. Therefore, appropriate advice on denture maintenance should be provided.

Mandibular implant overdentures followed for over 10 years: patient compliance and prosthetic maintenance.

PURPOSE: The mandibular implant overdenture is a popular treatment modality and is well documented in the literature. Follow-up studies with a long observation period are difficult to perform due to the increasing age of patients. The present data summarize a long-term clinical observation of patients with implant overdentures. MATERIALS AND METHODS: Between 1984 and 1997, edentulous patients were consecutively admitted for treatment with an implant overdenture. The dentures were connected to the implants by means of bars or ball anchors. Regular maintenance was provided with at least one or two scheduled visits per year. Recall attendance and reasons for dropout were analyzed based on the specific history of the patient. Denture maintenance service, relining, repair, and fabrication of new dentures were identified, and complications with the retention devices specified separately. RESULTS: In the time period from 1984 to 2008, 147 patients with a total of 314 implants had completed a follow-up period of >10 years. One hundred one patients were still available in 2008, while 46 patients were not reexamined for various reasons. Compliance was high, with a regular recall attendance of >90%. More than 80% of dentures remained in continuous service. Although major prosthetic maintenance was rather low in relation to the long observation period, visits to a dental hygienist and dentist resulted in an annual visit rate of 1.5 and 2.4, respectively. If new dentures became necessary, these were made in student courses, which increased the treatment time and number of appointments needed. Complications with the retention devices consisted mostly of the mounting of new female retainers, the repair of bars, and the changing of ball anchors. The average number of events and the rate of prosthetic service with ball anchors were significantly higher than those with bars. Twenty-two patients changed from ball anchors to bars; 9 patients switched from a clip bar to a rigid U-shaped bar. CONCLUSIONS: This long-term follow-up study demonstrates that implant overdentures are a favorable solution for edentulous patients with regular maintenance. In spite of specific circumstances in an aging population, it is possible to provide long-term care, resulting in a good prognosis and low risk for this treatment modality. For various reasons the dropout rate can be considerable in elderly patients and prosthetic service must be provided regularly.

Complete edentulism and socioeconomic factors in a Jordanian population.

This study considered the need and demand for complete dentures in a select group of 600 Jordanian adults and the relationship between complete edentulism and sociodemographic variables by means of a pilot-tested questionnaire. Both maxillary and mandibular dentures were fabricated for 505 subjects, while 95 needed complete dentures in only one arch. Significantly more men than women requested complete dentures. Approximately 80% (28 of 35) of subjects who required replacement dentures for esthetic reasons were women, while over 85% (18 of 21) of subjects who required a spare set of dentures were men. The findings suggest a significant relationship between sociodemographic variables and edentulism, with age, education level, and socioeconomic status playing vital roles in edentulism and denture demand.

Risk factors associated with denture stomatitis in the United States.

BACKGROUND: This study reports denture stomatitis (DS) prevalence from a large USA probability sample from the National Health and Nutrition Examination Survey, 1988-1994 (NHANES III). METHODS: Oral examinations were performed on 3450 individuals 18-90+ years of age (mean: 59.2; SD: 0.50 years), 57.7% male and 42.3% female. Multivariable logistic regression models were fitted for DS using sociodemographic, denture quality, blood analytes, alcohol and tobacco use, history of diabetes, and current antibiotic use as covariates. Odds ratios (OR), adjusted for other covariates in each model (AOR) are presented. RESULTS: Of 3450 removable denture wearers, 963 (27.9%) had DS. DS prevalence was associated with wearing maxillary (AOR: 6.20) and mandibular (AOR: 5.21) complete dentures continuously; smoking >/=15 cigarettes day (maxillary complete: AOR = 1.31; mandibular complete: AOR = 1.50; maxillary partial: AOR = 2.04); vitamin A deficiency (mandibular complete: AOR = 5.97; maxillary partial: AOR = 5.67; mandibular partial: AOR = 24.42). Maxillary dentures with inadequate relines had approximately half the OR of DS than those with adequate relines (maxillary complete: AOR = 0.42; mandibular complete: AOR = 0.50). CONCLUSIONS: Denture stomatitis prevalence is associated with the amount of tissue covered by dentures, low vitamin A levels, cigarette smoking, and constant denture wear.

Measuring the effect of intra-oral implant rehabilitation on health-related quality of life in a randomized controlled clinical trial.

The importance of assessing the impact of treatments for chronic conditions on an individual's quality of life has been well-established. In this randomized clinical trial, oral-health-related quality of life, measured with the Oral Health Impact Profile (OHIP), was compared between two groups of edentulous patients. One group (n = 54) received mandibular implant-supported overdentures, and the other group (n = 48) received conventional dentures. Assessments were performed pre-treatment and two months after the prostheses were delivered. The multivariate model showed that implant treatment was significantly associated with lower post-treatment OHIP scores (p = 0.0002), indicating a better quality of life. In addition, pretreatment OHIP scores, treatment allocation, age, sex, and marital status explained 31% of the variation in post-treatment OHIP scores (F = 0.0001). These results suggest that implant treatment provides significant short-term improvement over conventional treatment in oral-health-related quality of life.

Randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients. Part III: comparisons of patient satisfaction.

STATEMENT OF PROBLEM: There is insufficient evidence to indicate the functional superiority of mandibular implant-supported overdentures to justify their use in edentulous patients. PURPOSE: This study compared the benefits perceived by patients who received a new maxillary denture and a mandibular conventional denture (CD) and an implant-supported overdenture (IOD). METHOD: New maxillary and mandibular dentures were delivered to 89 diabetic denture wearers with clinically acceptable metabolic control who treated their diabetes either with insulin (IT) or without insulin (NIT). Of the 89 patients, 37 received maxillary and mandibular CDs and 52 received a maxillary CD and an IOD. Two questionnaires with categorical responses were used; the first contained 13 questions to ascertain a patient's absolute assessments of original dentures at entry and study dentures at 6- and 24-months after treatment completion; the second questionnaire had 11 questions that assessed the relative change perceived by patients with study dentures. Of the 78 patients who completed the posttreatment (PT) assessments at 6 months, 68 patients provided longitudinal data for questionnaire I and cross-sectional data for questionnaire II. In addition, 46 patients (18 CD and 28 IOD) also provided PT assessments at 24 months. RESULTS: Both mean scores and percentage distributions of longitudinal data for questionnaire I showed perceptual improvements with both types of study dentures. Improvements were higher in the IOD than in the CD group. Mean scores failed to show any significant differences between the 2 treatment groups. The only significant difference was found in the change in percentage distributions for perceptual chewing ability in favor of the IOD group. Even this advantage was lost at 24 months. With the comparative questionnaire, a higher percentage of patients in the IOD group than in the CD group perceived improvements with study dentures from their original dentures in chewing ability, chewing comfort, and denture security. However, mean differences were statistically significant in favor of the IOD group only for chewing ability and less difficulty to chew hard foods. CONCLUSION: The mandibular implant-supported overdenture offers same advantage in terms of perceived chewing function over the conventional denture.