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.

Oral health and treatment needs of the long-term hospitalised elderly.

OBJECTIVES: To determine the oral health and treatment needs of the long-term hospitalised elderly. SETTING: The Laakso long-term hospital, Helsinki, Finland. DESIGN: A cross-sectional study with clinical oral examinations. SUBJECTS: All long-term patients (n = 260) aged 60 and older. MAIN OUTCOME MEASURES: Edentulousness, presence and hygiene of dentures, mucosal findings, number of teeth, functioning teeth and tooth remnants, level of dental hygiene, and need for operative treatment. RESULTS: Subjects' mean age was 83.3 years (SD = 8.1); 42% were edentulous, 45% of women and 33% of men (p = 0.12). With no gender difference, 41% had removable dentures, but one in four were considered to be in need of repair or replacement. Denture hygiene was good in 19%, moderate in 44%, and poor in 37%, and for men worse than for women (p = 0.02). Stomatitis was found in 25%, and angular cheilitis in 28% of the denture wearers. The dentate subjects had on average 12.4 (SD = 8.6) teeth with a clear difference by age (p = 0.03), but no difference by gender. Dental hygiene was considered poor. Of the dentate subjects, 37% were in need of restorations, 51% of periodontal therapy and 42% of extractions. CONCLUSIONS: Oral cleanliness should be improved with regards to dentures and teeth. More attention should be focused on dental care of the long-term hospitalised elderly.

Clinical assessment of common patient complaints with complete dentures.

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

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

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

The orodental status of a group of elderly in-patients: a preliminary assessment.

OBJECTIVE: To provide a preliminary assessment of the orodental status and dental treatment requirements of a group of elderly in-patients. DESIGN: Cross-sectional. SETTING: Acute Care of the Elderly and Stroke Rehabilitation units at teaching hospitals in Merseyside. SUBJECT: 150 patients aged 58 to 94 years, in which a history could be validated at interview. INTERVENTION: Questionnaire administered by dentist and clinical examination. MAIN OUTCOME MEASURES: Registration with a dentist, prosthetic status and difficulties with dentures, denture hygiene and identification marking, dental treatment needs and evidence of mucosal pathology. RESULTS: Only 27% of patients claimed registration with a dentist. Three quarters of the patients were edentulous and 66 patients wore full dentures; 18 had no prostheses. Difficulties were experienced by one quarter of patients with upper dentures, compared with a half of lower denture wearers. Of the dentures available for inspection, 61% had removable soft debris, 66% were left out at night and 75% were cleaned by the patient, whilst on the ward. No dentures had evidence of identification marking. Of the 39 partially dentate patients, 75% required interventive dental treatment. Denture stomatitis was diagnosed in 29% of patients and 19 had evidence of benign mucosal pathology. CONCLUSIONS: The orodental status of this group of elderly in-patients was poor, with a high proportion being edentulous. Few were registered with a dentist and denture hygiene was inadequate. Lack of identification marking is a matter of concern. Closer liaison between hospital staff responsible for elderly in-patients is required, to improve the orodental health and quality of life of this medically compromised group of patients.

Evaluation of an optical instrument for objective assessment of oral mucosal erythema.

This study evaluated the sensitivity and reproducibility of an optical instrument, the Erythema Meter, for quantifying erythema of palatal mucosa. The instrument is based on the principle that haemoglobin in the vasculature selectively absorbs green light but has little effect on red light and allows derivation of an 'erythema index'. Non-clinical investigations were carried out by taking a series of Erythema Meter readings from each colour block on a red check-standard used by graphic artists for colour reproduction. For clinical assessment, 20 dentate patients with healthy palatal mucosa and 40 complete denture wearers (20 with denture stomatitis and 20 with healthy palatal mucosa) were enrolled, and palatal erythema determined both visually and using the Erythema Meter. Two weeks later the Erythema Meter readings for the 40 patients with healthy palatal mucosa were repeated, to allow assessment of the reproducibility of the Erythema Meter scores. The median erythema index was 12 (range 2-38) for dentate patients with healthy palatal mucosa and 5 (range 0-29) for denture wearers with healthy palatal mucosa. For denture stomatitis patients the median erythema index was 95 (range 36-117). The overall reproducibility coefficient was 88%. Visual scoring correlated poorly with the Erythema Meter scores for those with moderate degrees of erythema. The Erythema Meter provides an objective and reproducible means of measuring the degree of erythema of the palatal mucosa.

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

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

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

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

Oral disease in the elderly in long-term hospital care.

OBJECTIVE: To obtain baseline information on the prevalence of oral problems and disease in institutionalized elderly in a Scottish hospital. DESIGN: A cross-sectional clinical investigation with complementary microbiological studies as appropriate. SUBJECTS AND METHODS: A cohort of 147 elderly in five long-term care wards; collection of demographic data; clinical examination to determine: i) the dental and denture status and associated lesions such as Candida-associated denture stomatitis and angular cheilitis, ii) oral mucosal disease; swabs as appropriate for microbiology. MAIN OUTCOME MEASURES: Dental status, root caries prevalence; denture status and hygiene, and associated disease; oral mucosal health. RESULTS: Median period of institutionalization of 147 patients was 15 months and 65% were aged 80 years or more; the majority were significantly mentally impaired; 52% wore complete dentures, 9% were partially dentate, 19% possessed partial or incomplete dentures; 20% were neither dentate nor had dentures. Of 80 patients who verbalised their complaints, 35% complained of dry mouth and 45% had denture-related problems, principally discomfort. The commonest oral finding was a coated tongue (56%); angular cheilitis was present in 25%, and Candida-associated denture stomatitis in 19%; none had oral ulcers. CONCLUSIONS: There was considerable unmet dental need with significant oral disease and poor levels of oral and denture hygiene in this target group; both dental and medical professionals should act in concert to deliver curative as well as preventative dental care for the elderly living in institutions to improve their quality of life.

Assessment of an additive index for plaque accumulation on complete maxillary dentures.

There appears to be a relation between accumulation of plaque on complete maxillary dentures and denture stomatitis. The present index was introduced to assess the location and amount of plaque in some areas of the fitting surfaces of complete maxillary dentures. Scores were recorded in five defined areas on the denture base. Four ranked scores were used: 0 - no visible plaque, 1-plaque visible only by scraping on the denture base with a blunt instrument, 2-moderate accumulation of visible plaque, and 3-abundance of plaque. By summing up the scores from the five areas, the plaque was recorded on a scale from 0 to 15 points. The inter- and intra-reliability were tested for two examiners using the index on 50 complete maxillary dentures. Expressed in terms of Scott's Pi, inter-examiners agreement was 0.83, and intra-examiner 0.83 and 0.82 for examiners A and B, respectively. A simplification of the index was also presented. In this index the scores 0 and 1 were combined to score 0, -no visible plaque, and score 2 and 3 were combined to score 1, -visible plaque. Using this index, Scott's Pi was calculated to 0.91 for inter-examiner reliability. For the intra-examiners reliability Scott's Pi was calculated to 0.91 for examiner A and 0.89 for examiner B.