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.

Denture use and risk for cardiometabolic disease: observational and Mendelian randomization analyses.

AIMS: Denture use may potentially increase the risk of cardiometabolic diseases (CMDs), but the casual relevance and strength of the associations are currently unknown. METHODS AND RESULTS: A total of 495 938 participants from the UK Biobank were included in the observational analyses. Linkage disequilibrium score (LDSC) regression and Mendelian randomization analyses were employed to estimate genetic correlation and the associations between the genetic liability for denture use with coronary artery disease, myocardial infarction, heart failure (HF), any stroke (AS), ischaemic stroke, haemorrhagic stroke, type 2 diabetes (T2D), and related clinical risk factors. In observational analysis, denture use was associated with 14-25% higher risks of various CMDs. The LDSC analysis found that denture use showed a positive genetic correlation with CMDs (rg 0.21-0.38). Genetic liability for denture use was associated with an elevated risk of HF [odds ratio: 1.49 (1.20-1.83)] and T2D [1.11 (1.01-1.24)]. By integrating genetic summary data of denture use with the sum of decayed, missing, and filled tooth surfaces (DMFS), a clinical measure of dental caries obtained from an independent source, genetically determined denture use/DMFS was also associated with an elevated risk of AS [1.21 (1.04-1.40)]. Furthermore, genetically predicted denture use/DMFS was significantly associated with established cardiometabolic risk factors, including HDL cholesterol, triglycerides, waist circumference, waist-to-hip ratio, and height. CONCLUSION: Our study supported potential causal associations between the genetic liability for denture use and risks for HF, AS, T2D, and related clinical risk factors. These findings may inform prevention and intervention strategies targeting dental diseases and CMDs.

This study examined the association of denture use with cardiometabolic diseases (CMDs) and related clinical risk factors through Mendelian randomization analyses using data from UK Biobank and published consortia. Genetic liability for denture use was associated with an 11­49% higher risk of heart failure, stroke, and type 2 diabetes.The potential causal relationship between denture use and CMDs was further strengthened by the associations of denture use with HDL cholesterol, triglycerides, waist circumference, waist-to-hip ratio, and height, which are among the major risk factors of CMDs.

Contact allergies to dental materials in patients.

BACKGROUND: Concerns regarding contact allergies and intolerance reactions to dental materials are widespread among patients. Development of novel dental materials and less frequent amalgam use may alter sensitization profiles in patients with possible contact allergy. OBJECTIVES: To analyse current sensitization patterns to dental materials in patients with suspected contact allergy. METHODS: This retrospective, multicentre analysis from the Information Network of Departments of Dermatology (IVDK) selected participants from 169 834 people tested in 2005-2019 and registered with (i) an affected area of 'mouth' (and 'lips'/'perioral'), (ii) with the dental material in question belonging to one of three groups (dental filling materials, oral implants or dentures or equivalents) and (iii) with patch-testing done in parallel with the German baseline series, (dental) metal series and dental technician series. RESULTS: A total of 2730 of 169 834 tested patients met the inclusion criteria. The patients were predominantly women (81.2%) aged ≥ 40 years (92.8%). The sensitization rates with confirmed allergic contact stomatitis in women (n = 444) were highest for metals (nickel 28.6%, palladium 21.4%, amalgam 10.9%), (meth)acrylates [2-hydroxyethyl methacrylate (HEMA) 4.8%] and the substances propolis (6.8%) and 'balsam of Peru' (11.4%). The most relevant acrylates were HEMA, 2-hydroxypropyl methacrylate, methyl methacrylate, ethylene glycol dimethacrylate and pentaerythritol triacrylate. Few men were diagnosed with allergic contact stomatitis (n = 68); sensitization rates in men were highest for propolis (14.9%) and amalgam (13.6%). CONCLUSIONS: Allergic contact stomatitis to dental materials is rare. Patch testing should not only focus on metals such as nickel, palladium, amalgam and gold, but also (meth)acrylates and the natural substances propolis and 'balsam of Peru'.

Ingestion of a row of artificial dentures in an adult: A case report and review of the literature.

RATIONALE: Foreign body (FB) ingestion is a common clinical emergency, although in most cases, the FB can pass safely through the entire gastrointestinal tract without causing any damage. However, ingestion of large dentures is very rare and alarming, as it can threaten the intestinal mucosa and cause perforation of the gastrointestinal tract, among other complications. PATIENT CONCERNS: A 64-year-old Chinese male was referred to our hospital for removal of a FB, which was a large denture. Clinical symptoms included chest and upper abdominal pain. He had no cough or dyspnea. Medical history included a recent cerebral infarction, craniocerebral surgery, and being bedridden for a long term. DIAGNOSES: We initially suspected a single and smooth denture, complicated by pharyngeal and esophageal mucosal injury. Radiographic examination however showed a 70-mm long opaque object located in the middle and upper esophagus, close to the trachea and aorta. INTERVENTIONS: Multiple dentures and metal hooks were removed via endoscopy using a net, grasping forceps, and rubber jacket. OUTCOMES: The patient recovered well and experienced no postoperative complications. The patient was discharged 5 days after endoscopic therapy. LESSONS: Our case showed that endoscopy was effective for the retrieval of an esophageal FB. For sharp FBs, the use of a net and rubber jacket is a good choice. However, we advocate for appropriate surgery in patients in whom endoscopy is not possible after an accurate diagnosis or those with severe complications.

Compositional shifts within the denture-associated bacteriome in pneumonia - an analytical cross-sectional study.

Introduction. Bacterial pneumonia is a common cause of morbidity and mortality in elderly individuals. While the incidence of edentulism is falling, approximately 19 % of the UK population wear a full or partial removable denture. Despite advances in denture biomaterials, the majority of dentures are fabricated using polymethyl-methacrylate. Growing evidence suggests that colonization of the oral cavity by putative respiratory pathogens predisposes individuals to respiratory infection, by translocation of these microorganisms along the respiratory tract.Hypothesis/Gap Statement. We hypothesized that denture surfaces provide a susceptible colonization site for putative respiratory pathogens, and thus could increase pneumonia risk in susceptible individuals.Aim. This study aimed to characterize the bacterial community composition of denture-wearers in respiratory health compared with individuals with a confirmed diagnosis of pneumonia.Methodology. This was an analytical cross-sectional study, comparing frail elderly individuals without respiratory infection (n=35) to hospitalized patients with pneumonia (n=26). The primary outcome was the relative abundance of putative respiratory pathogens identified by 16S rRNA metataxonomic sequencing, with quantitative PCR used to identified Streptococcus pneumoniae.Results. There was a statistically significant increase in the overall relative abundance of putative respiratory pathogens (P<0.0001), with a greater than 20-fold increase in the bioburden of these microorganisms. In keeping with these findings, there were significant shifts in bacterial community diversity (Chao index, P=0.0003) and richness (Inverse Simpson index P<0.0001) in the denture-associated microbiota of pneumonia patients compared with control subjects.Conclusion. Within the limitations of this study, our evidence supports the role of denture acrylic biomaterials as a potential colonization site for putative respiratory pathogens, which may lead to an increased risk of pneumonia in susceptible individuals. These findings support prior observational studies which have found denture-wearers to be at increased risk of respiratory infection. Further research is needed to confirm the sequence of colonization and translocation to examine potential causal relationships.

Management of Chronic Atrophic Candidiasis (Denture Stomatitis)-A Narrative Review.

One of the most common oral diseases affecting people wearing dentures is chronic atrophic candidiasis or denture stomatitis (DS). The aim of the paper is to provide an update on the pathogenesis, presentation, and management of DS in general dental practice settings. A comprehensive review of the literature published in the last ten years was undertaken using multiple databases, including PubMed via MEDLINE, EMBASE, and Scopus. The eligible articles were analyzed to identify evidence-based strategies for the management of DS. Despite its multifactorial nature, the leading cause of DS is the development of oral Candida albicans biofilm, which is facilitated by poor oral and denture hygiene, long-term denture wear, ill-fitting dentures, and the porosity of the acrylic resin in the dentures. DS affects between 17 and 75% of the population wearing dentures, with a slight predominance in elderly females. The mucosal denture surfaces and posterior tongue are the common sites of DS, and the affected areas exhibit erythema, the swelling of the palatal mucosa and edema. Oral and denture hygiene protocols, adjusting or re-fabricating poorly adapting dentures, smoking cessation, avoiding nocturnal denture wear, and the administration of topical or systemic antifungals are the mainstay of management. Alternate treatments such as microwave disinfection, phytomedicine, photodynamic therapy, and incorporation of antifungals and nanoparticles into denture resins are being evaluated for the treatment of DS but require further evidence before routine use in clinical practice. In summary, DS is the most common oral inflammatory lesion experienced by denture wearers. Most patients with DS can be managed in general dental practice settings. Effective management by general dental practitioners may be supported by a thorough understanding of the pathogenesis, the recognition of the clinical presentation, and an awareness of contemporary treatment strategies.

Management of Denture Infection with Phytomedicine.

Natural teeth are an integral part of the masticatory system. Absence of dentition subjects the individual to compromised oral function, facial appearance and phonetics. Rehabilitation with dental prosthesis is imperative to restore form and masticatory activity. Currently, fabrication of removable and fixed prosthesis has become most predictable. Nonetheless, there is an increased prevalence of oral stomatitis observed over the years in edentulous individuals wearing removable dentures. Amongst the many pathogens that cause denture infections, Candida albicans is assumed to be the most virulent opportunistic agent. Different methods, such as mechanical, chemical, chemicmechanical, and pharmacological are tried to fight such infections. Regardless of various management strategies developed to treat denture stomatitis, the research continues to evolve the most optimal one. Improper oral and or denture hygiene maintenance, surface irregularities on denture, persistence of xerostomia and associated systemic illness pose risk for exaggeration of the disease. In extreme conditions, the development of aspiration pneumonia in geriatric patients is considered a threat to both dental and medical specialists. Therapeutic administration of synthetic anti-microbial drugs, along with meticulous oral hygiene maintenance are recommended protocols till date. However, limitations such as antibiotic resistance, side effects, counter drug reactions, cost of the medicaments predispose to origin of natural herbal products to treat denture stomatitis. Vast array of plant products are studied in previous literature, yet no definitive edge of one over the other is proven. This article intends to provide a mini-review on the different organic plant materials, also called as phytomedicines used for the treatment of candida associated denture stomatitis (CADS).

Impact of Denture Use on Ischemic and Bleeding Outcomes of Patients with Acute Myocardial Infarction.

Objective Oral diseases, including periodontitis and stomatitis, are highly prevalent worldwide and reportedly associated with the development of cardiovascular disease. Given the high rate of stomatitis in individuals wearing dentures, denture users may be at high risk of poor cardiovascular outcomes. We therefore investigated whether or not the use of dentures is associated with a poor clinical outcome in patients with acute myocardial infarction (MI). Methods This two-center retrospective observational study was conducted between January 2012 and March 2020. A total of 1,046 patients with acute MI who underwent primary percutaneous coronary intervention were divided into two groups according to denture use status. The primary outcomes included ischemic events (cardiovascular death, recurrent MI, and ischemic stroke) and major bleeding (Bleeding Academic Research Consortium type 3 or 5). Results Of the 1,046 patients with acute MI, 387 (37.0%) used dentures. An older age and prior MI were associated with an increased likelihood of denture use. During the mean 660-day follow-up period, ischemic and major bleeding events occurred in 169 (16.2%) and 102 (9.8%) patients, respectively. Denture use was associated with an increased risk of ischemic events, whereas no significant intergroup differences were observed in major bleeding outcomes. The results were similar among patients ≥75 years old. Conclusion More than one-third of the patients with acute MI wore dentures. Our findings suggest that denture use is significantly associated with an increased risk of ischemic events but not bleeding outcomes after acute MI.

Effect and Safety of Painless and Conventional Endoscopic Management of Denture Impaction in the Esophagus.

Objective: To improve the level of clinical diagnosis and treatment, reduce the incidence of complications, and provide the basis for clinicians to choose an appropriate treatment, this research explores the removal methods of the impacted denture in the esophagus by endoscopy. Methods: Based on the clinical information, treatment methods and complications of 72 patients with denture impaction in the esophagus admitted to our hospital from January 2016 to March 2021, which were divided into the group treated with painless endoscopy and the group treated with conventional endoscopy, retrospective analysis of the therapeutic effect and complications was conducted. Results: There was no statistically significant difference between the two groups in terms of denture removal rate (P > 0.05). There were statistically significant differences between the two groups in terms of operating time and incidence rates of complications during and after the procedure. The operating time of the group treated with painless endoscopy was significantly shorter than the group treated with conventional endoscopy (P < 0.05). The incidence rates of complications during and after the procedure of the group treated with painless endoscopy were significantly lower than the group treated with conventional endoscopy (P < 0.05). Conclusions: Compared with the conventional endoscopy, painless endoscopic management of denture impaction in the esophagus under general anesthesia with tracheal intubation improves the clinical efficacy and reduces the adverse reactions. Thus, it is worthy of clinical popularization and application.

Aspiration of a Row of Artificial Dentures in an Adult: A Case Report.

Clinical findings of foreign body aspiration, generally, are subtle. Scrutinous clinical suspicion is always recommended. Here, we present a rare case of an adult male, who under the influence of alcohol had aspirated a row of his artificial denture without his conscience of where his denture got missing and presented to our outpatient department with non-specific symptoms. With clinical examination and advanced diagnostics, he was successfully managed with rigid bronchoscopy. With the advancement in diagnostic techniques and our widened knowledge of the condition, utmost early detection has been possible and our case report reinforces the need for a low threshold for foreign body aspiration suspicion, especially in adults with dentures, and the use of rigid bronchoscopy as a plausible tool for the prompt management of the aspiration. Keywords: bronchoscopy; case reports; dentures; foreign bodies.

Tooth Loss, Denture Use, and Cognitive Impairment in Chinese Older Adults: A Community Cohort Study.

BACKGROUND: Evidence regarding the associations of tooth loss and denture use with incident cognitive impairment is inconclusive in older adults, and few prospective studies have examined the potential interaction between tooth loss and denture use in these specific populations. METHODS: Data were assessed from 17 079 cognitively normal older adults aged ≥65 years, participating in the Chinese Longitudinal Healthy Longevity Survey. The outcome of interest was cognitive impairment (assessed by the Chinese version of Mini-Mental State Examination). The number of natural teeth and status of denture use were collected by a structural questionnaire. RESULTS: A total of 6456 cases of cognitive impairment were recorded during 88 627 person-years of follow-up. We found that compared with participants with 20+ teeth, those with 10-19, 1-9, and 0 teeth had increased risks of incident cognitive impairment (p-trend < .001). Participants without dentures also had a higher risk of incident cognitive impairment, compared with those who wore dentures. Effect modification by denture use was observed (p-interaction = .010). Specifically, among those without dentures, the adjusted hazard ratio (95% confidence interval) for participants with 10-19, 1-9, and 0 teeth were 1.19 (1.08, 1.30), 1.28 (1.17, 1.39), and 1.28 (1.16, 1.41), respectively, as compared to those with 20+ teeth. In contrary, among denture users, detrimental effect was only observed among those with 0 teeth (hazard ratio 1.14, 95% confidence interval: 1.16, 1.41). CONCLUSIONS: In Chinese older adults, maintaining 20+ teeth is important for cognitive health; denture use would attenuate the detrimental effects of tooth loss, especially for partial tooth loss, on cognitive impairment.

A 10-Year Review of the Complications Caused by Ingested and Aspirated Dentures.

INTRODUCTION: Dentures are worn by 20% of the United Kingdom population for both physical and psychological symptoms associated with tooth loss. However, significant morbidity and mortality can result if dentures are swallowed or aspirated. This 10-year review investigated the development of complications following denture aspiration or ingestion, and identified key learning points. METHODS: The Medline database was searched for cases of denture ingestion or aspiration from October 1, 2009, to October 31, 2019. Search terms included "dental prosthesis, denture, dental plate, bridge and false teeth" and "swallow, ingest, eat, aspirate and inhale." Potential factors influencing the development of complications were assessed (hollow viscus perforation, fistula formation, abscess, bowel obstruction, necrosis, hemorrhage, and airway obstruction). Statistical analysis was performed using χ2 and Pearson correlation tests in R Studio. No ethical approval was required. RESULTS: Eighty-five patients were identified from 77 case reports. Fourteen articles were excluded due to insufficient information. Complications were documented in 37.6% (n = 32) of patients with 2 cases resulting in death. Duration of symptoms over 1 day (P = .005) and delayed removal beyond 4 days post-ingestion (P = .017) was significantly associated with increased rates of complications. There was no significant association between complication rate and patient age, denture type, level of impaction, or radiolucency. CONCLUSION: Denture aspiration or ingestion can have serious consequences. Factors impacting complication rate revolve around early recognition and treatment. Clinician awareness of the potential risks of dentures is paramount to early diagnosis. We recommend early intervention to reduce the morbidity associated with this unassuming device.

Association Between Number of Teeth, Denture Use and Frailty: Findings from the West China Health and Aging Trend Study.

OBJECTIVE: Frailty and poor oral health are both common age-related conditions. However, the association between oral health and frailty has not been explored thoroughly among older Chinese adults. We aimed to investigate the associations between number of teeth, denture use, and frailty among older adults in western China. DESIGN: Cross-sectional study. SETTING: Community-based. PARTICIPANTS: Participants were 4037 community-dwelling individuals aged 60 and older from the West China Health and Aging Trend (WCHAT) study. MEASUREMENTS: Frailty was assessed using the physical frailty phenotype (PFP) and categorized as non-frail, prefrail and frail. In addition, number of teeth and denture use were examined by calibrated dentists. Multinomial logistic regression models were performed to examine the association between number of teeth, denture use, and frailty. RESULTS: The overall prevalence of frailty was 6.7% among 4037 participants aged 60 and older in western China. Participants with no more than 20 teeth were associated with higher odds of being prefrail or frail whether wearing dentures or not. Denture using could not help lower the odds of being prefrail or frail for older adults with fewer teeth. CONCLUSIONS: This study suggested that frailty was associated with having fewer teeth (≤20 teeth) among older Chinese adults. Future research involving targeted interventions addressing number of teeth may help provide information to establish effective strategies for frailty prevention in older adults.

Usefulness of the newly developed artificial denture plaque for practical denture care training.

OBJECTIVES: The aim of this study was to investigate whether the newly developed artificial dental plaque (A-DP) is useful as an educational tool for denture care of dental hygienist that compared it with conventional artificial dental plaque from the viewpoint of practical skills. MATERIAL AND METHODS: The 125 dental hygienist school students and 26 dental hygienists who had clinical experience were subjected a practical training of denture plaque control using the conventional denture plaque (C-DP) and the A-DP. The questionnaires based on the semantic differential method were used to survey whether the A-DP is similar to the real denture plaque (R-DP). Factor analysis by rotation of promax was carried out. RESULTS: In the results of the factor analysis, the two factors could be detected in students and three factors in dental hygienists. The total score of each denture plaque was calculated for each factor, and correlation coefficient was examined. There was significant correlation between the A-DP and the R-DP at the first factors, both students and dental hygienists. C-DP was not similar to R-DP in all factors. CONCLUSIONS: These results suggested that A-DP resembles R-DP better than C-DP. It was concluded that the A-DP was similar to the R-DP and could be a potent educational tool for practical denture care.

The prevalence of denture related mucosa lesions among patients managed in a Nigerian teaching hospital.

INTRODUCTION: the prevalence of denture related mucosa lesions (DRML) varies across different countries and a recent study reported an increasing trend in its prevalence. The objective of this study was to determine the prevalence of DRML and factors related to the lesions among denture wearers seen in a Nigerian teaching hospital. METHODS: interviewer's administered questionnaire was used to obtain information from consecutive patients that had used removable denture for at least six months and consented to participate. Data related to gender, age, types of denture and presence of denture induced oral lesions were obtained, entered into a computer and analyzed using IBM SPSS Version 20. Descriptive statistics were expressed as frequency and percentages. Fisher's exact test was performed for discrete variables. A P-value less than 0.05 was regarded as statistically significant. RESULTS: a total of 104 respondents participated in the study and 14 had DRML giving a prevalence of 13.5%. The majority, 11 out of the 14 (78.57%) presented with mucosa ulceration, while 8 (57.14%) out of the 14 cases of DRML were caused by over extension of the denture flanges. There was no statistically significant relationship between daily removal of denture fore going to bed to sleep at night and DRML (p=0.776). CONCLUSION: the prevalence of denture related mucosal lesion was 13.3% and the major cause was over extension of denture flange. There is need to emphasize adherence to review appointments for early detection and correction of denture instability and over extension of denture flange to prevent DRML.

Clinical Analysis of Denture Impaction in the Esophagus of Adults.

Denture impacted in the esophagus of adults has been a complex foreign body for otolaryngologists. We reviewed clinical characteristics, diagnosis, and treatment of these patients and evaluated computed tomography (CT) scans to identify a better method of dealing with such tricky situations. Twenty-nine patients who underwent rigid esophagoscopy were included in this retrospective study conducted at the University hospital. The patients underwent preoperative tests and examinations, including complete blood count, blood type and coagulation, electrocardiogram, and CT. The commonest symptoms were retrosternal pain, dysphagia, and odynophagia. Duration of the foreign body impacted within 24 h was 65.5%. CT findings revealed that 4 of 24 cases had complications in the upper esophagus, with 3 of the 4 cases in the mid-esophagus and 1 in the lower esophagus. Complications were related to the duration and location of the obstruction (P < 0.05). The location and complications based on CT findings were coherent with rigid esophagoscopy findings. Denture impaction in the esophagus can be fatal. Early intervention is crucial for prognosis. CT is used for diagnosing and guiding doctors in managing. The commonest location of impacted dentures was the upper esophagus with a lower incidence of complications. The incidence of an impacted denture in the mid-esophagus was low but with a high risk of complications. The incidence of an impacted denture in the lower esophagus was rare. Surgery and proper treatment ensure a good prognosis.

Impacted denture in the oesophagus: review of the literature and its management.

Foreign body impaction in the oesophagus is a common cause of acute dysphagia. Oesophageal impaction of sharp objects such as dentures can be life threatening due to the risk of oesophageal perforation. This condition requires urgent treatment, and therefore prompt diagnosis and management is vital to avoid complications. Diagnosing oesophageal foreign body can be challenging due to its poor localising symptoms. We describe a case of an impacted denture in which considerable delays to treatment were encountered, and discuss the pitfalls and lessons learnt. This case and review of the literature draw attention to clinical assessment, investigation and treatment options for oesophageal foreign body impaction.