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.

Biomechanical variables affect peri-implant bone loss in implant-supported fixed complete dentures: A methodological and prospective study.

PURPOSE: Implant-supported fixed complete dentures (IFCD) experience failures and complications related to biological and technical risk factors. This study investigated the effect of biomechanical variables of IFCD on 1-year peri-implant bone loss at the buccal, palatal/lingual, mesial, and distal implant sides. A new method was used to measure the geometric biomechanical variables of IFCD using cone beam computed tomography (CBCT). METHODS: The study sample consisted of 246 external hexagon implants supporting 48 hybrid IFCD in 44 patients. CBCT images obtained immediately (T0) and 1 year (T1) after prosthesis installation were used to measure the support polygon area, clinical crown/implant (C/I) ratio (vertical lever), anteroposterior power and resistance arms, anterior and posterior cantilevers (horizontal levers), and peri-implant bone remodeling (T1-T0). Data were analyzed using multilevel multivariable models. RESULTS: The average total bone loss in the mandible and maxilla were 0.88 mm, with a loss of 0.62 mm in the mandible and 1.08 mm in the maxilla. The C/I ratio had a significant effect on bone loss on the mesial, distal, and palatal/lingual sides (P <.05). The anterior cantilever had a protective effect on the lingual side of the anterior implant. No effect on bone loss was found for the support polygon area, posterior cantilever, resistance arm, or power arm (P >.05). CONCLUSIONS: The results suggest that the C/I ratio and anterior cantilever in IFCD affect peri-implant bone loss according to the implant side and position in the arch.

Impacto do uso de próteses totais na qualidade de vida de idosos institucionalizados / Impacto del uso de prótesis total en la calidad de vida de los ancianos institucionalizados / Impact of the use of complete dentures on the quality of life of institutionalized elderly people

RESUMO Introdução: O uso de próteses totais tem impacto na qualidade de vida relacionada à saúde bucal e os idosos são uma parcela da população a ser pesquisada sob essa perspectiva. Objetivo: Avaliar a autopercepção do impacto do uso de próteses totais na qualidade de vida relacionada à saúde bucal de idosos institucionalizados. Métodos: Participaram 20 idosos do Lar dos Idosos Recanto do Tarumã, Curitiba, Paraná, Brasil. Foram avaliados aspectos demográficos, econômicos, de hábitos e clínicos, juntamente com aplicação do questionário Geriatric Oral Health Assessment Index. Os dados foram submetidos à análise descritiva e bivariada (Teste do Qui-Quadrado), com significância de 5 porcento. Resultados: A média de idade foi de 75,2 anos (DP= 8,8) e o tempo médio de uso de prótese foi de 27,9 anos (DP= 18,5). Renda inferior a um salário mínimo foi indicada por 80,0 porcento, e visitas ao cirurgião-dentista pela última vez há mais de um ano, por 70,0 porcento. Os piores relatos foram referentes à mastigação, representados por problemas para mastigar alimentos e desconforto ao comer, com 25 porcento de respostas positivas em cada questão; a soma das frequências das respostas "às vezes" e "sempre" quanto à insatisfação ou à infelicidade com a aparência da boca foi reportada 60 porcento dos pesquisados. A retenção insatisfatória da prótese inferior se deu em 50,0 porcento casos, enquanto os problemas com oclusão estiveram presentes também em metade da amostra. Os defeitos estiveram presentes em 70,0 porcento das próteses superiores e 45,0 porcento das inferiores. Não foi encontrada associação significativa (p> 0,05) entre as variáveis independentes e o desfecho. Conclusões: Os idosos avaliados, independentemente das condições das próteses totais, relataram qualidade de vida relacionada à saúde bucal satisfatória(AU)

RESUMEN Introducción: El uso de prótesis totales tiene un impacto en la calidad de vida relacionada con la salud bucal, y los ancianos son parte de la población que se investigará desde esta perspectiva. Objetivo: Evaluar la autopercepción del impacto del uso de prótesis totales en la calidad de vida relacionada con la salud bucal de ancianos institucionalizados. Métodos: Participaron 20 ancianos de "Lar dos Idosos Recanto do Tarumã", Curitiba, Paraná, Brasil. Los aspectos demográficos, económicos, de hábitos y clínicos se evaluaron junto con la aplicación del cuestionario Geriatric Oral Health Assessment Index. Los datos fueron sometidos a análisis descriptivo y bivariado (prueba de chi cuadrado), con significación del 5 por ciento. Resultados: La edad media fue de 75,2 años (DE= 8,8) y el tiempo medio de uso de la prótesis fue de 27,9 años (DE= 18,5). Los ingresos menores a un salario mínimo se indicaron en el 80,0 por ciento, y las visitas al cirujano dental la última vez, hace más de un año, en el 70, 0 por ciento. Los peores informes estaban relacionados con la masticación, representados por problemas para masticar los alimentos y la incomodidad al comer, con el 25 por ciento de respuestas positivas en cada pregunta. La suma de las frecuencias de las respuestas "a veces" y "siempre" sobre la insatisfacción o la infelicidad con la apariencia de la boca se informó en el 60 por ciento de los encuestados. La retención insatisfactoria de la prótesis inferior se produjo en el 50 por ciento de los casos, mientras que la oclusión también presentó problemas en la mitad de la muestra. Los defectos estuvieron presentes en el 70,0 por ciento de las prótesis superiores y en el 45,0 por ciento de las inferiores. No se encontró asociación significativa (p> 0,05) entre las variables independientes y el desenlace. Conclusiones: Los ancianos evaluados, independientemente de las condiciones de las prótesis totales, informaron una calidad de vida relacionada con la salud bucal satisfactoria(AU)

ABSTRACT Introduction: The use of complete dentures has an impact on oral health-related quality of life. Elderly people are the population sector to be researched into from this perspective. Objective: Evaluate the self-perception of the impact of the use of complete dentures on the oral health-related quality of life of institutionalized elderly people. Methods: The study sample was 20 elderly people from Lar dos Idosos Recanto do Tarumã, Curitiba, Paraná, Brazil. Evaluation of demographic and economic details, habits and clinical aspects was based on the information collected with the Geriatric Oral Health Assessment Index questionnaire. The data were subjected to descriptive and bivariate analysis (Chi-squared test), with a significance of 5 percent. Results: Mean age was 75.2 (SD = 8.8) years and mean time of denture use was 27.9 (SD = 18.5) years. Income was below minimum wage in 80.0 percent of the participants, whereas the last visit to the dentist had occurred more than a year ago in 70.0 percent. The worst reports had to do with chewing, represented by problems to chew food and discomfort when eating, with 25 percent positive answers to each question. The sum of the frequencies of the answers "sometimes" and "always" about dissatisfaction with or unhappiness about the appearance of the mouth was reported by 60 percent of the respondents. Unsatisfactory retention of the lower denture occurred in 50.0 percent of the cases, whereas occlusion problems were present in half of the sample. Defects were present in 70.0 percent of the upper dentures and 45.0 percent of the lower dentures. No significant association (p> 0.05) was found between independent variables and outcome. Conclusions: The elderly people evaluated, regardless of the conditions of their complete dentures, reported satisfactory oral health-related quality of life(AU)

Risk factor model of mechanical complications in implant-supported fixed complete dentures: A prospective cohort study.

OBJECTIVES: This prospective cohort study estimated the effect of technical and clinical factors on mechanical complications in implant-supported fixed complete dentures (IFCDs). The patient's perception of the impact of oral rehabilitation on quality of life was assessed. MATERIAL AND METHODS: A non-probabilistic sample consisted of 88 consecutive patients treated with 94 screw-retained, metal-acrylic IFCDs. Data collection included sociodemographic variables, presence and intensity of bruxism, maximal occlusal force, opposing arch, design of the metallic framework, distribution of occlusal contacts, and quality of life (OHIP-14). IFCD-level data were analyzed using Kaplan-Meier survival analysis and Cox regression model. Quality of life data were analyzed by paired Student t test. RESULTS: During a mean follow-up of 35.1 ± 18.3 months, 16/94 IFCDs (17%) had repairable mechanical complications because of loosening/fracture of artificial teeth (n = 15) and screw loosening (n = 1). Framework design (retention pins <4 mm) was a significant risk factor for complications (HR = 11.038; p = 0.027) when adjusted for sex. Mechanical complications were not associated with sex, body mass index, thickness of the acrylic resin veneering, type of opposing arch, distribution of occlusal contacts and force, protrusion interference, presence/intensity of bruxism or maximal occlusal force. OHIP-14 total scores decreased after IFCD treatment for both patients with or without complications. CONCLUSIONS: Within the limitations of this study, the results suggest that clinical success is associated to framework design with retention pins equal or longer than 4 mm. Quality of life improved with IFCD treatment, even in patients with mechanical complications.

Eficácia do diacetato de clorexidina incorporado a um reembasador macio no tratamento da estomatite protética: um ensaio clínico randomizado / Efficacy of chlorhexidine diacetate incorporated into a soft liner rebase in the treatment of denture stomatitis: a randomized clinical trial

O objetivo deste estudo piloto foi comparar a eficácia de um reembasador acrílico macio com ou sem diacetato de clorexidina a 1% no tratamento de pacientes com estomatite protética. As hipóteses testadas foram: (I) o eritema seria melhorado (IIa): a contagem de unidades formadoras de colônias seria reduzida, (IIb): a predominância de um tipo morfológico de Candida seria correlacionada com características clínicas e, (IIc) se uma concentração inibitória mínima do antimicrobiano, poderia ser capaz de atuar sobre o crescimento do fungo. Dezesseis pacientes desdentados totais, portadores de prótese e com estomatite protética foram distribuídos aleatoriamente para os grupos controle (reembasamento com Trusoft) e grupo teste (reembasamento com Trusoft contendo 1% de clorexidina) sendo acompanhados por exames clínicos e laboratoriais por 14 dias. Os parâmetros analisados nas duas consultas de acompanhamento foram: avaliação clínica (exame e fotos) e avaliações microbiológicas (esfregaços e culturas de palato e prótese total). Este estudo foi um ensaio clínico randomizado, duplo-cego,controlado.Os resultados obtidos demonstraram que a superfície do eritema foi significativamente reduzida, mas não diferiu significativamente entre os dois grupos (P> 0,05), assim como a redução da contagem de Candida durante o tratamento entre os grupos (P> 0,05). O tipo de Candida não pôde ser correlacionado ao estágio clínico alcançado. Os resultados dos testes de concentração inibitória mínima, revelaram que uma concentração de 0,05 µg/ml de clorexidina já é capaz de inibir o crescimento de 85% das cepas de testadas.A hipótese principal foi confirmada, o que pode ser interpretado como uma remissão clínica acelerada em ambas as terapias propostas. Embora as hipóteses secundárias não tenham sido confirmadas, a persistência de Candida pode ser apenas a colonização, e a plasticidade morfológica de Candida parece ser fortemente influenciada pela virulência fúngica. Sendo assim, os resultados da análise de concentração inibitória mínima sugerem que uma concentração subinibitória de clorexidina possa estar atuando na virulência da Candida spp. No entanto, não foram encontrados resultados para confirmar a eficácia clínica do diacetato de clorexidina a 1% incorporado ao reembasador macio testado no tratamento da estomatite protética.

The aim of this pilot study was to compare the efficacy of rebase using soft acrylic liner with or without 1% chlorhexidine diacetate in denture stomatitis patients. It was hypothesised that: (I) erythema would be improved (IIa): colony forming unit count would be reduced, (IIb): the predominance of a morphological type of Candida would be correlated with clinical features and, (IIc) a minimum inhibitory concentration of the antimicrobial, could be able to act on the growth of the fungus.Sixteen patients who wearing removable dentures and diagnosed with denture stomatitis were randomly assigned to the control groups (rebase with resilient liner) and test group (rebase with resilient liner containing 1% of chlorhexidine), followed by clinical and laboratory tests for 14 days. The analyzed parameters at two follow-up were: clinical evaluation (examination and photos) and microbiological evaluations (smears and cultures of palates and dentures). This study was a randomized, double-blind, controlled clinical trial. The results obtained showed that the erythema surface was significantly reduced, but did not differ significantly between the two groups (P> 0.05), as did the reduction of colony forming unit during treatment between the groups (P> 0.05) . The Candida type could not be correlated to the achieved clinical stage. The minimum inhibitory concentration test results showed that a concentration of 0,05 µg/ml chlorhexidine is already able to inhibit the growth of 85% of the tested strains. The primary hypothesis was confirmed, which can be interpreted as an accelerated clinical remission in both proposed therapies. Although secondary hypotheses have not been confirmed, Candida's persistence may be just colonization, and the morphological plasticity of Candida seems to be strongly influenced by fungal virulence. Thus, the results of the minimum inhibitory concentration analysis suggest that a subinhibitory concentration of chlorhexidine may be acting on the virulence of Candida spp. However, no results were found to confirm the clinical efficacy of 1% chlorhexidine diacetate incorporated into the soft liner in denture stomatitis.

Improving practice guidelines for the treatment of denture-related erythematous stomatitis: a study protocol for a randomized controlled trial.

BACKGROUND: Denture-related erythematous stomatitis (DES) is a chronic biofilm-mediated disease, affecting one in every three complete denture wearers. Antifungals are the treatment most commonly prescribed by oral health professionals, based on the belief that colonization by Candida spp. is the main cause of DES. However, high recurrence rates and adverse effects are commonly observed, prompting the need for practice guidelines regarding treatment. Results from our pilot study demonstrate that palatal brushing can reduce the palatal inflammation and potentially associated Candida carriage without any need for antifungal therapy. The objective of this study is to validate these pilot results by means of a randomized controlled trial (RCT) and provide a practice guideline for clinicians. METHODS/DESIGN: A pragmatic, two-parallel-arm, multicenter RCT will be conducted in Canada, Brazil, and Chile. Fifty-two adult complete denture wearers presenting with moderate to severe DES will be allocated randomly to two groups: the Intervention arm will consist of palatal brushing and standard oral and denture hygiene measures, while the Control arm will include only standard oral and denture hygiene measures. The study outcome will be the oral Candida carriage. Participants will be assessed at baseline, and at 3 and 6 months post intervention. Descriptive, bivariate, and mixed models with repeated measures will be performed following the intention-to-treat principle. DISCUSSION: This pragmatic RCT will serve to provide a clinical practice guideline regarding the use of preventive measures in the treatment of biofilm-mediated oral diseases. Moreover, it will have a great impact on reducing the harm of antifungal overtreatment on patients suffering from DES. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02686632 . Registered on 15 February 2016.

Distribution of traumatic injuries after the installation of complete dentures in adult patients

Aim Describe the location of traumatic lesions of the oral mucosa that develop after the installation of complete dentures, as well as to quantify the number of post-operative controls that are required. A descriptive study was conducted by examining 84 patients who attended the dental center of Universidad de Los Andes, San Bernardo, during the period from July 2012 to July 2013. A sample of 120 edentulous patients was obtained. After the fabrication and installation of the complete dentures, at least 3 post-operative controls were performed and the location of oral lesions was recorded. Documentation of the association between the patient's clinical variables and the appearance of oral lesions during the first 3 controls was performed using a logistic regression. Results For maxillary dentures, 5 post-operative visits were made and 6 controls for mandible dentures. In the upper jaw the anatomical areas of higher incidence of traumatic injuries were: canine fossa (23.9%), average bridle (23.1%), and distobuccal sulcus (20.1%). In the lower jaw, the highest number of lesions were recorded on the anterior lingual flank (16.5%), anterior and posterior lingual flank (13.4%), and distobuccal sulcus (12.8%). A significant association was observed between subjects who reported consumption of cholesterol-lowering medications and the development of traumatic lesions of the oral mucosa (OR: 0.25 and 95% CI: 0.055-0.939). The installation of complete dentures does not determine that the treatment has ended. Post-operative controls are needed to assess areas of erythema and ulceration.

Objetivo Describir la ubicación y frecuencia de las lesiones traumáticas de la mucosa oral que se generan después de la instalación de las prótesis dentales completas, y cuantificar el número de controles postoperatorios necesarios. Se realizó un estudio descriptivo, examinando a 84 pacientes que asistieron al centro dental de la Universidad de Los Andes, durante el período comprendido entre de julio de 2012 y julio del de 2013. Se obtuvo una muestra de 120 pacientes edéntulos. Después de la fabricación e instalación de las dentaduras completas se realizaron por lo menos 3 controles postoperatorios y la localización de las lesiones orales fue registrada. La documentación de la asociación entre las variables clínicas de los pacientes y la aparición de lesiones orales durante los 3 primeros controles fue realizado por medio de una regresión logística. Resultados Para prótesis maxilar 5 visitas de controles postoperatorios fueron realizados y 6 para mandibulares. En el maxilar superior las zonas de mayor incidencia de lesiones traumáticas fueron: fosa canina (23,9%), flanco medio (23,1%) y distovestibular del surco (20,1%). En la mandíbula se registraron mayor frecuencia de las lesiones en el flanco lingual anterior (16,5%), anterior y posterior (13,4%) y distovestibular del surco (12,8%). Una asociación significativa se observó entre los sujetos que reportaron consumo de medicamentos reductores del colesterol y el desarrollo de las lesiones traumáticas de la mucosa oral (o: 0,25 e IC: 0,055-0,939). La instalación de las prótesis dentales completas no determina que el tratamiento haya terminado. Los controles postoperatorios son necesarios para evaluar las áreas de eritema y ulceración.

Oral squamous cell carcinoma misdiagnosed as a denture-related traumatic ulcer: A clinical report.

A 65-year-old woman presented with an ulcerated lesion in the alveolar ridge mucosa, which appeared after new dentures had been inserted. Despite many treatment attempts, the lesion did not recede, even with the interruption of denture wearing. A biopsy was performed, and histopathologic examination revealed an ulcerated, invasive, poorly differentiated oral squamous cell carcinoma. The time from the patient's first contact with the prosthodontist because of the lesion until the appropriate diagnosis was established was approximately 6 months. This clinical report documents a significant delay in the oral squamous cell carcinoma diagnosis and treatment because of a clinical misdiagnosis of a traumatic ulcer resulting from complete dentures. Prosthodontists should be aware of the importance of early diagnosis of oral cancer among elderly prosthesis wearers.

Avaliação da atividade proliferativa celular das lesões bucais causadas pelo uso de próteses totais através da impregnação tecidual pela prata / Proliferative cellular activity evaluation of lesions caused by dentures through tissue silver impregnation

Introdução: As próteses totais visam conservar a função do sistema estomatognático do paciente totalmente edêntulo. Porém, na mucosa bucal podem aparecer manifestações cuja principal causa são as próteses totais mal adaptadas. Objetivo: o presente estudo objetiva investigar a proliferação tecidual das lesões causadas por próteses totais removíveis através do método de impregnação pela prata (AgNOR), com isso facilitando o tratamento e a determinação do prognóstico das lesões a serem estudadas. Metodologia: foram selecionados todos os casos das lesões bucais mais comumente associadas à utilização de próteses totais registradas no Serviço de Diagnóstico Histopatológico do ICB­UPF nos anos de 2012 e 2013, tendo sido encontrados 5 casos de granuloma piogênico, 5 casos de hiperplasia de fundo de sulco, 5 casos de fibroma de irritação e 2 casos de fibroma ossificante periférico. Os cortes histopatológicos das lesões foram impregnados pela prata (método AgNOR), tendo sido obtido, com auxílio do programa Image Tool®, o número de NORs de 100 células de cada caso, resultando numa média de NORs em cada grupo de lesões. Resultados: os resultados obtidos foram tabulados em planilha eletrônica e a comparação do número médio de NORs de cada grupo foi realizado por meio do teste estatístico ANOVA, 5% de significância. Resultados: o grupo das hiperplasias de fundo de sulco mostrou média de 2,41 NORs por núcleo, o grupo dos granulo mas piogênicos mostrou 2,44, o fibroma de irritação 2,22, e o fibroma ossificante periférico mostrou média de 1,89 NORs por núcleo celular, diferindo estatisticamente esta lesão das anteriormente mencionadas (p = 0,002). Conclusão: o fibroma ossificante periférico mostrou ser a lesão causada por prótese total removível com a menor atividade proliferativa celular. Tal estudo precisa ser complementado por futuros estudos clínicos.

Introduction: the total dentures are aimed at preserving the function of the stomatognathic system of the fully edentulous patient. However, in the oral mucosa may appear manifestations whose main cause are the totally unsuitable dentures. Objective: this study aims to investigate the proliferation of tissue lesions caused by removable dentures by impregnation method for silver (AgNOR), thereby facilitating the treatment and determining the prognosis of the lesions to be studied. Methodology: we selected all cases of oral lesions most commonly associated with the use of dentures recorded in Histopathological Diagnostic Service ICB-UPF in the years 2012 and 2013, having been found 5 cases of pyogenic granuloma, 5 cases of hyperplasia, 5 cases of irritation fibroma and 2 cases of peripheral ossifying fibroma. Histopathological lesions cuts were impregnated by silver (AgNOR method), having been obtained with the aid of the program Image Tool®, the number of NOR cells 100 in each case, resulting in an average NORs in every group of lesions. Results: the results were tabulated in a spreadsheet and comparing the average number of NORs of each group was conducted through ANOVA, 5% significance level. Results: The group of hyperplasias showed average of 2.41 NORs per nucleus, the group of pyogenic granulomas showed 2.44, the irritation fibroma 2.22, and peripheral ossifying fibroma showed average of 1.89 NORs for cell nucleus, differing significantly from that of the aforementioned lesions (p = 0.002). Conclusion: the peripheral ossifying fibroma proved the injury caused by removable dentures with lower cell proliferative activity. This study needs to be complemented by future clinical studies.

Masticatory efficiency in complete denture wearers with reduced dental arches--a randomised cross-over study.

One obstacle to placing artificial posterior teeth in manufacturing complete dentures is a reduction of the space between the maxilla and the mandible. Occasionally, second molar placement is not performed, as it does not affect aesthetics, phonetics or comfort. The aim of this study was to compare the masticatory efficiency between patients wearing maxillary and mandibular complete dentures with reduced dental arches (without second molars) (WSM) and with full dental arches (FDA). Twenty subjects were divided into two groups and randomly received new complete dentures. Patients in Group 1 were given dentures WSM, and those in Group 2 were given dentures with FDA. After the post-placement visits, an initial masticatory efficiency test was performed with Optocal, an artificial test food. Fifteen days later, second molars were placed in Group 1 and removed from Group 2, and a new test was performed. Comminuted material was treated and sieved under vibration. The mean and standard deviation of masticatory efficiency with FDA were 10.4 and 8.1, respectively. In the tests WSM, the mean and standard deviation were 8.4 and 3.3, respectively. After removing the second molars in Group 2 and adding them in Group 1, the mean and standard deviation were 15.7 and 14.7 for Group 1 and 12.5 and 10.4 for Group 2, respectively. Within the limitations of this study, placing artificial teeth up to the first molars can be performed when needed without compromising masticatory efficiency.

Effect of complete and partial removable dentures on chewing movements.

Partial or complete edentulism impairs mastication. However, it is unclear how the chewing cycle is affected by prosthetics. We evaluated the chewing movements of patients fitted with complete (CD) or removable partial denture (RPD). A total of 29 subjects were kinesiographically evaluated during chewing of peanuts and Optocal portions in a random sequence. The subjects were divided into two groups according to prosthesis type. Group RPD was composed of 14 partially edentulous patients using a lower distal extension RPD (mean age 61 ± 8 years), and group CD contained 15 completely edentulous patients using CD (mean age 65·9 ± 7·9 years) in both jaws. Opening, closing, occlusal and masticatory cycle times, movement angle (opening and closing), maximum velocity (opening and closing), total area and chewing cycle amplitudes were evaluated. The results were subjected to anova and Tukey's HSD test at a significance level of 5%. The RPD group exhibited shorter opening and closing phases and masticatory cycle time (P < 0·05). Maximum velocities were also higher in the RPD group, irrespective of the test material (P < 0·05). The area and amplitude of the chewing envelope was smaller in the CD group (P < 0·0001). The test material did not influence chewing cycles in any of the parameters evaluated (P > 0·05). RPD wearers use a faster chewing sequence with greater vertical and lateral jaw excursions compared with CD wearers.

Dificuldades diárias associadas às próteses totais / Daily difficulties associated with full conventional dentures

A efetividade de serviços de saúde pode ser avaliada pela ótica da qualidade de vida. Assim, este estudo avaliou o serviço de reabilitação a partir das dificuldades diárias associadas a próteses totais convencionais (PTC), produzidas entre 2007 e 2009, pelos Centros de Especialidades Odontológicas (CEO) de uma mesorregião do Rio Grande do Norte (RN). Realizou-se um estudo seccional com 138 usuários dessas PTC, coletando-se os dados por exame clínico e questionário baseado no indicador Oral Impacts on Daily Performances. Utilizaram-se os testes de Fisher e Qui-quadrado para testar associação das variáveis. Como resultado, 42% da amostra relatou dificuldades, relacionadas à PTC, para executar atividades bucais. Tais dificuldades foram mais frequentes e intensas nas atividades de comer, falar e sorrir. No total, 58,7% da amostra não tinha dentes funcionais. Quanto à avaliação clínica das PTC, 57,2% das superiores e 9,2% das inferiores estavam satisfatórias. Houve associação da presença de dificuldades e a ausência de dentes funcionais, mas não com PTC inadequadas. Assim, os CEO foram efetivos na reabilitação com PTC superior, já que as dificuldades encontradas integram limitações próprias a tal reabilitação. Por outro lado, o custo benefício da reabilitação inferior deve ser reavaliado.

The effectiveness of health services can be evaluated from the quality of life (QOL) standpoint. Thus, this study evaluated rehabilitation services using full conventional dentures (FCD) of Specialized Dental Care Centers (SDCC) in Rio Grande do Norte (RN) regarding daily difficulties associated with these dentures made between 2007 and 2009. A cross-sectional study was conducted with 138 users of these FCD, collecting data by clinical examination and a questionnaire based on the Oral Impacts on Daily Performances index. The Fisher and chi-square tests were used to test the association between the variables. The result was that 42% of users reported difficulties in executing oral activities due to FCDs. These difficulties were more frequent and intense in the activities of eating, speaking and smiling. In general, 58.7% of users did not have functional teeth. In relation to the clinical evaluation of FCDs, 57.2% of upper and 9.2% of lower FCDs were satisfactory. There was an association between difficulty and the absence of functional teeth, but not with inadequate FCDs. Thus, the SDCCs were effective in upper FCD rehabilitation, since the difficulties encountered are within the standard limitations of this type of rehabilitation. On the other hand, the cost-benefit of rehabilitation of lower FCDs must be evaluated.

[Daily difficulties associated with full conventional dentures]. / Dificuldades diárias associadas às próteses totais.

The effectiveness of health services can be evaluated from the quality of life (QOL) standpoint. Thus, this study evaluated rehabilitation services using full conventional dentures (FCD) of Specialized Dental Care Centers (SDCC) in Rio Grande do Norte (RN) regarding daily difficulties associated with these dentures made between 2007 and 2009. A cross-sectional study was conducted with 138 users of these FCD, collecting data by clinical examination and a questionnaire based on the Oral Impacts on Daily Performances index. The Fisher and chi-square tests were used to test the association between the variables. The result was that 42% of users reported difficulties in executing oral activities due to FCDs. These difficulties were more frequent and intense in the activities of eating, speaking and smiling. In general, 58.7% of users did not have functional teeth. In relation to the clinical evaluation of FCDs, 57.2% of upper and 9.2% of lower FCDs were satisfactory. There was an association between difficulty and the absence of functional teeth, but not with inadequate FCDs. Thus, the SDCCs were effective in upper FCD rehabilitation, since the difficulties encountered are within the standard limitations of this type of rehabilitation. On the other hand, the cost-benefit of rehabilitation of lower FCDs must be evaluated.

Impact of local and systemic factors on additional peri-implant bone loss.

OBJECTIVE: To assess the impact of local and systemic factors on additional peri-implant bone loss. METHOD AND MATERIALS: From a total of 253 patients, 193 were selected (126 women) and restored with 722 implants, in place for at least 1 year. Patients had previously attended the supportive periodontal/peri-implant therapy program at the Department of Implant Dentistry at the Federal University of Santa Catarina, Brazil. The study was divided according to physiologic (PBL < 2 mm) or additional bone loss (ABL >= 2 mm) evaluated from the time of prosthesis placement to the reassessment visit. Data collection and analysis included evaluation of systemic factors, such as history of periodontal disease, heart disease, hypertension, diabetes mellitus, hyperthyroidism/hypothyroidism, osteoporosis, kidney disease, alcohol abuse, smoking habits, chemotherapy, radiation therapy, menopause, and hormone replacement. Analysis of local factors included implant platform, diameter, location, time in function, and type of prosthesis. RESULTS: No systemic factors influenced ABL (P > .05). Considering local factors, only time in function and type of prosthesis influenced ABL (P < .05). CONCLUSION: Fixed partial dental prostheses and full-arch fixed prostheses present higher rates of ABL. In addition, all types of prostheses showed greater ABL when in function for more than 4 years.

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.

Epidemiology and etiology of denture stomatitis.

Denture stomatitis, a common disorder affecting denture wearers, is characterized as inflammation and erythema of the oral mucosal areas covered by the denture. Despite its commonality, the etiology of denture stomatitis is not completely understood. A search of the literature was conducted in the PubMed electronic database (through November 2009) to identify relevant articles for inclusion in a review updating information on the epidemiology and etiology of denture stomatitis and the potential role of denture materials in this disorder. Epidemiological studies report prevalence of denture stomatitis among denture wearers to range from 15% to over 70%. Studies have been conducted among various population samples, and this appears to influence prevalence rates. In general, where reported, incidence of denture stomatitis is higher among elderly denture users and among women. Etiological factors include poor denture hygiene, continual and nighttime wearing of removable dentures, accumulation of denture plaque, and bacterial and yeast contamination of denture surface. In addition, poor-fitting dentures can increase mucosal trauma. All of these factors appear to increase the ability of Candida albicans to colonize both the denture and oral mucosal surfaces, where it acts as an opportunistic pathogen. Antifungal treatment can eradicate C. albicans contamination and relieve stomatitis symptoms, but unless dentures are decontaminated and their cleanliness maintained, stomatitis will recur when antifungal therapy is discontinued. New developments related to denture materials are focusing on means to reduce development of adherent biofilms. These may have value in reducing bacterial and yeast colonization, and could lead to reductions in denture stomatitis with appropriate denture hygiene.

Clinical and antimicrobial efficacy of NitrAdineTM-based disinfecting cleaning tablets in complete denture wearers

OBJECTIVE: This study evaluated the efficacy of NitrAdineTM-based disinfecting cleaning tablets for complete denture, in terms of denture biofilm removal and antimicrobial action. MATERIAL AND METHODS: Forty complete denture wearers (14 men and 26 women) with a mean age of 62.3±9.0 years were randomly assigned to two groups and were instructed to clean their dentures according to two methods: brushing (control) - 3 times a day with denture brush and tap water following meals; brushing and immersion (Experimental) - brushing the denture 3 times a day with denture brush and tap water following meals and immersion of the denture in NitrAdineTM-based denture tablets (Medical InterporousTM). Each method was used for 21 days. Denture biofilm was disclosed by a 1 percent neutral red solution and quantified by means of digital photos taken from the internal surface before and after the use of the product. Microbiological assessment was conducted to quantify Candida sp. RESULTS: An independent t-test revealed a significant lower biofilm percentage for the experimental group (4.7, 95 percent CI 2.4 to 7.9) in comparison with the control group (mean 37.5, 95 percent CI 28.2 to 48.1) (t38=7.996, p<0.001). A significant reduction of yeast colony forming units could be found after treatment with Medical InterporousTM denture tablets as compared to the control group (Mann-Whitney test, Z=1.90; p<0.05). CONCLUSION: The present findings suggest that NitrAdineTM-based disinfecting cleaning tablets are efficient in removal of denture biofilm. In addition, a clear antimicrobial action was demonstrated. Therefore, they should be recommended as a routine denture maintenance method for the prevention of the development of microbial biofilm induced denture stomatitis.

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.

Exploratory factor analysis of the Brazilian OHIP for edentulous subjects.

The use of seven domains for the Oral Health Impact Profile (OHIP)-EDENT was not supported for its Brazilian version, making data interpretation in clinical settings difficult. Thus, the aim of this study was to assess patients' responses for the translated OHIP-EDENT in a group of edentulous subjects and to develop factor scales for application in future studies. Data from 103 conventional and implant-retained complete denture wearers (36 men, mean age of 69.1 +/- 10.3 years) were assessed using the Brazilian version of the OHIP-EDENT. Oral health-related quality of life domains were identified by factor analysis using principal component analysis as the extraction method, followed by varimax rotation. Factor analysis identified four factors that accounted for 63% of the 19 items total variance, named masticatory discomfort and disability (four items), psychological discomfort and disability (five items), social disability (five items) and oral pain and discomfort (five items). Four factors/domains of the Brazilian OHIP-EDENT version represent patient-important aspects of oral health-related quality of life.