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.

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.

Immediate loading of implants in the maxilla: survival and bone loss after at least 2 years in function.

PURPOSE: To compare survival and peri-implant bone loss around immediately loaded surface-enhanced implants in the maxilla supporting single crowns (SCs), fixed partial dentures (FPDs), and fixed full-arch dentures (FFDs). MATERIALS AND METHODS: The study included all subjects referred for implant treatment in the maxilla followed by immediate loading between November 2004 and 2007 with at least 2 years of follow-up. Smokers were excluded. Implant survival and bone loss were assessed by a calibrated external examiner who compared digital periapical radiographs taken during recall visits with baseline radiographs (day of loading = day after implant placement). An implant was considered successful when bone loss did not exceed 1 mm. Survival of implants supporting SCs, FPDs, and FFDs was compared using the log-rank test. A linear mixed-effect model analysis was used to evaluate bone loss because of clustering of implants in patients. RESULTS: Three hundred six implants were placed in 55 patients (31 women, 24 men; mean age, 57.5 ± 11.4 years; range, 19 to 77 years) and followed for a mean of 35 ± 10.2 months (range, 24 to 58 months). One implant failed, resulting in an overall survival rate of 99.7% on the implant level and 98.2% on the patient level. No statistically significant differences were observed in the survival rates for SCs (100%), FPDs (98%), and FFDs (100%). The overall mean bone loss was 0.27 ± 0.37 mm (range, 0.00 to 2.55 mm) and was not influenced by the prosthetic reconstruction. CONCLUSION: Immediate loading of fluoride-modified implants in the maxilla is a predictable and reliable treatment option with high survival rates and limited peri-implant bone loss after 2 years. No statistically significant differences were found between implants supporting SCs, FPDs, and FFDs.

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.

Congruency of stereo lithographically produced surgical guide bases made from the same CBCT file: a pilot study.

PURPOSE: This is a pilot study evaluating the effect of the algorithms and production processes of four commercial manufacturers of stereolithographically produced surgical guide. MATERIALS AND METHODS: A singular Dicom file was used to produce six distinct duplicate dentures, which function as the base for surgical guides. The duplicate dentures were repeatedly fitted (n = 10) into an impression of the occlusal surface of the original scan appliance. The gaps between the incisal edge of teeth #8 and #9 and the corresponding imprints in the vinyl polysiloxane impression were photographed, digitally recorded, and measured in a blinded fashion. RESULTS: Nobel Biocare mean was 0.56 mm (range 0.49-0.65), I-dent mean was 0.57 mm (range 0.31-0.74), Materialise II mean was 1.12 mm (range 0.90-1.40), Blue Sky Bio II mean was 1.13 mm (range 0.93-1.35), Materialise I mean was 1.43 mm (range 1.21-1.86), and Blue Sky Bio I mean was 2.17 mm (range 2.06-2.34). The difference between the fit of the Nobel Biocare and the I-dent guide bases and the guide bases from Materialise and Blue Sky Bio is statistically significant (p < .05). CONCLUSION: The algorithms and production processes of the different manufactures do influence the congruency outcome of the produced surgical guide bases. Within the limits of this study, we were unable to produce a perfect fit, although some duplicate dentures showed minimal errors. The implications of the discrepancies need further study.

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.

Denture stomatitis and its risk indicators in south Brazilian older adults.

OBJECTIVE: The purpose of this study was to evaluate if socio-demographic, behaviour and health variables are risk indicators for denture-related stomatitis in community-dwelling older adults from Carlos Barbosa, Brazil. MATERIALS AND METHODS: In this cross-sectional study, 872 subjects aged 60 years or more were evaluated. Data collection included dental examinations and questionnaires to assess socio-demographic, behaviour, general and oral health data. All questionnaires and examinations were carried out during 2004. Associations between the independent variables and the outcomes 'prevalence of denture stomatitis' or 'prevalence of granular stomatitis' were adjusted by means of multivariate logistic regressions. RESULTS: Participants with denture stomatitis were significantly more likely to be females, to display increased amounts of plaque, and significantly less likely to visit the dentist for treatment. Participants with granular stomatitis were significantly more likely to be females and participants with granular stomatitis were significantly more likely to be females, aged 70 years or more and current smokers. In addition, participants with granular stomatitis displayed increased amounts of plaque. CONCLUSION: The data presented here confirms the central role of denture biofilm accumulation in denture stomatitis. It also indicates that smoking may increase susceptibility to infection in its most severe form.

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.

Oral status and its association with obesity in Southern Brazilian older people.

BACKGROUND AND OBJECTIVE: The loss of a functional dentition imposes eating difficulties and food avoidance, which may be detrimental in terms of nutritional status and health. The objective of this study was to investigate whether tooth loss and edentulism that were not rehabilitated with dental prostheses were associated with obesity among elderly in Southern Brazil. MATERIALS AND METHODS: A random sample of 872 independently living elderly was evaluated by means of a cross-sectional study. Socio-demographic, medical history and behaviour data were assessed using a standardised questionnaire. Two trained dentists assessed the number of teeth and use of prostheses in accordance with the WHO criteria. Height and weight were assessed and used to generate body mass index (BMI = weight (kilos)/height (cm)(2)) data. Participants were categorised into non-obese (BMI 30). Multivariate logistic regression was used to model the relationship between number of teeth and use of dental prostheses with obesity adjusting for confounders. RESULTS: Multivariate logistic regression revealed that edentulous persons wearing only upper dentures (OR = 2.34, 95% CI 1.18-4.27) and dentate participants with one to eight teeth wearing 0-to-1 prosthesis (OR = 2.96, 95% CI 1.68-5.19) were more likely to be obese. CONCLUSION: The results show that a poorer oral status, represented by having fewer teeth that were not replaced by dental prostheses, was associated with obesity in Southern Brazil older people, suggesting a close relationship between poor oral status and systemic conditions that may have important clinical implications.

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.

In vivo force measurements on maxillary implants supporting a fixed prosthesis or an overdenture: a pilot study.

STATEMENT OF PROBLEM: In this preliminary study, an attempt was made to measure in vivo forces simultaneously on 5 maxillary implants with different types of superstructure. MATERIAL AND METHODS: Force measurements were carried out on 1 test patient with 5 ITI implants in the edentulous maxilla. A screw-retained fixed complete denture and an overdenture were fabricated for comparative measurements of forces. The overdenture could be mounted to 2 different types of bars. The measuring method was used with piezo-electric force transducers that were directly mounted onto the implants. This allowed for simultaneous measurements of forces in 3 dimensions, ie, in axial and transverse directions. Static and functional forces such as maximum biting (clenching), biting on a bite plate, and chewing food were registered. All measurements were repeated in the same way 2 years later. RESULTS: The registered forces exhibited similar force patterns with both types of superstructure and both types of bars for overdenture connection. The force magnitudes were significantly different for the 3 dimensions (P<.05) with highest forces along the implant axis. On the posterior implants, force magnitudes were significantly higher (P<.05) than on the anterior implants in all 3 dimensions. On the anterior implants, under some test conditions, the transverse force components reached up to 100% of the axial force or even exceeded it during the chewing of food. During maximum biting, no upward force (tensile force) was found on any implant with the fixed complete denture, but upward force was found on one anterior implant with the overdenture. When chewing food, small force magnitudes in upward directions were regularly found with both superstructures. The force patterns between the first and second registrations showed similar trends, and no obvious differences were found. CONCLUSION: From these results it was concluded that similar patterns of force transmission onto the implants are observed with a fixed complete denture and an overdenture connected to maxillary implants. The bar design did not significantly influence the force pattern.

Gastroenterological drugs and denture stomatitis.

The aim of this study was to investigate the medical and dental variables related to the presence of denture stomatitis. The study population was comprised of 106 elderly people (82 women, 24 men; mean age, 81.3 years) using a maxillary complete denture and living in a geriatric nursing home in Oulu, Finland. The following variables were used in the analysis: medical diagnoses, which could have a possible biological association with stomatitis; daily use of drugs; ability to cope with everyday life; oral hygiene; and the condition of the denture. The prevalence of stomatitis was 52% among residents wearing complete dentures. Patients receiving gastroenterological drugs had less stomatitis (p = 0.01, chi-square). The results suggest a preliminary finding that older adults using gastroenterological drugs had less stomatitis.

Keratinization of palatal mucosa beneath metal-based removable partial and acrylic-based complete dentures compared with normal palatal mucosa: a clinical, cytological and histological study.

Normal human palatal epithelium is an orthokeratinizing tissue with a well-developed stratum corneum. Several cytological and histological studies showed that when the palate covered by a denture fully or partially, keratinization of the mucosa changes. The results of some studies suggested that keratinization changes from orthokeratosis to parakeratosis, and there is a reduction in the thickness of stratum corneum. Whereas the results of some other studies showed increased orthokeratinization. This study was planned to determine changes in keratinization of palatal mucosa in denture wearers compared with normal palatal mucosa. Keratinization of palatal mucosa was examined by mainly exfoliative cytology in three groups. Group-1 consisted of 51 patients wearing metal-based removable partial denture; group-2 consisted of 50 patients wearing acrylic-based complete denture and group-3 including 57 healthy volunteers who have not been wearing denture served as the controls. In each group, the results of exfoliative cytology were supported by histological examinations. Statistical results showed that either acrylic-based complete or cobalt-chromium-based removable partial dentures seem to reduce the quantity and/or quality of the keratin layer. The mean values of keratinization and the thickness of stratum corneum were significantly lower in the complete denture group than in the partial denture group. Furthermore the reliability of exfoliative cytology was confirmed by the guidance of histological examination.

Functional adaptability to changes in lower denture shape.

Forces exerted on the right and left lingual and buccal flanges of Kennedy Type I mandibular dentures were studied using an 8 channel recording technique, during resting, swallowing, talking, reading and simulated mastication. The effects of adaptation, head position and incremental thickening of the flanges were determined. Highest forces were recorded when swallowing, with smaller differences between the other activities. Lingual forces were higher than buccal, and posterior forces higher than anterior ones. There was a highly significant relationship between increases in flange thickness of 2 and 3mm and increases in peak forces. Evidence for adaptation and effects related to head position was weaker.