|Year : 2016 | Volume
| Issue : 4 | Page : 275-280
Assessment of denture hygiene maintenance among elderly patients in Nizamabad (Telangana) population: A survey
Pothala Gautham, Molugu Mallikarjun, Kalyan Chakravarthy, Kandukuri Rohan Kumar, Veerendra Budege, Nagesh Bodankar
Department of Prosthodontics, Meghna Institute of Dental Sciences, Nizamabad, Telangana, India
|Date of Web Publication||23-Dec-2016|
Kandukuri Rohan Kumar
Department of Prosthodontics, Meghna Institute of Dental Sciences, Mallaram (v), Nizamabad, Telangana
Source of Support: None, Conflict of Interest: None
Objective: To determine the denture cleanliness and denture hygiene habits in complete denture wearers in Nizamabad's population.
Materials and Methods: In this study, a self-administered structured questionnaire was developed to know the attitude of the patients from the Department of Prosthodontics regarding denture hygiene. The study sample consisted of a total of 200 subjects, which included 110 (55%) males and 90 (45%) females.
Results: Nearly half of the subjects cleaned their dentures daily (70%). Participants from the younger age group and who had been wearing dentures from 0 years to 5 years maintained a better frequency of cleaning. The majority of these subjects used brush and toothpaste for denture cleansing. After seeing the condition, approximately half of the dentures were rated as dirty (48%). Around 41% of patients were not satisfied with their cleansing methods and 78.5% of the patients claimed that their dentists did not inform them about how to clean their dentures. Older dentures tended to be dirtier than the newer ones (P = 0.0001) and had a higher incidence rate of accompanying denture stomatitis (P = .0001).
Conclusion: The poor condition of complete dentures seen in the population was mainly due to irregular cleansing habits and also less usage of cleansing solutions. Dentists should give proper instructions regarding the maintenance of denture hygiene.
Keywords: Cleansing angents, cleansing habit, denture hygiene
|How to cite this article:|
Gautham P, Mallikarjun M, Chakravarthy K, Kumar KR, Budege V, Bodankar N. Assessment of denture hygiene maintenance among elderly patients in Nizamabad (Telangana) population: A survey. J NTR Univ Health Sci 2016;5:275-80
|How to cite this URL:|
Gautham P, Mallikarjun M, Chakravarthy K, Kumar KR, Budege V, Bodankar N. Assessment of denture hygiene maintenance among elderly patients in Nizamabad (Telangana) population: A survey. J NTR Univ Health Sci [serial online] 2016 [cited 2020 Apr 5];5:275-80. Available from: http://www.jdrntruhs.org/text.asp?2016/5/4/275/196562
| Introduction|| |
Tooth loss in any adult population is highly likely to increase as the population ages because the factors that lead to the loss of teeth - dental caries, loss of periodontal support, a history of dentoalveolar trauma, and a history of dental care are additive over time. For this reason, the rates of complete tooth loss are customarily the highest in the oldest age groups. 
Complete dentures are the most common treatment for total loss of teeth in a dental arch. Although the prevalence of total tooth loss continues to decline among adults, population shifts have resulted in a sustained, even slightly increasing demand for complete dentures.  Rehabilitative treatment is successful only when patients are motivated and aware of the correct prosthesis usage and hygiene. The accumulation of stains and soft and hard debris on removable dentures may have undesirable effects on the patient's oral health. The quality of the denture fitting surface, occlusal relations, denture age, and hygiene are important factors contributing to the prevalence of oral mucosal lesions associated with denture use. 
Lesions of the oral mucosa associated with wearing of removable dentures may represent acute or chronic reactions to microbial denture plaque, a reaction to constituents of the denture base material, or a mechanical denture injury. The lesions constitute a heterogeneous group with regard to pathogenesis. They include denture stomatitis, angular cheilitis, traumatic ulcers, denture irritation hyperplasia, flabby ridges, and oral carcinomas. 
Care of dentures and the mucosal tissues of the edentulous mouth are important for the overall health, especially in older persons. Unclean dentures causing or contributing to oral mucosal disease and/or impairment in eating, therefore, may have a more profound effect on a frail elder person than on a younger, healthier person. 
There are various methods and materials that evolved over a period so as to provide efficient plaque control. These include:
Mechanical: Brush, pastes and powders, ultrasonics.
Chemical denture cleansers: Alkaline peroxides, alkaline hypochlorides, acids, disinfectants.
Recent methods: Enzymes.
Peracini et al.  reported that 58.49% of the patients used immersion for cleaning and among the substances used for immersion of the dentures, water was the most frequently used (38.71%) followed by sodium hypochlorite (33.87%). In the study by Baran and Nalça, 42.9% of the patients immersed their dentures in water and only 1.6% immersed them in hypochlorite solution. Hoad-Reddick et al.  found that a combination of methods (brushing and soaking) was used more frequently.
Patients should be instructed to rinse their dentures and their mouths after meals whenever possible. The mucosal surfaces of the residual ridges and the dorsal surface of the tongue also should be brushed daily with a soft brush; denture cleansers may also be used. However, it has been observed that the majority of denture wearers do not pay necessary attention to the cleanliness. This may be due to decreasing manual abilities due to advanced age. ,
This cross-sectional study/survey aimed to investigate the denture hygiene habits among old age denture wearers from the department of prosthodontics.
| Materials and methods|| |
The present cross-sectional survey was conducted among denture wearer patients coming for follow-up in the department of prosthodontics and implantology from December 2013 to January 2015.
The study sample consisted of a total of 200 participants; out of them, 110 (55%) were males and 90 (45%) were females. They were further categorized according to age groups 41-50 years (Group I), 51-60 years (Group II), and ≥60 years (Group III).
After obtaining ethical clearance from the committee, a questionnaire was developed and given to the patients to be filled. The purpose of the survey was explained to the subjects and their written consent was obtained.
The survey was performed by means of a questionnaire and clinical examination of the patients' oral mucosa and cleanliness of their dentures. The questionnaire sought to identify the types and frequencies of denture-cleaning methods, satisfaction with the method used, age of dentures, and whether patients had ever been instructed on how to clean their dentures. An examiner administered surveys from December 2013 to January 2015. The questionnaire was based on previously conducted surveys by Hoad-Reddick et al.  and Osborne et al. ,
Questions relating to denture cleanliness and use were as follows:
The dentures were classified into four groups according to their ages:
- How long have you been using your dentures?
- 2When do you wear your dentures?
- How frequently and by which method(s) do you clean your dentures?
- Do you feel you can clean your dentures properly?
- Has a dentist or his/her staff ever shown you or told you how to clean dentures?
- How often do you visit your dentist?
Group 1-0-5 years old; Group 2-6-10 years old; Group 3-11-30 years old; and
Group 4-over 31 years old. For the analysis of cleansing methods, results were pooled so that the three groups ultimately compared consisted of those who brushed only, those who soaked only, and those who performed a combination of brushing and soaking.
After the dentures were removed from the mouth and rinsed under tap water to clean off newly accumulated mucin and food debris, they were examined under a standardized light source to evaluate their cleanliness. Meanwhile, the oral mucosa was examined visually to assess the presence or absence of stomatitis.
The cleanliness of the denture was noted and scored based on the levels of the debris and stain. This scoring was done according to the studies conducted by Hoad-Reddick et al. ,
Score 1 (clean): Dentures showed no soft/hard debris or stain.
Score 2 (dirty): Soft debris was still present between the teeth after washing under tap water, and/or hard debris or stains were present around the gingival margins and were lingual to the mandibular central incisors or buccal to the maxillary molars.
Score 3 (extremely dirty): Soft debris was packed not only between the teeth but also over the tissue surface of the denture, and/or hard debris and stains covered the teeth, flanges, tissue surface, and palate.
A chi-square test was used to analyze the results, and values of P < .05 and P < .01 were considered to be statistically significant.
| Results|| |
Patients were distributed into four denture age groups as follows:
65 patients had dentures that were 0-5 years old, 90 patients had dentures that were 6-10 years old, 35 patients had dentures that were 11-30 years old, and only 10 patients had dentures that were over 31 years old [Table 1].
Dentures were worn by 104 patients (52%) during daytime only, by 82 patients (41%) for the full 24 h, and by 14 patients (7%) for either eating or social reasons only. The respondents used a variety of methods for cleaning their dentures. The methods used by patients are shown in [Table 2]. The most preferred regimen (42% of the patients) was brushing only with toothpaste while the least used method was soaking in mouthwash (one patient). Of all the respondents, 10 patients preferred soaking, 2 used a household cleanser of the hypochlorite type, while 7 used cleansing tablets. On the other hand, 75 patients preferred a combination of methods, which consisted primarily of brushing their dentures regularly but soaking irregularly while 40 used brushing combined with cleansing tablets. Thus, cleansing tablets was the method of choice for only 20% of all the respondents.
Dentures were cleaned daily by 70.0% of the patients, two to three times weekly by 11% of the patients, and once weekly by 14% of the patients; 5% claimed to be unable to remember how frequently they cleaned their dentures. Of all the patients performing daily cleaning, 38% were doing it once, 21% twice, and 11% three times a day [Table 3].
One hundred forty-three patients (59%) seemed satisfied with their cleaning methods and thought their dentures to be clean. Most of the patients (81%) stated they had never been shown how to clean dentures by their dentist or dental staff.
One hundred twenty-six (63%) visited their dentists only when they had problems with their dentures while 74 (47%) had never visited.
Correlation between various parameters
The results of denture cleanliness are shown in [Table 4]. Only 13% of the patients had clean dentures. The relationship between cleanliness of dentures and prior instruction from a clinician is shown in [Table 5]. There was a significant correlation between denture cleanliness and prior instruction (P = .0001). The majority of the patients with clean dentures (21 out of 26 patients) were previously instructed by their dentists. Stomatitis was observed in 51.5% of all the respondents. The relationship between the prevalence of stomatitis and frequency of denture cleaning is shown in [Table 6]. There was no statistically significant correlation between denture stomatitis and frequency of denture cleaning (P > .05).
|Table 5: Relationship between cleanliness of dentures and prior instructions |
Click here to view
|Table 6: Relation between prevalance of denture stomatitis and frequency of cleaning |
Click here to view
The relationship between age of dentures and presence or absence of stomatitis is shown in [Table 7]. According to the results, the incidence of stomatitis increased significantly as the dentures aged (P = .0001).
|Table 7: Relation between prevalence of denture stomatitis and age of dentures |
Click here to view
The results of denture cleanliness with regard to denture age are shown in [Table 8]. The relationship between denture age and level of cleanliness was found to be highly significant (P = .0001). The dentures were observed to be dirtier as the duration of denture use increased. The relationship between the presence or absence of stomatitis and denture cleanliness is shown in [Table 9]. There was a significant correlation between denture cleanliness and the presence of stomatitis (P = .0001). As dentures became dirtier, the incidence of stomatitis increased. For the extremely dirty denture group, the number of patients with stomatitis was larger than the number of patients with healthy mucosa.
|Table 8: Relationship between age of the dentures and cleanliness of dentures |
Click here to view
|Table 9: Relationship between cleanliness of dentures and prevalence of denture stomatitis |
Click here to view
| Discussion|| |
The survey revealed the denture cleansing habits of a group of 200 subjects. Brushing only, with toothpaste, was the most preferred regimen employed by 42% of the patients. A comparison between the results of the present questionnaire and that conducted by Kulak-Ozkan et al.  and Idil Dikbas et al. shows that the majority of denture wearers employ brushing as the sole method of cleaning. Jagger and Harrison  also reported similar results in their survey. Toothpastes have the advantage of being simple to use and relatively inexpensive. However, if used overenthusiastically or with an incorrect brushing technique, they can cause damage to the denture base materials. Among users who preferred only the soaking method, soaking in a cleansing tablet was the most used method (3.5%). Chemical methods have the advantage of being simple to use. However, some can be costly and may cause deterioration of the denture base material in the form of discoloration (bleaching) of acrylic resin 5 or corrosion of the metal.
Studies ,,, show that some denture wearers experience difficulty in satisfactorily cleaning their dentures, and many wear dirty dentures. Our study confirmed this finding, with 48% of the respondents wearing dirty dentures and 39% wearing extremely dirty dentures. While 143 patients (59%) seemed to be satisfied with their cleaning methods and considered their dentures clean, only 26 (13%) patients' dentures were assessed as clean by the examiner. The findings of this survey agreed with those of previous surveys, , suggesting that a large number of people do not know how to clean their dentures as a result of either never having been given instructions or not following instructions. The use of dentures for 24 h by a majority of the patients (41%) could be a cause of dirty dentures as well.
Prior instruction from a clinician appears to have a positive influence on the cleanliness of dentures. It was recorded that only 43 of 200 patients were instructed in the denture cleaning protocol and only 21 of those patients actually had clean dentures. This observation emphasizes the importance of patient education.
In this survey, older prostheses were dirtier than the newer ones and associated with a higher incidence of denture stomatitis. Both correlations coincided with the results of Hoad-Reddick et al.  and were statistically significant.
In the present study, 51.5% of the respondents exhibited signs of stomatitis. Several authors have reported variations in the occurrence of denture stomatitis ranging 11-67%. ,, Clinical examination was used to determine the status of oral mucosa, which was similar to several studies. , Regarding the frequency of cleaning, previous surveys showed similar results for the number of patients who cleaned daily (between 74.1% and 83.0%), which was consistent with our results (70.0%). While most researchers did not examine the relationship between frequency of cleaning and prevalence of denture stomatitis, Kulak-Ozkan et al.  reported that an increased incidence of stomatitis was seen in patients who cleaned their dentures once a day, compared to patients who cleaned less than once a day and our results were similar to these studies.
| Conclusion|| |
In the present study, most of the patients were unaware of the measures of cleaning dentures and did not clean their dentures satisfactorily, which likely a result of negligence of both clinicians (inadequate hygiene instruction) and patients (failure to seek periodic recalls or follow hygiene instructions). Maximum patients used brushing only to clean the dentures among which brushing using toothpaste was the preferred one. Combination method of cleaning dentures was the next most common with cleansing tablets as the most common cleansing agent. Only a negligible number used chemical method, i.e., immersion in cleansing solution. Awareness needs to be increased among denture wearers by conducting educational and motivational camps. Further research with microbiological examination of the patient's oral mucosa is required to accurately correlate the various factors studied.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Douglass CW, Gammon MD, Atwood DA. Need and effective demand for prosthodontic treatment. J Prosthet Dent 1988;59:94-104.
Shay K. Denture hygiene: A review and update. J Contemp Dent Pract 2000;1:28-41.
Patel IB, Madan G, Patel B, Solanki K, Chavda R. Behaviours and hygiene habits of a sample population of complete denture wearers in Ahmedabad. J Int Oral Health 2012;4:29-38.
Budtz-Jorgensen E. Oral mucosal lesions associated with the wearing of removable dentures. J Oral Pathol 1981;10:65-80.
Abelson DC. Denture plaque and denture cleansers: Review of the literature. Gerodontics 1985;1:202-6.
Peracini A, Andrade IM, Paranhos Hde F, Silva CH, de Souza RF. Behaviors and hygiene habits of complete denture wearers. Braz Dent J 2010;21:247-52.
Hoad Reddick G,Grant AA, Griffiths CS. Investigation into the cleanliness of dentures in an elderly population. J Prosthet Dent 1990;64;48-52.
Murtomaa H, Kononen M, Laine P. Age and maintenance of removable dentures in Finland. J Oral Rehabilitation 1992;19:123-8.
Bunett CA , Calwell E, Clifford TJ. Effect of verbal and written education on denture wearing and cleansing habbits. Eur J Prosthodont Restorative Dent 1993;2:79-83
Osborne J, Maddick I, Gould A, Ward D. Dental demands of old people in Hampshire. Br Dent J 1979;146;351-5.
Hoad-Reddick G. Grant AA. Prosthetic status: The formation of a schedule. J Prosthet Dent 1988;59:105-10.
Kulak-Ozkan Y, Kazaoglu Y, Ankan A. Oral hygiene habits. Denture cleanliness, presence of yeast and stomatitis in elderly people. J Oral Rehjabil 2002;29:300-04.
Jagger DC. Denture plaque and denture cleansing-The best approach.Br Dent J 1995;178;413-7.
Ritchie GM. A report of dental findings in a survey of geriatric patients. J Dent 1973;1:106-112.
Polyzols GL. Denture cleansing habits. A survey. Aust Dent J 1983;28:171-3.
Schou L, wright C, Cumming C, oral hygiene habits, denture plaque, presence of yeast and stomatitis in institutionalized elderly in Lothiam Scotland. Community dent oral epidemiol 1987;15:85-9.
Budtz- Jorgenson E Loe H. Chlorhexidine as a denture disinfectant in the treatment of denture stomatitis Scand J Dent Res 1972;80:457-64.
Barbeau J. Seguim J, Goulet JP, et al
. Reassessing the presence of Candida albicans in denture related stromatitis. Oral surg Oral med Oral Pathol Oral Radiol Endod 2003;95:51-9.
Jegenathan S, Payane JA, Thean HP. Denture stomatits in an elderly edentulous Asian population. J Oral Rehabil 1997;24:468-72.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]