Cairo Dental Journal (24) Number (3), 537:543 September, 2008

ProStHEtic StAtuS And NEEdS oF SAudi GEriAtric EdEntuLouS PAtiEntS in JEddAH

Fahad H. Banasr1
1. Assistant Professor of Removable Prosthodontics, King Abdul Aziz University

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physical conditions of complete dentures in addition to intra-oral examination to assess the prosthetic status and needs for these patients.

ABSTRaCT
his study was conducted on a group of Saudi edentulous patients 65 years of age and over. They were 135 males and 112 females having complete maxillary and/or mandibular complete dentures. The interviews were done, followed by evaluation of

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INTRODUCTION

necessary a contra-indication for medical or dental advances are partly the consequences of age itself, partly the result of wear and tear on the tissues and partly the common as age advances.(2) treatment.(1) The changes seen in the mouth as age

Aging is a normal life process. Age itself is not

The geriodontist (generally the prosthodontist) is in a strategic position to evaluate, correct and reduce the number of prosthetic failures in aging patients by a thorough understanding of the various oral changes occurring during this period.(5) We have little information on what dental treatment this population might need and there is no published work available in the dental literature concerning these points, especially in Saudi Arabia.

consequences of the fact that certain diseases become A number of studies have been conducted on the

dental status and oral health of the elderly. Most of these studies revealed that the dental and oral health of the elderly was very poor.(3) The attitude of the public to

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1.

THE AiM oF tHiS StudY WAS to

old people, inspite of their considerable contribution to society, remains unchanged. We continue to neglect and patient generally needs most of the necessary dental services in his life at any age when he is at least able to tolerate and possibly afford them. ignore them. It is still bad news to be old.(4) The geriatric
2. 3.

Assess the dental state and need for treatment of Saudi geriatric edentulous patients in Faculty of Dentistry King Abdulaziz University, Jeddah. Evaluate the prosthetic needs for those individuals. Provide a baseline data before establishment of dental programs for people aged 65 years and over in the dental public health services.

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MATERIAL AND METHODS

Some stability: the denture base demonstrated moderate rocking on its supporting structure under pressure, but could be easily reseated.

Criteria of Patients Selection Saudi edentulous individuals 65 years of age and over. Dental screening were conducted on a group of

No stability: the denture base exhibited extreme it was difficult to reseat the denture. 2. Denture retention: Good retention: the denture remained seated on opening and offered maximal resistance to vertical forces.

They were presented to the out-patient clinic, Faculty of

rocking on its structures under pressure, so that

Dentistry, King Abdulaziz University, Jeddah. They had complete maxillary and/or mandibular complete dentures and were asking for denture adjustment or replacement. Dental Examination Format examinations Intra-oral examination of soft and hard All individuals were given visual and digital

Some retention: little resistance was offered to opening.

tissues were done. Areas suspected of being pathologic were recorded and referred for further evaluation and were demographic information, prosthetic status and and extra-orally and evaluated as regards physical and special prosthetic examination form. Examination of Prosthetic Status Clinical examination was conducted in three stages:
1. 2.

vertical pull but the denture remained seated on

possible treatment. Other data collected for each subject needs. Old complete dentures were examined intra clinical findings. All data were collected and recorded on

No retention: the maxillary denture dropped and the mandibular denture unseated on opening, no resistance was observable to vertical forces.

3. Interocclusal space: it was evaluated by measuring dimension using Willis bite gauge. Measurements and 6 mm and 7 mm or more.

the difference between the rest and occlusal vertical were recorded where the space was less than 1 mm

Intra-oral examination of oral mucosa and tongue. Extra-oral examination of old dentures including base, artificial teeth and state of denture. Intra-oral evaluation of dentures regarding stability, retention, interocclusal space and centric relation.

4. Centric relation: the jaw relationship was deemed unacceptable if the path of closure was interrupted or if an uneven slide greater than one quarter of a cusp occurred.

5. State of the denture: as the dentures were removed from the month, the subject was asked to place them in a small dish. The cleanliness of the denture was had either soft or hard debris. Criteria for treatment needs ment or replacement of dentures, were based on criteria described by Grabowski and Bertram.(7) 1. Cleaning: A denture was assessed as needs cleaning if it had soft or hard deposits that could not be removed by rinsing under running water. The criteria for treatment needs, easons for adjust-

3.

Criteria for Diagnosis and Coding were based on studies of Reddick and Grant.(6) The criteria for evaluating the complete dentures

noted and scoring was undertaken as clean or unclean

1. Denture stability: it was measured by applying alternate pressure on occlusal surfaces of premolar teeth, using the index finger of each hand. Sufficient: the denture base demonstrated slight or no rocking on its supporting structures under pressure.

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2. Adjustment/easing/Selective grinding: A denture

was assessed as requiring adjustment to relieve trauma when it was associated with (a) localized trauma, (b) ulceration or (c) irritation hyperplasia.

of the oral mucosa caused by dentures and did not respond to simple adjustment and (e) an edentulous patient had missed denture. Data recorded in the prosthetic examination forms,

3. Repair: A repair was indicated when the jaw relation, were satisfactory, but the denture was broken in a manner that could be repaired without affecting these factors.

occlusion, vertical dimension, stability and retention

specially designed for this study, were collected, presented and statistically analyzed using statistical package system tables were performed according to the need. (SPSS). Prevalence figures and frequency distribution

4. Reline: A denture reline was indicated where vertical dimension, centric jaw relation and centric occlusion were correct, but retention and stability were poor or the patient was experiencing undue pain.

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RESULTS

dental screening conducted on a group of Saudi geriatric edentulous patients 65 years of age and over. They were presented within the period of 01 January 2006 to 31 December 2007. This study included 135 males and 112 females having complete maxillary and / or mandibular dentures or replacement by new ones.

Data collected in this study were obtained from

5. Replacement: A denture was considered to need

replacement in the following circumstances (a) denture was inadequate because of breakage or deformation, (b) denture was not anatomically satisfactory, (c) denture

had incorrect vertical dimension or incorrect centric

relation, (d) presence of irritation or inflammation

complete dentures and asking for adjustment of old

TAbLE (1) Characteristics of the study sample according to age and gender distribution Male no. 107 22 6 135 % 79.3 16.3 4.4 100 no. 96 14 2 112 Female % 85.7 12.5 1.8 100

Age 65-69 70-74 75 and older Total

TAbLE (2) Distribution of completely edentulous individuals according to gender and their prosthetic status Male no. 102 23 10 135 % 75.6 17.3 7.1 100 no. 92 14 6 112 Female % 82.1 12.5 5.4 100

Prosthetic Status Maxillary and mandibular complete denture Maxillary complete denture Mandibular complete denture Total

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Fahad H. Banasr

C.D.J. Vol. 24. No. (3)

mandibular complete dentures represented 75.6, 17.3, and 7.1% of the total male sample respectively. The and 5.4%.

This table shows that males with maxillary and/or

reported among 13.3, 9, and 1.8% of females sample respectively. Examination of the physical condition of the prosthe-

corresponding percentage of females were 82.1, 12.5, This table revealed that 74.8% of males and 81.2% of

sis revealed that cracked or broken base, broken teeth, 8.9, 4.4, 9.6 and 13.3 of males and 5.4, 4.5, 8.9 and 7.1% of females respectively.

teeth wear and unclean denture were diagnosed among

females presented with no oral lesions. On the other hand,

traumatic ulcer, epulis fissuratum, inflammatory papillary 5.2, 6.6 and 4.5% of males. It was 8.3, 4.4, 2.6 and 3.5% of females respectively.

hyperplasia and denture stomatitis were detected in 8.9,

among males showed that 72.6% of the prosthesis had

Intra-oral examination of the complete dentures

sufficient stability 16.3% had good retention, 10.4% had <1mm interocclusally and 89.6% had acceptable centric relation. The corresponding values among females centric 78.6, 65.1, 10.7 and 91.1% respectively. relation. The corresponding values among females were

tongue were found among 12.6, 11.1 and 6.7% of

Atrophic glossitis, white hairy tounge and fissured

examined males. Meanwhile these tongue lesions were

TAbLE (4) Distribution of individuals according to gender and tongue lesions Male no. 94 17 15 9 135 % 69.6 12.6 11.1 6.7 100 no. 85 15 10 2 112 Female % 75.9 13.3 9 1.8 100

Type of lesions No lesion Atrophic glossitis White hairy tongue Fissured tongue Total

TAbLE (5): Evaluation of the physical condition of examined complete dentures Male no. 12 6 13 18 % 8.9 4.4 8.6 13.3 no. 6 5 10 8 Female % 5.4 4.5 8.9 7.1

Physical condition of complete denture Cracked or broken base Broken teeth Teeth wear Unclean denture

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TAbLE (6) Prosthetic status of the study sample Male No. Sufficient Stability Some stability No stability Good Retention Some retention No retention < 1 mm Inter-occlusal space 2-6 mm > 7 mm Centric relation Acceptable Unacceptable 98 15 22 86 29 20 14 111 10 121 14 % 72.6 11.1 16.3 63.7 21.5 14.8 10.4 82.2 7.4 89.6 10.4 No. 88 9 15 73 22 17 12 87 13 102 10 Female % 78.6 8 13.4 65.1 19.6 15.2 10.7 77.7 11.6 91.1 8.9

Clinical examination

TAbLE (7) Prosthetic needs of the examined individuals Male no. Cleaning Adjustment Repair Reline Replacement Total 1.8 28 13 32 44 135 % 13.3 20.7 9.6 23.8 32.6 100 no. 8 21 7 25 51 112 Female % 7.1 18.8 6.3 22.3 45.5 100

Showed that 13.3, 20.7, 9.6, 23.7 and 32.6 of the examined males had the need for cleaning, adjustment, repair, reline and replacement of their dentures

respectively. Meanwhile these prosthetic needs accounted for 7.1, 18.8, 6.3, 22.3 and 45.5 of the examined individuals respectively.

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C.D.J. Vol. 24. No. (3)

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DISCUSSION

This study was carried out as a survey of prosthetic status and needs of Saudi geriatric edentulous patients to out patient Clinics, Faculty of Dentistry, King Abdul Aziz University. They were 65 years of age and over. This is in accordance with definition of geriatric patients which is the cohort of people aged 65 years and older.(8) The present study shows that a considerable number of examined individuals has one form or another of oral lesions. It was 25.2% in males and 18.8% in females. The majority of these oral lesions (traumatic ulcer, epulis fissuralum, inflammatory papillary hyperplasia or denture stomatitis) was related to the prosthesis, which was unsatisfactory in one way or another. These results are in agreement with another. These results are in agreement with other studies. Sheppard et al(9) reported that 46.1% of denture wearers had oral lesions. Dorey et al(10) concluded that tissue response to denture trauma was 17%. Other problems were papillary hyperplasia 12%. These oral lesions may be due to the soft tissue beneath the denture is not readily displaced(11) and is often subjected to higher levels of stress than it was designed to bear. Also, the oral flora may be altered as a result of food debris and plaque that collect beneath the mucosal surface of the denture and palate.(12) In addition, dentures may induce a proliferative or degenerative response in the oral mucosa.(13) Regarding tongue lesion, 30.4% of examined males and 24.1% of females had one of the following lesions. Atrophic glossitis was present in 12.6% and 13.3% of examined males and females respectively. These findings go in accord with study of Bhaskar.(14) While hairy tongue was recorded in 12.6% of examined males and 9% of female individuals. Fissured tongue was found in 6.7% and 1.8% of males and females respectively. Bhaskar(14) found the same condition in 6.5% of his examined cases. El-Karanshawi(15) reported fissured tongue to be present in 10% of his studied cases. Omar(16) found this lesion in 11.9% and 11.5% of two studied groups. These tongue lesions might be due to age changes or systemic conditions having oral manifestations.

complete dentures were having either cracked of broken base, broken or wear teeth, or unclean dentures. These drop, prolonged use of dentures, poor oral hygiene or improper denture construction. findings might be due to ill-fitting dentures, accident

On evaluation of the physical condition of examined

unsatisfactory in one way or another on intra-oral examination. There was no stability in 11.1% and 13.4% respectively. In a similar way, no retention was found of examined complete dentures in males and females in 14.8% and 15.2% of dentures for males and females. Interocclusal space was more than 7 mm in 7.4% for males and 11.1% for females. Unacceptable centric dentures might be due to severe residual ridge resorption and/or teeth off the ridge. Loose dentures resulted from

A high percentage of examined dentures were found

relation was recorded in 10.4 and 8.9%. Poor stability of

poor fitness as consequence of ridge resorption, over or

under extended borders or dry mouth. Reduced vertical of teeth wear and/or ridge resorption followed by settling

dimension (interocclusal space > 7mm) might be a result of dentures. Unacceptable centric relation resulted from either incorrect registration of occlusal relationship or teeth wear with resultant reduced vertical dimension.

individuals, 32.6% and 45.5% of females need new complete dentures. 67.4% and 54.5% of males and females respectively were in need of other forms of

As regards the prosthetic needs of examined

prosthetic treatments (cleaning, adjustment, repair and reline). This is due to the fact that females cannot tolerate any minor defects their dentures.

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THE StudY CondudEd tHAt

Most of oral lesions found in the geriatric edentulous patients were related to unsatisfactory dentures. Oral and tongue lesions must be diagnosed and appointments.

2.

treated either locally or systematically at recall Geriatric edentulous patients must be checked regularly to evaluate their prosthetic status and needs.

3.

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REFERENCES
9.

status of edentulous and complete denture wearing patients, J AmDent Assoc 83: 614, 1971. Dorey JL, Blasbery B, MacEntee MI and Conklin, RJ: Oral mucosal disorders in denture wearers, J prosthet Dent., 53: 210-213, 1985. 10. Flesich, L.: A study of the oral tissues subjected to physical stress, Int Assoc Dent Res, 1979, p. 302 (Abstr no. 840). 11. Barrels, L.W.: Local and systemic factors in oral moniliasis, NY, J Dent 35: 283, 1965. 12. Razek, M.K.A. and Shaabar, NA: Histochemical and histopathologic studies of alveolar mucosa under complete dentures, J Prosthet Dent 39: 29, 1978. 13. Bhaskar, C.S.N: Oral lesions in the aged population, Geriatrics, 23 (10) 137-149, 1968. 14. El-karanshawi, A.Y.: Prosthodontic for geriatric patients, Thesis, Faculty of Dentistry, Alexandria University, 1978. 15. Omar, N.A.T.: Prosthetic needs of the aging patients in geriatric homes of Alexandria and El-Gharbia, Thesis, Faculty of Dentistry, Alexandria University 1982.

Winkler SH.: The geriatric complete denture patient, Dent. Clinics of North America, 21: 403-414, 1972.

2.

Cawson R.A.: Oral and dental problems of the elderly, Essential of surgery and pathology, 3rd ed., 199-203, 1970, Churchill, L.

3.

Smith, JM and Sheiham A.: Dental treatment needs and demands of an elderly population in England, Community Dent. Oral Epidemiol. 8: 360-364, 1980.

4.

Fox, B.: Quality dental care for the elderly, Brit. Dent. J. 150: 143-146, 1981.

5.

Massler, M.: Oral problems in the aging patient, J. Indian Dent. Assoc. 55: 13-15, 1976.

6.

Reddick, G.H and Grant AA.: Prosthetic status: The formation of a schedule, J Prosthet Dent. 59: 105-110, 1985.

7.

Grabowski M, and Bertram V.: Oral health status and the need of dental treatment in the elderly Danish population.

8.

Sheppard, I.M., Schwartz L.R. and Sheppard SM: Oral