Prevalence Of Oral Mucosal Lesions In Complete Denture Wearers - A Retrospective Study

Keywords

Age; Sex; Lesion; Denture Stomatitis; Angular Cheilitis; Complete Denture.

Introduction

Oral lesions in complete denture wearers are caused due to tissue changes, ill fitting prosthesis, pathogens, and lead to altered clinical presentations and sometimes even complications [14]. Due to the dynamic environment of the oral cavity and loading of oral mucosa, denture could be the direct cause for these changes. Alterations in oral environment, tissue responses and alteration may also be influenced by presence or absence of systemic illness and other diseases. Medical conditions that can cause hyposalivation and parafunctional are more likely to cause mucosal alterations [18, 21, 24, 12]. Diabetes mellitus was considered as a major risk factor for denture stomatitis and denture hyperplasia [6, 29, 11].

Denture stomatitis is the most common oral lesion seen in denture wearers. It is an inflammatory condition which causes changes in oral mucosa in denture bearing areas mostly in maxilla due to increased surface area of the palate [5, 26]. This can be characterized by erythema and swelling of the affected region [20]. In a study of 463 random complete dentures using patients, prevalence of denture stomatitis was found to be 65% [3, 28]. It is found to have female prediction, i e., more frequently seen in females than in males [25, 13, 27, 29].

Angular cheilitis is a lesion that is clinically diagnosed by appearance of deep fissures affecting the angle of the mouth and it has ulcerated appearance [16]. Studies suggest that loss of vertical dimension is a major cause for occurrence of this lesion, and is associated with candid a colonization with denture wearers and poor oral hygiene. Prevalence of angular cheilitis in complete denture patients is upto 30% [7, 4].

Other common lesions are inflammatory hyperplasia, epulis fissuratum which are caused due to the reaction caused by ill fitting denture-it causes tissue hyperplasia in the areas which are in contact with the denture. There were seen in 5-10% of dentures wearing patients. In large scale study these lesions were seen in 6.3% in the 55-64years age group and 11.5% in 65 above age groups [1, 19]. The lesions are caused due to chronic irritation/ injury/illfitting/unstable dentures or extended flanges. Proliferation of the tissues takes place soon after prosthetic treatment [9]. Inorder to prevent these conditions the complete denture patient should be well educated aboud denture maintenance and about the periodic examination due to changing supporting tissues for the detection of early mucosal lesion, so that oral and denture hygiene is maintained. In order to prevent or reduce the recurrence of the lesion, patient should be recalled and reviewed for examination regularly. The aim of the study is to know about the prevalence of the lesions present in patients who are using complete dentures and factors associated to the lesions such as habits, systemic illness, previously studies are done based on lesions that are caused due to denture, this study focuses on correlation between other factors and the lesions.

Materials and Methods

The study was a retrospective study conducted in a university setting, The approval for this study was obtained from the institution ethics board. The clinical information of the patient was obtained from the Hospital. Case details of patients were retrieved from 86000 patients visiting Saveetha Dental College in the time period of June 2019 to March 2020. The sample size contained 506 complete edentulous patients out of which 22 patients with denture associated lesions were selected. Sampling bias was minimised by collecting all the data available and no sorting process was done. Cross Checking and evaluation of data was done with both the clinical photographs of the patient and cytological smears when available. Parameters like age, gender, habits, systemic illness, lesion, maintenance of denture, correction were collected and verified. The data was tabulated in excel sheet coded and entered in SPSS software IBM 20 for statistical analysis. Descriptive statistics- percentage, mean, standard deviation were analysed. Chisquare test was done to compare proportions of two groups and p value < 0.05 was considered to be statistically significant.

Results and Discussion

There were a total of 506 complete denture patients reporting to the hospital in the given time period. 22 patients (4.3%) had oral lesions associated with denture irritations. The distribution of age groups is summarised in figure 1. The most commonly affected age group was 61-70 years, followed by 71-80 years, the least common affected age group is 41-50 years. Most commonly affected gender is females(63.6%) than males (36.4%). The most commonly diagnosed lesion was denture stomatitis (68.2%) followed by angular cheilitis (31.8%) (Table 1) There was no statistical significance between age, gender, lesion and systemic illness. (Figures 2-4).

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Figure 1:

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Figure 1. Bar diagram representing frequency distribution of denture wearing patients with different age groups having oral mucosal lesions. X axis represents the different age groups and Y axis represents the number of patients with oral lesions. More frequent occurrence was observed in elderly population within 61-70 years of age.

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Table 1:

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Table 1. Frequency distribution of different lesions seen in the study population.

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Figure 2:

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Figure 2. Bar charts depicting the association of oral mucosal lesions with different age groups. Red: Angular Cheilitis, Blue: dentureStomatitis. X axis represents the age of the patients and Y axis represents the number of patients. There was no significant association between oral mucosal lesions and different age groups. Pearson’s Chi square p = 0.44 hence not significant.

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Figure 3:

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Figure 3. Bar charts showing the distribution of oral mucosal lesions among males and females. Blue; male, Red; Female. X axis represents the Oral lesions that are caused due to complete dentures irritation along with gender, Y axis represents the number of patients. There was no significant association between the distribution of oral mucosal lesions among males and females. Pearson’s Chi square test, p=0.20 (>0.05) hence not significant.

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Figure 4:

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Figure 4. Bar charts depict the association between oral mucosal lesions and systemic illness. Blue; no systemic illness, Red; Diabetes melitus, green; hypertension. X axis represents the oral lesion along with the systemic illness. Y axis represents the number of patients. There was no significant association between oral mucosal lesions and systemic illness. Pearson’s chi square test, p = 0.22 (>0.05) hence not significant.

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The study was conducted among 506 Complete denture wearers, out of which 22 had denture associated oral lesions. It was observed that the most commonly affected age group was 61-70 years. Similar results were observed in the study [2] and [22, 14, 13] This is because old people are more likely to lose their teeth rather than younger population and hence require prosthesis. The most commonly affected gender was females rather than males. Studies suggest that oral lesions are more common in females than in males [8, 13], This could be due to the prolonged usage of denture by females for aesthetics reasons [22] compared to males and infrequent cleaning.

Denture stomatitis was the most commonly observed lesion (68.18%) followed by angular cheilitis (31.8%). Studies suggest that denture stomatitis is the most common oral lesion that is caused due to colonization of candida [17, 14]. Poorly maintained dentures with plaque accumulation and use of dentures even during sleep may be a major cause of denture stomatitis in elderly population. Also the maxillary denture have more palatal coverage providing an environment for candida growth [10, 28]. An ill fitting denture may promote plaque accumulation leading to poor oral hygiene. It also important to know that the swallowing or aspiration of denture plaque would expose immunocompromised patients and medicated patients to the risk of unexpected infections.

Angular cheilitis is associated with loss of vertical dimension and colonization of candida, Different studies suggested that an increase in the frequency of angular cheilitis with increase in length of usage of denture, which suggest that loss of vertical dimension could be an important cause, as it is assumed that the overclosure of the jaws will produce occlusive folds at the angles of the mouth in which saliva tends to collect and the skin subsequently becomes macerated, fissured and secondarily infected and colonized mainly with Candida and few bacterial species such as Staphylococcus aureus. Poor oral hygiene, severe desorbed ridge and decrease in the face vertical height of occlusion can cause active colonization of Candida, which results in angular cheilitis among the elderly and institutionalized people leading to nutritional deficiency and impaired quality of life [23].

In the present study, diabetes mellitus was the most common systemic illness followed by hypertension-similar finding has been observed in a study [22, 13, 28], however it was observed that there was no statistical significance seen between both these values this could be because of the smaller sample size of the present study. The limitations of the study is that the sample is small and all the diagnosis is based on clinical findings. The status of the tissue and denture was not noted. Studies should be conducted on a larger population so as to identify the defects leading to these lesiona and provide improved care.

Conclusion

According to the study the most common oral lesion seen among complete denture wearers is denture stomatitis. This study reveals that elder population aged more than 60 years and females are most commonly affected. Systemic illness and smoking are risk factors.

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