Aisha Kiran1 , Faiza Amin2
1. Dow Dental College, Dow University of Health Sciences, Karachi, Pakistan
2. Dow Dental College, Dow University of Health Sciences, Karachi, Pakistan
Corresponding author: “Dr. Aisha Kiran” < drkiranbds@yahoo.com >
Received: 6 January 2016, Accepted: 25 March 2016
How to CITE:
Kiran, A. Amin, F. Perception Towards Materials and Methods Available for Maintenance of Denture. J Pak Dent Assoc 2016; 25(1): 21-25.
Objective:
To evaluate perceptions about materials and methods available for post insertion denture care amongst removable denture wearers and to find out effect of education in adapting to correct methodology of cleaning the prosthesis.
Introduction:
Ignorance about maintenance of oral prosthesis leads to many oral health related problems. Adequate understanding of post insertion care is significant for the longevity and comfort of the prosthesis.
Methods:
An aggregate of hundred patients were chosen using convenience sampling from the department of prosthodontics (OPD) of Dow Dental College and Dow international Dental College. Questionnaire was designed to evaluate objectives. Subjects were interviewed about age, gender, educational status, frequency, method of cleaning, soaking material and awareness about removal habits of denture before sleeping. The information acquired by this study was analyzed by utilizing SPSS programming version 16.0. Simple descriptive statistics was applied. Chi-Square test was applied to determine the association of education with cleaning methods test at p value<0.05.
Results:
Majority of participants cleaned their dentures with tooth paste and brush (44%) while 62% clean them daily. Majority of subjects were removing their dentures (80%) before sleeping. Water was the most frequent (62%) soaking medium when denture was not in use. Adequate maintenance of dentures was significantly associated with level of education.
Conclusion:
The perceptions of study participants towards denture maintenance were adequate.
Keywords:
Maintenance of denture, perceptions, prosthesis, cleaning of denture.
Introduction
Adequate cleaning of the dentures may rate low on the priority list of some denture wearers. For these patients, a quick brushing and occasional five-minute soak might be the extent of their denture care and some of them might not even clean them. Carelessness of keeping denture clean results in developing oral health related problems like stomatitis, malodor, bacterial endocarditis and fungal infections1 which in turn cause denture discomfort and compromise persons health. Denture wearer might face disability of mastication speech, difficulty in social interactions and decline in general systemic health if their denture care is not adequate. Local infections can be minimized by keeping dentures out of oral cavity for 6 – 8 hours per day2. In another study3 it was concluded that proper maintenance of denture enhance oral health and performance of prosthesis.
Diabetes Mellitus is a common disease among elderly patients, if they are using any kind of removable denture and unable to clean them adequately they are more prone to develop denture induced stomatitis4. Another study5 showed that denture maintenance follow-up visits have extreme importance in order to evaluate condition and oral health of wearer, majority of patients do not consult dentist for checkups of their dentures.
Denture surface is porous and rough which act as substrate for microorganism to adhere and grow. This may be aesthetically unpleasing, cause of altered taste and foul smell from mouth. Oral health diseases related to prosthesis depend upon fitting surface, occlusion and cleaning habbits of the denture6. An Invitro study by Charman K et al.7 showed that dental biofilm formation accumulate more on rough surfaces than on smooth of prosthesis. Denture stomatitis is an inflammation of oral mucosa clinically that appears as localized redness due to localized denture irritation. It may also be associated with immune compromised state and drugs8. Past study conducted by Buket et al.9 showed that there is a presence of positive association between poor oral hygiene and denture stomatitis. Adequate daily cleaning of dentures helped to minimize incidence of this condition.
Denture should be washed daily with non-abrasive denture cleaning products outside the mouth. It should not be immersed more than 10 minutes in bleaching.10 Denture wearers should be informed about rinsing their mouth and denture after every meal whenever it is possible. It has been showed through studies that with age it is difficult to maintain hygiene due to reduced manual efficiency11. Assistance is required to help these kinds of patients for post insertion care of dentures.
Evaluation about our community awareness regarding denture care and convincing these patients to adopt a more stringent daily cleaning routine was the main purpose of utilizing this questionnaire in our survey. Study was conducted to compare socioeconomic conditions with denture hygiene awareness12 but no study was done to compare the association of education on adapting proper denture cleaning methodology. The aim of our study is to assess perception towards maintenance of denture and association of education on adapting proper cleaning methodology.
Methodology
This cross sectional survey was conducted among the denture wearers that visited for follow up to Dental Outpatient department of Prosthodontics in Dow Dental College, Karachi Pakistan from 15th December 2015, till 15th January 2016. The estimated sample size was hundred, taking 97.6% prevalence on how the patients keep their dentures clean with 3% margin of error. A total of hundered participants were included in the study regardless of which material and time period the dentures are being made / used. All those individuals who refused to participate in the study and those who had any kind of neuromuscular disability were excluded.
After acquiring permission from competent authorities, a questionnaire comprising of ten questions regarding denture maintenance was designed in English language. It was filled by researchers who interviewed the study participants. First part of the questionnaire was related to demographic details of participants like age, gender, education status and occupation. Participants having no primary education were considered uneducated and those who had received education from any institution either primary or secondary were considered as educated subjects. In second part, the perception towards denture cleaning habits, methods and frequency, status of information they had received from dentist on post denture insertion care and nocturnal denture wearing habits were noted. Before interviewing, participants were informed and assured verbally about keeping their provided information confidential.
The information achieved by this study was analyzed by utilizing SPSS programming version 16.0. Simple descriptive statistics and Chi-Square was used to determine the association of education with cleaning methods test at p value<0.05.
Results
The demographic characteristics of participants are shown in Table 1. All subjects were in the age group of 55 to 65 years from both genders (females 54 and 46 males). Most of the participants were using denture since 1 to 5 years as shown in Table 1.
Regarding post denture insertion cleaning instructions by their dentist, 74% of participants had received instructions while 14% were not being informed about it. Most of them were cleaning daily by mechanical method (brushing) with toothpaste (Table 1).
Majority (80%) removed their dentures before sleeping (Table 2). On removal most of them were soaking in water as demonstrated in Table 2.
Fig. 1 portrays that proper cleaning methods were adapted adequately by educated participants while uneducated participants are not cleaning their dentures with correct methodology.
Chi-square test was applied to find out whether education is associated with proper cleaning methodology or not. Significant results were obtained (p-value=0.004) for using proper method of cleaning dentures when compared among educated and uneducated subjects.
Discussion
Adequate cleaning gives longevity to the prosthesis by maintaining health of oral tissues as it helps in reducing biofilm formation, bioburden of microorganism and fungal growth10. Maintenance of denture will be successful only when denture wearers are motivated and aware of correct methodology to be adapted. Maintenance of a denture can also be achieved by making patients aware about significance of follow up visits for their denture. In our study findings, 52.52% not went for follow up visits. Previous study concluded that denture wearers were not informed about preventive and maintenance care of their dentures9. Post insertion checkup visits was not found to be frequent might be due to lack of awareness, cost of dental visit or fear and anxiety to visit dentists. None other study has been done in this region for assessing comparison between educated and uneducated participants perception towards adapting appropriate methodology of cleaning prosthesis.
Our results demonstrate education was significantly associated with adequate denture cleaning, as shown in the result that 81% educated participant are using adequate method of cleaning.
A review done by Felton et al.10 enlisted guidelines for the care and maintenance of denture in which they stated that daily removal of the prosthesis along with appropriate method of cleaning is necessary for maintenance of denture. In our study authors reveal that only 62% denture wearers are in the habit of cleaning dentures daily, 32% cleaned it when they found it dirty and 2% were not in a habit of cleaning their dentures.
Similar study was done by Dikbas et al.3 and Marchinni et al.5 showed that 82.9% and 77.5% patients did not receive denture care instructions from their dentists respectively, whereas in our study we found that denture wearers are getting proper instructions from their dentist the only lacking that we are facing in our region is proper follow-up visits which are of prime importance for the maintenance. The rationale of annual follow-up visits is that normal physiological process can produce changes in the bone structure. These changes might cause malfunction of prosthesis Felton et al.10 recommended that denture wearers must go for post insertion visits annually for maintenance of denture fit, function and assessment of oral health status. Regarding post insertion visits for the maintenance of denture our study reveals that 48% went for follow-up visits and most of them that is 52% were not visited dentist for denture care. Low follow up visits from the denture wearer might be due to low economic status or lack of proper instructions given by the dentist.
For cleaning prosthesis, brushing with toothpaste reduces the biofilm formation as compare to use water alone as cleaning method13. Similar study done by Parajuli et al.14 showed majority use water and some were using soap and water without use of brush. Results obtained by previous studies done by Marchini et al.5 and Kulak Ozkan et al.15 showed 84.9%, 79.7% brushed their dentures for cleaning respectively. In our study majority of participants that is 44% use tooth paste and brush, whereas 20% of them use water for cleaning and 4% and use of cleaning tablets (chemical method) which is quite low among all findings. Dentifrices containing nonabrasive constituent such as calcium phosphate is recommended. Abrasives and bleaching components in tooth paste may cause surface abrasion3. Tooth brush containing soft filaments with low force application for cleaning of dentures is most advisable method by clinicians.
Chemical methods are simple to use but due to high cost and metal corrosion its usage is low. It is recommended for elderly with low motor skill responded denture wearers16 Mechanical method (brushing) easy to use and inexpensive so it is the most popular method adapting for cleaning dentures by its wearers in developing countries, previously done studies stated that 100%17, 80%18, 79.7%5 are using Mechanical (brushing) as a cleaning method. In past study effective recommended method of cleaning is combination of brushing and soaking19. Further research need to be done to find out preferred method against pathogens.
According to guidelines for care and maintenance of denture it is mentioned that denture should be immersed in water while not using it to avoid warping10. In our study most of participants reported soaking their dentures in water. Study opposes our finding that was done by Veres et al.16 stated that only 5% subjects immerse their denture in water while it is not in use.. According to Felton et al.10 denture should not be immersed in sodium hypochlorite (cleaning chemical) for time period more than 10 minutes. Placement of denture for longer duration in hypochlorite (NaOCl) may damage the denture. In study by Felipucci et al.20 It is stated that sodium hypochlorite causes spot corrosion by oxidation of the surface; therefore it is not suitable for removable partial dentures. Peracini et al.17 found that water was the most immersing media for denture followed by Naoel .
The results of this study suggest that there is need to encourage denture wearers for follow-up visits to maintain oral health. Guidelines of denture care and maintenance should be included in continuing education programs for dental practitioners. Keeping the fact in mind that literacy rate of Pakistan is low; according to survey done by UNESCO literacy rate is 55%. Government and related academic institutions must adopt and encourage alternative awareness methods like advertisements, denture care awareness programs with demonstrations, which should be conducted by professionals. There are inexpensive cleaning methods and materials are available but awareness need to be developed. Further research is required to be done to explore affective methods of mechanical and chemical denture cleaning against harmful pathogens.
Conclusion
1. Majority of the study participants had received guidelines from dental practitioners that shows that dentists are educating enough about the maintenance of the denture.
2. There were noticeable differences in cleaning habits among educated compared to uneducated participants.
3. The frequently reported methods were Brush with Toothpaste 44%, followed by soap water 32%. Only 4% participant used tablets.
Choose the Best Questions
1. Most popular method adopted for cleaning denture wearers is:
a. Chemical method
b. Mechanical method
c. Ultrasonic method
d. Microwave method
2. Preferred method of denture cleaning according to clinician advise:
a. Chemical method
b. Combination of chemical and mechanical method
c. Mechanical method
d. Ultrasonic method
3. Reason of low usage of chemical method amongst denture wearers:
a. High cost and metal corrosion
b. Warpage and discoloration
c. Surface abrasion and discoloration
d. Foul spell and bad taste
4. Immersion time for denture in sodium hypochlorite should not exceed more than 10 minutes because it can cause:
a. Discoloration
b. Spot corrosion
c. Warpage
d. Cracks
Note: Correct Answer in Bold Font
Author's Contribution
Dr. Aisha Kiran conceived and designed the study, also responsible for manuscript topic selection, questionnaire designing, patient selection, interviewing of patients, data entry, data analysis and write up. Dr. Faiza Amin participated and provided her assistance in designing the study, data entry and writing the manuscript.
Disclosure
Declared none.
References
[1] Coulthwaite L, Verran J. Potential pathogenic aspects of denture plaque. British journal of biomedical science. 2007; 64(4): 180-189.
[2] Zissis A, Yannikakis S, Harrison A. Comparison of denture stomatitis prevalence in 2 population groups. The International journal of prosthodontics. 2005; 19(6): 621-625.
[3] Dikbas I, Koksal T, Calikkocaoglu S. Investigation of the cleanliness of dentures in a university hospital. The International journal of prosthodontics. 2005; 19(3): 294-298.
[4] Guggenheimer J, Moore PA, Rossie K, et al. Insulin-dependent diabetes mellitus and oral soft tissue pathologies. II. Prevalence and characteristics of Candida and candidal lesions. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2000; 89(5): 570-576.
[5] Marchini L, Tamashiro E, Nascimento D, Cunha V. Self‐reported denture hygiene of a sample of edentulous attendees at a University dental clinic and the relationship to the condition of the oral tissues. Gerodontology. 2004; 21(4): 226-228.
[6] Patel IB, Madan G, Patel B, Solanki K, Chavda R. Behaviours and Hygiene Habits of a sample population of complete denture wearers in Ahmedabad. JIOH. 2012; 4(2): 30-38.
[7] Charman K, Fernandez P, Loewy Z, Middleton A. Attachment of Streptococcus oralis on acrylic substrates of varying roughness. Letters in applied microbiology. 2009; 48(4): 472-477.
[8] Wilson J. The aetiology, diagnosis and management of denture stomatitis. British dental journal. 1998; 185(8): 380-384.
[9] Evren BA, Uludamar A, Işeri U, Ozkan YK. The association between socioeconomic status, oral hygiene practice, denture stomatitis and oral status in elderly people living different residential homes. Archives of gerontology and geriatrics. 2011; 53(3): 252-257.
[10] Felton D, Cooper L, Duqum I, et al. Evidence‐Based Guidelines for the Care and Maintenance of Complete Dentures: A Publication of the American College of Prosthodontists. Journal of Prosthodontics. 2011; 20(s1): S1-S12.
[11] Kanlı A, Demirel F, Sezgin Y. Oral candidosis, denture cleanliness and hygiene habits in an elderly population. Aging clinical and experimental research. 2005; 17(6): 502-507.
[12] Chowdhary R, Chandraker NK. Clinical survey of denture care in denture‐wearing edentulous patients of Indian population. Geriatrics & gerontology international. 2011; 11(2): 191-195.
[13] Panzeri H, Lara EHG, Paranhos HdFO, et al. In vitro and clinical evaluation of specific dentifrices for complete denture hygiene. Gerodontology. 2009; 26(1): 26-33.
[14] Kumar PP, Pramita S, Shraddha S, Kumar SR, Babu BB, Arjun B. Evaluation of the behaviours and hygiene habits of complete denture wearers in the eastern nepal.
[15] Kulak‐Ozkan Y, Kazazoglu E, Arikan A. Oral hygiene habits, denture cleanliness, presence of yeasts and stomatitis in elderly people. Journal of oral rehabilitation. 2002; 29(3): 300-304.
[16] Veres E, Wolfaardt J, Hnizdo E. Denture cleansers: Part III--A survey of materials and methods employed by denture wearers. The Journal of the Dental Association of South Africa= Die Tydskrif van die Tandheelkundige Vereniging van Suid-Afrika. 1985; 40(10): 591.
[17] Peracini A, Andrade IMd, Paranhos HdFO, Silva CHLd, Souza RFd. Behaviors and hygiene habits of complete denture wearers. Brazilian dental journal. 2010; 21(3): 247-252.
[18] Coelho C, Sousa Y, Dare A. Denture‐related oral mucosal lesions in a Brazilian school of dentistry. Journal of oral rehabilitation. 2004; 31(2): 135-139.
[19] Dills S, Olshan A, Goldner S, Brogdon C. Comparison of the antimicrobial capability of an abrasive paste and chemical-soak denture cleaners. The Journal of prosthetic dentistry. 1988; 60(4): 467-470.
[20] Felipucci DNB, Davi LR, Paranhos HFO, Bezzon OL, Silva RF, Pagnano VO. Effect of different cleansers on the surface of removable partial denture. Brazilian dental journal. 2011; 22(5): 392-397.