Complete Denture Complications Among Patients in a Teaching Hospital of Karachi

Shujah Adil Khan¹                             BDS, MDS

Haroon Rashid^{2                                            BDS, MDSc}

Adnan Sukkurwalla^{3                       BDS, MMedSci}

Asma Naz⁴                                                          BDS, FCPS (Prosthodontics)

INTRODUCTION

oss of a teeth leads to impairment of oral function, esthetics and phonetics, making prosthodontic involvement necessary¹. Since there has been an increase in the life expectancy of elderly individuals, an increase in the demand of prosthetic restorations has also been noted.  Edentulism in Pakistan occupies an estimated

4.1% of the total population aged 65 years and above, with a projected increase to 9.3% by 2030¹. Due to an increase in the life expectancy of elderly individuals, prosthetic treatment for edentulous patients shall never lose importance².

Removable partial and complete dentures are two commonest treatment modalities that are simple and cost effective. However faults in prosthesis may arise due to improper denture designing by the clinician and lack of technical skills. One of the most common reasons for denture failure in Pakistan is the allocation of vital clinical denture work to the dental technician by the dentist³. Prosthodontic technicians have an important role in successful complete denture therapy however; denture faults and subsequent failures may occur due to lack of technical skills of a laboratory technician. Thus, it is highly recommended that a trial denture is always examined by the clinician in a meticulous manner⁴.

Due to ridge resorption with time, retention and stability of a denture is compromised leading to compromised patient’s function (mastication). Pain and inability to communicate properly due to reasons outlined above, may give rise to psychosocial problems5. The aim of the current study was to evaluate satisfaction among complete denture wearers while understanding specific complaints regarding denture usage.

METHODOLOGY

In this cross sectional analytical study, data from 65 edentulous patients who were wearing complete dentures was collected. The patients were wearing dentures for a period of 1 year and were recalled between March 2014 to May 2014 at the department of Prosthodontics, Dr. Ishrat ul Ebad Khan Institute of Oral Health Sciences. Inclusion criteria only involved patients who had worn complete dentures fabricated by post graduate residents and undergraduate students of DIKIOHS. The dentures were examined and patients were interviewed. Every patient’s age, gender, and variables for satisfaction were recorded on a Visual Analog Scale (VAS)⁶. The VAS scale was used to record the satisfaction of the patients regarding the chewing ability, aesthetics of the denture and the phonetics.

Each denture was examined for its vertical dimension and graded as low, normal or high, whereas the centric relationship was recorded as either correct or incorrect. Phonetic method as proposed by Silverman was used to establish the vertical dimension⁷ and three-finger chinpoint guidance method was used to assess the centric relation⁸. Following complications associated with complete denture wearers were observed and recorded:

• Development of ulcers
• Teeth lost due to fracture of the denture teeth
• Fractures of the Denture base
• Denture related stomatitis
• Loss of denture retention

Various parameters that have potential effects on patient satisfaction and denture complication were assessed using SPSS version 18. Descriptive statistics like percentage, mean and median were used. Quantitative data were tested with student t-test to find the relation between different variables.

RESULTS

A total of Sixty-five patients with a mean average age of 63.48 ± 8.42 years were included in this study. Amongst all, 31 were females (47.6%) while the remaining 34 were males (52.3%). The complications observed in the patients with regards to their frequency were:

• 84.6% – Loss of denture retention
• 44.6% – Developing of ulcers
• 30.7% – Loss of denture teeth due to fracture
• 27.6% – Fractures of the denture base
• 7.6% – Denture  stomatitis

Age and gender distribution has been enumerated in Table 1 and Table 2 shows VAS scores of patient’s denture aesthetics, the phonetics and their chewing ability.

Denture’s condition, vertical dimension and the centric relation are the parameters that are enumerated in Table 3 while incidence of complications are shown in Table 4. There is no significant relation between the patient’s

satisfaction and complications in the procedures (P > 0.05); also the VAS scores or incidence of complications. It was also found that centric relation or vertical dimensionhad no significance between them (P > 0.05).

DISCUSSION

The majority of the edentulous patients were more than 65 years old and were using dentures for more than 10 years. That had resulted in mucosal changes which was noticed in about 44-63% of cases. A clinical analysis has recommended that 40% of the dentures after a period of 5 years and 80% of dentures after a 10 year period must be replaced9. Elderly individuals are more likely to have difficulty in accepting a new denture specially if they face difficulty in chewing, or have noticed a significant change in their facial appearance^10,11. The mandibular dentures are more likely to show instability and lack of retention due to presence of limited surface area. These problems become even more significant in cases where there is severe residual ridge resorption in mandible.  Major problem reported by such patients is unbearable pain during chewing possibly due to denture trauma^12,13,14.

The present study drives our attention to the most commonly encountered problem i.e. loss of retention (84.6%) closely followed by mucosal irritation (44.6%). Ongoing bone atrophy may have attributed to the above mentioned problems as it leads to a decrease in the alveolar crestal height^14,15. According to the current study, 27.6% patients have had fractures in their dentures, which may have been due to careless handling of the denture during maintenance and accidental droppings. Accidental damage or heavy occlusal forcees are found to be the main reasons behind the midline fracture of an acrylic denture10,16.

Rest vertical dimension (RVD) and occlusal vertical dimension (OVD) become compromised when bone

resorption occurs^15,17. Generally, a relatively low OVD is preferred by the clinicians as it causes less discomfort. The results of the present study are consistent with these findings (69.2%). An increase in the OVD results in denture clicking sounds during speech or may cause unclear phonetics specially if the patient consciously tries to stop the clicking sound¹⁴.  Centric relation has shown to effect denture’s comfort^12,19 however; no such findings were recorded in the present study.

Current study only focused on data collected from the department of prosthodontics DIKIOHS and was limited. Studies have indicated that the results are different if the data is collected  from a larger general population of complete denture wearers rather than a single teaching hospital^{1-3,5,12,13,14}. A cross-sectional study involving larger number of patients from different clinical centers is required to reach a more reliable conclusion in future.

CONCLUSION

Within the limitations of the current study, complete denture wearers in a teaching hospital commonly encountered the problem of retention loss. Other problems included development of ulcers, loss of denture teeth and fractures of the denture base.

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1. Department of Prosthodontics Dr Ishrat ul Ebad Khan Institute of Oral Health Sciences Dow University of Health Sciences, Karachi, Pakistan.

2. Assistant Professor. Department of Prosthodontics, Ziauddin College of Dentistry, Karachi, Pakistan.

3. Senior Registrar, Department of Community Dentistry,Fatima Jinnah Dental College, Karachi, Pakistan.

4. Assistant Professor and Head, Department of Prosthodontics, Dr. Ishrat ul Ebad Khan Institute of Oral Health Sciences – Dow University of Health Sciences, Karachi, Pakistan.

Corresponding author: “Dr Sujhah Adil Khan ” < shujah.adil@gmail.com >