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 Table of Contents  
Year : 2022  |  Volume : 1  |  Issue : 2  |  Page : 92-98

Attitude of complete denture wearers to denture maintenance and recall visits: A 10-year observational study

1 Department of Restorative Dentistry, Faculty of Dentistry, University of Lagos, Lagos, Nigeria
2 Department of Restorative Dentistry, Faculty of Dentistry, Lagos State University, Lagos, Nigeria
3 Department of Restorative Dentistry, Faculty of Dentistry, Bayero University, Kano, Nigeria
4 Department of Restorative Dentistry, Faculty of Dentistry, University of Ibadan, Oyo, Nigeria

Date of Submission21-Dec-2021
Date of Decision05-Mar-2022
Date of Acceptance05-Mar-2022
Date of Web Publication09-Apr-2022

Correspondence Address:
Bolanle Oyeyemi Akinboboye
Department of Restorative Dentistry, Faculty of Dental Sciences, University of Lagos, PMB 12003, Lagos.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/abhs.abhs_23_21

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Background: The demand for complete dentures will persist due to population growth and people living longer. The study assessed denture hygiene and maintenance practices over a period of 10 years. Methods: This was a 10-year prospective study of individuals rehabilitated with complete dentures. Data on socio-demographics, reasons for denture demand, and causes of tooth loss were retrieved before denture prescription. Data regarding denture maintenance practices, frequency and rationale for recall visits, quality of health, and patients’ perceived overall satisfaction were recorded after dentures had been in use by the participants. Data were collected over the course of review appointments and were retrieved using structured questionnaires based on the American College of Prosthodontists denture care and maintenance guidelines and the Oral Impacts on Daily Performance indicator. Retrieved data were analyzed with IBM SPSS Statistics version 21. Level of statistical significance was set at P ≤ 0.05. Results: Forty patients with a mean age of 69.5 ± 16.7 years were enrolled in the study. About 63.2% were male, and many (57.9%) were without co-morbidities. Most (68.4%) had dentures replacing both arches. At recall, 15.8% reported brushing dentures with toothpaste and 34.2% slept with dentures. There was a low (25%) compliance with recall appointments. This was mainly (73.3%) due to lack of motivation. Most (68.4%) of participants were satisfied with their dentures. Conclusion: The adherence to denture hygiene guidance within the limit of this study among complete denture wearers was found to be good but there was poor adherence to the denture maintenance regime.

Keywords: Adherence, assessing, complete denture, hygiene

How to cite this article:
Akinboboye BO, Adenuga-Taiwo OA, Ikusika OF, Dosunmu OO. Attitude of complete denture wearers to denture maintenance and recall visits: A 10-year observational study. Adv Biomed Health Sci 2022;1:92-8

How to cite this URL:
Akinboboye BO, Adenuga-Taiwo OA, Ikusika OF, Dosunmu OO. Attitude of complete denture wearers to denture maintenance and recall visits: A 10-year observational study. Adv Biomed Health Sci [serial online] 2022 [cited 2022 Aug 11];1:92-8. Available from: http://www.abhsjournal.net/text.asp?2022/1/2/92/342802

  Background Top

It is reported that edentulism rates will remain constant or increase due to the growth in population [1]. This implies that there will always be a demand for complete denture and the need for denture maintenance. The American College of Prosthodontists has established an evidence-based guideline for the care and maintenance of complete dentures [2]. This guideline was established to ensure optimal level of oral health in the edentulous patients. In view of its association with systemic health and psychosocial interactions [3], adherence to these guidelines can be evaluated by socio-dental indicators [4].

Wearing of dentures carries the risk of denture plaque accumulation. Unhygienic dentures may predispose to denture stomatitis, aspiration pneumonia and upper respiratory tract infections [5]. Therefore, the guidelines propose practices to facilitate denture care to include denture cleaning, control of denture biofilm, and yearly patient recall on denture maintenance.

This adherence of a patient denotes the degree to which his/her behavior matches with the health practitioner advice [6,7]. It is necessary to understand the adherence of patients to their denture care and recall interval in order to assist the prosthodontists to better manage the edentulous patients. The dentist may then have an evidence base on which to base patient management decisions. The aim of this study was therefore to assess factors affecting long-term compliance to guidelines for complete denture care and recall interval in a Nigerian population.

  Materials and Methods Top

Ethical approval (ADM/DCST/221) was obtained from the Ethics Review Board, and all procedures adhered to the principles of the World Medical Association Declaration of Helsinki as adopted in Fortaleza Brazil, 2013. A minimum sample of 35 individuals was determined from the average clinic attendance for complete dentures in the 3 years prior to commencement of the study. A two-part structured questionnaire was designed and validated among the complete denture wearers and was found to be adequate. The first part of the questionnaire was designed to retrieve mainly socio-demographic data from the participants and was administered at recruitment. The second part of the questionnaire retrieved data on adherence to recall visits along with denture hygiene and maintenance practices. The questionnaire was designed based on the principles of The American College of Prosthodontists Guidelines [2] and the Oral Impact on Daily Performance (OIDP) Indicator [8].

Forty consenting individuals were recruited into the study from clinic attendees at the Prosthetic Dental Clinic of Lagos University Teaching Hospital. The inclusion/exclusion criteria included consenting patients with one or both edentulous arches demanding for new complete dentures, those without systemic disorders that might result in the modification of treatment, active and not senile patients. The first part of the questionnaire was administered at recruitment, whereas the second part was continuously administered as they presented themselves for recall appointments. Adherence to the first recall visit was taken as a criterion for continued participation and inclusion in data retrieval.

Data obtained with the questionnaires were entered into an electronic spreadsheet and analyzed with IBM SPSS Statistics version 21.0. Frequencies were recorded as simple proportions and underwent descriptive statistics. Means were tested for association by cross tabulation, and the level of statistical significance was set at P ≤ 0.05. Results were displayed in tables and graphs.

  Results Top

Forty participants were recruited for this study, but two did not come for first recall visit, so they were excluded from the study. The mean age was 69.5 ± 16.7 years, with male preponderance (63.2%) and the highest proportion attained the primary educational level. The majority demanded for complete denture on both jaws (68.4%). About one-third (39.5%) of the populations studied replaced their dentures during the 10-year period and over half (53.3%) of this proportion replaced twice or more [Table 1].
Table 1: Demographic and clinical characteristics of participants.

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Only 39.5% had complaints during recall visit, and the main post-insertion complaint was that of problems with mastication (86.7%). All participants washed the dentures at least once a day, with a majority (78.9%) using tooth brush and mild soap as cleaning agents for dentures [Table 2]. Only two participants used denture cleansers as adjunct, and no participants reported using denture adhesives. The majority (68.4%) were satisfied with their denture [Figure 1].
Table 2: Complaint during recall visit.

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Figure 1: Satisfaction to denture therapy.

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More than a third (34.2%) of the participants did not adhere to instructions on denture storage, as they practiced overnight sleeping with their dentures in the mouth [Figure 2]. Four of the participants who came for recall visit died before the end of the study. During the period of the study, the female survival rate was greater than that of the male participants [Figure 3].
Figure 2: Adherence to denture storage instructions.

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Figure 3: Survival function using the Kaplan–Meier statistical test.

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Almost half of the participants (46.2%) wearing upper and lower complete dentures practiced overnight sleeping with dentures in the mouth and this was statistically significant (P = 0.027). No statistically significant association was found between adherence to overnight denture storage and sociodemographic characteristics [Table 3].
Table 3: Association between adherence to denture storage and socio-demographic characteristics and denture type.

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Reasons for not adhering to maintenance visit were financial constraints (20%), lack of motivation (73.3%), and long distance from the hospital (6.7%). There was a decline in proportion of participants’ denture maintenance visit from 24 h to 6 months (21 participants, 53.3%) post-insertion period, after which it became constant at yearly maintenance.

There is more impact of dentures on mastication with more males (9%) having difficulty than females (5%) [Table 4]. However, the difference between the average OIDP score in males (1.22) when compared with females (1.77) is not statically significant (t=−0.74, P = 0.34) [Table 5].
Table 4: Impact of denture treatment on quality of life.

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Table 5: OIDP average scores by gender and level of significance.

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  • Never or less than once a month—0 points;

  • Once to twice a month—1 point;

  • Once to twice a week—2 points;

  • Three to four times a week—3 points;

  • Almost every day—4 points

  •   Discussion Top

    Complete tooth loss is the accumulated effect of dental disease, especially dental caries and periodontal diseases [7]. Complete denture demand and use has been associated with a mean age of 69 years in a study done in Madrid, Spain [8]. The findings of this study are similar to the findings in the Madrid study. Another study [9] reported a mean age of 65.6 years suggesting that demand for complete dentures occurs in the seventh decade more commonly. However, we are cautious about extrapolating this inference from the studies as small sample size and recruitment method may affect the results obtained from these kinds of studies [10]. However, the edentulous state will continue to be associated with increasing age as periodontal attachment loss is a progressive and not a sudden phenomenon [11].

    A previous study done in Ibadan, Nigeria reported more males demanding for complete dentures, which is similar to the findings in this study [12]. There are however other studies which have reported a higher incidence of tooth loss and complete denture wearing in women [13-15]. The reason for this difference cannot be inferred within the limits of these studies and is unlikely to be only related to gender. There are many complexly interrelated factors such as disparities in dental diseases burden, socio-economic factors, and cultural beliefs that may also be influential [16].

    In this study, the commonest post-insertion complaint was that of difficulty in chewing. This was similar to reports from previous studies that listed difficulty in chewing as one of the most common post-insertion complaints [17]. Other common post-insertion complaints were pain, discomfort, altered speech, accumulation of food under the denture, and esthetic concern [12, 18, 19]. There has been no agreement on the commonest post-insertion complaint, and the reason for this has been attributed to regional and personal differences [20]. Pain, discomfort, and lack of retention [17, 21, 22] have been suggested as commonest complaints in contrast to the finding of difficulty in chewing in this study. Although association of mastication and dietary type are not conclusive, it might be proposed that the type of diet in the environment (both hard and soft diet) that this study was conducted could have influenced the finding. There is need for further investigation in this area.

    Assessments of patients’ satisfaction with their dentures are constrained by the various methods of assessment and rating. This study evaluated denture satisfaction by assessing the affective state of quality of life through oral impact on daily activities questionnaire. Most of the participants had overall satisfaction in agreement with other studies [20, 23, 24]. This satisfaction was based on patients’ perception of satisfaction; however, those who were not satisfied had different reasons for not being satisfied such as difficulty in mastication. Other reasons were difficulty in speech and smiling. The proportion of those affected emotionally was less than 15%. Personality and psychological influence have been implicated in the satisfaction of complete denture [25], and other psychological tools have been suggested for the assessment of psychological influence and satisfaction [26].

    The findings in this study on oral hygiene measures practiced by more than half of the participants with very few using denture cleansers and low compliance to yearly professional cleaning are a contrast to a previous study that reported poor adherence to denture hygiene measures [27]. The reasons for this previous finding were attributed to lack of standardization of denture care instructions and lack of evidence that denture hygiene instructions were previously given to patients. In this present study, there was standardization of instructions and this could have accounted for the level of adherence to denture hygiene instructions, although adherence to maintenance visit was still low.

    Over half of the population studied did not comply with denture storage instruction because they slept with dentures in the mouth, increasing the risk of oral mucosa inflammation and other systemic disease such as pneumonia [28]. There is also the risk of increased apnea and hypopnea index, increased incidence of obstructive sleep apnea–hypopnea syndrome, increased morning diastolic blood pressure, and increased mortality if not intercepted early [29]. Wearing of both upper and lower complete dentures had a significant association with overnight wearing of dentures. It is suggested that instructions on removal of dentures before overnight sleep should be emphasized, especially in this group of patients.

    Denture adhesives are used to ensure retention of dentures [30], but it has been implicated in mucosal inflammation [31] toxicity in zinc-containing adhesives, and neurotoxicity [32]. However, none of the participants used denture adhesives. The decline in the proportion of participants who maintained recall visit from 24-h to 6 months may suggest that participants who maintain 6 months recall visit are likely to maintain yearly recall visit. The female survival rate was greater in this study, and this could be confirming that the life expectancy of females is stated to be higher than that of males in some countries such as America [33]. Difficulty in mastication was reported in some respondents, especially the males; this could be due to the different factors. It has been suggested that indicators assessing social well-being outcomes should also be put into consideration with oral assessment. Chewing difficulty has been reported to be an idiosyncratic pointer as many factors can be causative agents [34]. These include intraoral status, psychosocial factors such as food preferences, treatment information, and denture expectations [35]. It could also be a trust issue or patient’s perception of treatment, dental practitioner, or the hospital [36]. Our finding was a contrast to the Korean study that reported more women having difficulty in chewing [34]. The reason for this cannot be ascertained. It is reported that oral problems have negative impact on adequate maintenance and hygiene [37]. Therefore, it is crucial that complete denture therapy should be instituted with holistic approach in order to ensure adequate denture care, hygiene, and maintenance. There are limitations of sample population and sampling method in this study. Further research involving larger sample size should be encouraged in future.

    Study limitations

    In this study, there are limitations that were discovered. These included sample population and sampling method, which would require further research involving large sample size to be encouraged in future.

      Conclusion Top

    The compliance to denture hygiene guidance within the limit of this study was found to be good, but there was poor adherence to denture maintenance regime. There is a need to re-emphasize denture maintenance and storage instruction, especially in patients wearing complete denture on both jaws. A larger study with a wider population is recommended.

    Authors’ contribution

    BOA and OOD conceived the research concept, BOA and OOD developed research, and BOA performed field work and data analysis. BOA, OAA, and OFI prepared the first draft, and all authors reviewed and approved the final version of the manuscript.

    Ethical statement

    Ethical approval was obtained from the Lagos University Teaching Hospital Ethical Committee on December 21, 2009.

    Financial support and sponsorship

    There was no financial support for the research.

    Conflicts of interest

    The authors have no conflicts of interest.

    Data availability statement

    Data collected and analyzed are available with the corresponding author and are properly stored electronically with no name and contact to ensure confidentiality.

    Patients’ consent

    Patients’ consent was obtained after explaining the study procedures.

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      [Figure 1], [Figure 2], [Figure 3]

      [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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