PROBLEMS ASSOCIATED WITH AGING AND DENTURE WEARING IN COMPLETELY EDENTULOUS PEOPLE

INTRODUCTIONCOMPLETE EDENTULISM

DENTURESASSOCIATED PROBLEMS WITH NEW DENTURE WEAR

GERONDONTOLOGYASSOCIATED PROBLEMS WITH AGING IN COMPLETE

EDENTULISMASSOCIATED PROBLEMS WITH AGING IN COMPLETE

DENTURE WEAR PROBLEM MANAGEMENT

CONCLUSION.

TABLE OF CONTENT

Edentulism (partial or total) is an indicator of the oral health of a population (Brodeur, et al 1996). It may also be a reflection of the success or preventive and treatment modalities put in place by the health care delivery system (Otuyemi, Ndukwe 1997) since it has being described as the “final marker of disease burden for oral heath (journal of dental research, 2007)

Complete edentulism can be defined as the physical state of the jaw(s) following removal of all erupted teeth and the condition of the supporting structures available for reconstructive or replacement therapies (Garry, Skiba, et al, 1999).

INTRODUCTION

COMPLETE EDENTULISM

Edentulism has being described as irreversible (journal of dental research, 2007) and a major form of management is DENTURE WEAR.

Dentures, also known as false teeth, are prosthetic devices constructed to replace missing teeth; they are supported by the surrounding soft and hard tissues of the oral cavity.

Conventional dentures are removable. However, there are many different denture designs, some of which rely on bonding or clasping onto teeth or dental implants

DENTURES

Maxillary denture

Mandibular denture

DENTURE: CATEGORIES

DENTURES: TYPES

COMPLETE DENTURE WEAR

Complete denture can either be conventional or immediate.

It is estimated that the need for complete dentures will have increased from approximately 54 million in 1991 to approximately 61 million in 2020 (US estimate, Douglass, et al, 2002).

Although the rate of edentulism will have decreased, the aging population will bring with it an increase in number of teeth loss (US estimate, Feine, Carlsson 2003).

In a study carried out in Nigeria (ile-ife and Lagos), the demand for complete denture increased with age (Esan et al, 2004)

COMPLETE DENTURE: PREVALENCE

The advent of denture has helped with lots of complications associated with the edentulous state, the image below explains a lot:

COMPLETE DENTURE: COMPLICATIONS MANAGED

Among the complications associated with edentulism complete denture has helped with include: Mastication Aesthetics Pronunciation Self-esteem

However, denture wear has not come without its own related problems.

COMPLETE DENTURE: COMPLICATIONS MANAGED

Apart from problem associated normally with a well fixed complete denture, McCord and Grant, 2000 in the British Dental Journal grouped factors causing complete denture problem into:

Adverse intraoral anatomical factors e.g. atrophic mucosa

Clinical factors e.g. poor denture stability Technical factors e.g. failure to preserve the

peripheral roll on a master cast. Patient adaptational factors

COMPLETE DENTURE: ASSOCIATED PROBLEM CAUSES

Excessive Salivation: In the first 12 to 24 hours of wearing denture, the patient face the problem of excessive salivation as the brain misinterprets it to be food.

Sore spots as they compress the denture bearing soft tissue (mucosa) may also arise

Eating and speaking difficulty

With adaptation and few denture adjustments in the days following insertion of the dentures can take care of this problems

NEW COMPLETE DENTURE: PROBLEMS ASSOCIATED

Gerondontology: is the branch of dentistry that deals with the oral health problems of the old people. one of the problems of aging is that some of the bodily functions do not maintain their efficiency. There are lots of oral health problems associated with aging,

edentulous or not ranging from root caries, Gingivitis, Periodontitis, xerostomia, candidiasis to list a few.

Complete edentulism only aggravate some and in some cases, introduce new ones.

While the use of denture help manage some of the problems introduced by the edentulism, with aging it also aggravate some oral health problem, modify some and might introduce new ones

The focus of this slide is however the last two cases.

GERONDONTOLOGY

EXTRA-ORAL CHANGES

Skinskin becomes thin, wrinkled and dried

Lipage reduces the concavity and pout of the upper lip

PROBLEMS ASSOCIATED WITH AGING IN COMPLETE EDENTULOUS PEOPLE

Naso-labial grooveNaso-labial groove deepens, which produce a sagging look to the middle third of the face.

Fat padsatrophy at subcutaneous end buccal pads of fat hollows the cheeksdue to loss of fat, support for the pre symphysial pad of fat disappears and upper lip droops over maxillary teeth

EXTRA ORAL CHANGES

Oral mucosa becomes thin, easily abraded, and frequently reacts unfavorably to the pressure of dentures.

Mandibular ridge resorption: a Clinical Evaluation of Mandibular Ridge Height In Relation To Aging and Length of Edentulism performed by Dr.Mandya et al published in journal of Dental and Medical Sciences, 2013 concluded from the study result that:

The reduction in mandibular height has a linear relationship to age.The Early mean % reduction in mandibular height was followed by slower mean resorption as the period of edentulism increased in both age groups.

INTRA ORAL CHANGES

In older age groups, the progression of mandibular resorption in relationship to edentulism period was faster

than in the younger age groups. A constant % reduction of mandibular height occurs as

length of edentulism period increases. A non-significant comparison between the two age groups

i.e. mandibular ridge height reduction was constant between the aging and length of edentulism .

It is based on this (showing severity difference) that complete edentulism was divided into four classes

INTRA ORAL CHANGES

COMPLETE EDENTULISM: CLASS 1Mandibular residual bone height: 21mm or greater.

INTRA ORAL CHANGES

COMPLETE EDENTULISM: CLASS 2Mandibular residual bone height: 16-20mm

INTRAORAL CHANGES

COMPLETE EDENTULISM: CLASS 3Mandibular residual bone height: 11-15mm.

INTRAORAL CHANGES

COMPLETE EDENTULISM: CLASS 4Mandibular residual bone height: 10mm or less.

INTRAORAL CHANGES

EXTRA ORAL CHANGESWrinkles above/ around lips or at corners of mouth: Denture has moved back and no longer supports the lips. This may be due to bone loss/ loss of skin elasticity

PROBLEMS ASSOCIATED WITH COMPLETE DENTURE

WEAR WITH AGING

Angular cheilitis: loss of vertical support for the denture (bone loss) can cause mouth to over close. This can change the way the leaps seal together and cause saliva to pool at the corners of the mouth. The excess moisture in this area may cause the skin to become irritated and man increase fungi infection.

EXTRA-ORAL CHANGES

becomes thin, easily abraded, and frequently reacts unfavorably to the pressure of dentures sometimes leading to sore spot in the mouth

stomatitis and other mild inflammations are the mucosal lesions encountered most frequently in older edentulous mouths, especially of older men who wear dentures, smoke tobaccos and drink alcohol excessively

ORAL MUCOSA

oral cancer or precancerous lesions are unusual in western countries, although they are the most common forms of cancer on the Indian subcontinent and in other parts of Asia

external carcinogens such as nicotine and alcohol could be more damaging to the oral mucosa in old age because of atrophy, increase mitosis with slow turnover of cells, and increased number of elastic fibers. therefore it is likely that there is risk of oral cancer is increased among edentulous denture wears.

ORAL MUCOSA

Poor-fitted dentures: the fitness of the denture to the oral mucosa decrease with the wearer’s lifetime. This is due to bone resorption, edentulous jaw ridges tend to resorb with aging, especially the alveolar ridge of the lower jaw. Mucosa also reacts to being chronically rubbed by dentures.

Poor fitted dentures is further associated with problems as:Increase in bone resorption rateGaggingPain Denture slipping and movingEpulis fissuratum among others

BONE RESORPTION AND DENTURE FITTING

Speaking difficulty

Chewing difficulty

Sore spots in the mouth

OTHER PROBLEMS INCLUDE

Journal of clinical and diagnostic research in 2014 published a study on problems faced by complete denture wearing elderly people living in Jammu District (singh et al). The problems were classified into 4 classes:

Physical problem Social problem Psychological problem Clinical observation

The following tables summarises their findings among the male respondents, this is just to point out that most of the problems does not occur in all the people together

PROBLEM PREVALENCE

BY THE DENTISTFixing Denture DiscomfortNo matter what the cause, Ill-fitting dentures can be fixed by adentist. Three techniques are typically used, which are:Relining. A liquid acrylic molds the denture closely to shape of the gums.Recasting: The dentures can be re-made to get a better fit.

Mini-implants. This procedure is becoming more routine, and it is extremely effective. Mini implants are insertedinto the bone, to stabilize dentures. This minimally invasiveprocedure can typically be accomplished in one visit.

MANAGEMENT OF PROBLEMS ASSOCIATED WITH COMPLETE

DENTURES

Taking Care of DenturesFalse teeth require just as much as care as natural teeth. The following tips are recommended for denture wearers:Clean and brush dentures every day. Plaque and tarter can stillbuild up just like on natural teeth.Use a toothpaste and toothbrush specially designed for dentures.Regular toothpaste and brushes are abrasive enough to scratch thesurface of dentures.Soak dentures at night. Dentures may lose their shape if they areallowed to dry out. Remove the dentures, clean them and soakthem in denture cleanser overnight.

MANAGEMENT BY PATIENT

Visit your dentist for regular hygiene checkups. Even people whohave no natural teeth and wear full dentures should have theirmouth examined annually for signs of gum disease and oralcancer, and also for proper denture fit.

Store dentures in a safe place. Dentures are delicate and maybreak if dropped even a few inches. When not wearing dentures,store them away from children and pets.

CONCLUSION