Dentures: Causes of problems faced by wearers

Designing dentures

A well-designed denture can restore chewing ability, improve speech, have aesthetic appeal and help maintain overall oral health.¹

Creating functional and comfortable dentures requires careful custom planning and consideration of the following factors:^1,2

Clinical
Anatomical
Technical

Principles of good denture design

Three overarching principles form the foundation of good denture design

For good denture design, the three overarching principles are:

Retention The denture should be resistant to the forces that can cause it to move vertically away from supporting tissues, that is, the movement of the saddle away from the ridge.^2,3
Stability The denture should be as stable as possible, resisting any lateral movement and avoiding constant reminders of its physical presence in the patient’s mouth.^3-5
Support The denture should be resistant to the forces that may cause it to move towards the supporting tissues, that is, movement of the saddle towards the ridge.⁴

Restricted oral anatomy and denture retention/stability

Restrictions in patient oral anatomy can limit denture retention and stability.^6,7Well-fitting denture performance can be limited by patients’ oral anatomy,² and can be gradually affected by bone resorption over time.^7,8

Impact of oral anatomy

Factors limiting retention:

Surface area defined by individual oral anatomy⁶
- Small lower jaw
- Flat alveolar ridges
- Small basal seat

Patient impact:

Low denture retention^6,8and stability⁷
Poor chewing ability^7,8
Poor denture satisfaction⁷

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Poor denture hygiene can compromise oral health^9–11

The impact of poor oral hygiene
Poor denture hygiene can compromise oral health^9–11

Poor hygiene with partial dentures may compromise the health of remaining natural teeth by:¹⁰

Harbouring germs that can compromise remaining teeth and oral surfaces^12–14

Encouraging increased plaque accumulation, which may lead to gum problems^10,11,15

For those with full dentures, poor hygiene can also result in plaque and calculus building up on the denture^16,17
The concerns of inadequate hygiene

Poor denture hygiene may put full and partial denture wearers’ oral health at risk.^9–11
Poor oral health and patient wellbeing
Hygiene-related design principles and the causes of problems faced by denture patients

Poor oral health may affect patients’ overall wellbeing as well as their oral health. Poor denture hygiene may also increase a patients’ risk of pneumonia.¹²

Consideration of hygienic principles during the denture design process may help avoid the risk of hygiene-related complications by:⁴

Creating dentures that are easy for the patient to clean and care for

Avoiding unnecessary coverage of gingival tissues

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Inadequate denture cleaning may lead to denture stomatitis^19,20

Up to 88% of denture wearers do not clean their dentures effectively.²¹

Up to 67% of full denture wearers have denture stomatitis.¹⁹

Denture stomatitis

Denture stomatitis is commonly associated with a yeast infection that causes the area underneath the denture to become very red.

Left untreated, it can cause soreness of the mouth and may lead to poorly fitted dentures in the future.^19–21

Stomatitis is caused by microbial biofilm on the denture-fitting surface (rather than the mucosal surface) and poorly fitted dentures.²⁰

The prevalence of denture stomatitis is strongly linked with the amount of denture plaque.¹⁹

Some of the denture-related patient factors associated with stomatitis include poor denture hygiene and wearing dentures at night.¹⁹

Effective education can reduce the risk of inadequate dental hygiene practices

Medical conditions and hygiene proficiency affect denture performance

A dry mouth can limit normal denture retention^6,22

A dry mouth is a subjective feeling of dryness that may result from a decrease in the production of saliva (hyposalivation).²³

A dry mouth is more prevalent in the elderly population due to increased use of medication and susceptibility to disease.^24,25

Prevalence in women tends to be higher than in men.²⁶
Up to 48% of denture wearers experience a dry mouth
Causes:⁶

Side effects of medications

Radiation therapy

Systemic diseases

Diseases of the salivary glands
Impact on retention

Lack of saliva disrupts normal denture retention.^6,22

Polident - helping your patients on their journey to optimal denture care

Impact on patient quality of life

Find out about the impact that dentures have on patients’ daily lives

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Diagnosis

Explore an overview of diagnosing issues with denture performance

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Management

Explore an overview of maintaining the performance of dentures

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Denture care

Find out more about denture care

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The Polident range

Find out how the Polident range can help your patients

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Patient care resources

Download resources for your patients and clinic

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References

Lynch CD. Dent Update 2012; 39:118–126.
Campbell SD et al. J Prosth Dent 2017; 118:273–280.
British Society of Prosthodontics. Guidelines in prosthetic and implant dentistry. 1996. Available at: http://www.bsspd.org/File.ashx?id=13928 (last accessed July 2018).
Stilwell C. Dent Update 2010; 37:682–690.
Besford JN, Sutton AF. Br Dent J 2018; 224:141–148.
Shay K. In: Zarb GA et al. (eds). 1997. Boucher’s Prosthodontic Treatment for Edentulous Patients. St Louis: Mosby, pp. 400–411.
Huumonen S et al. J Oral Rehabil 2012; 39:384–390.
Felton D et al. J Prosthodont 2011; 20:S1–S12.
Takamiya AS et al. Gerodontology 2011; 28:91–96.
Zlatarić DK et al. J Periodontol 2002; 73:137–144.
Davenport JC et al. Br Dent J 2000; 189:646–657.
Coulthwaite L, Verran J. Br J Biomed Sci 2007; 64:180–189.
Machado-Mengatto C et al. Abstract 0192 presented at IADR. April, 2008.
Gao N et al. J West China Univ Med Sci 1998; 29:33–37.
Rodan R et al. Jordan Med J 2012; 19:53–58.
Marchini L et al. Gerodontology 2004; 21:226–228.
de Castellucci Barbosa L et al. Gerodontology 2008; 25:99–106.
Kiesow A et al. J Prosthet Dent 2016; 115:189–198.
Petersen PE, Yamamoto T. Community Dent Oral Epidemiol 2005; 33:81-92.
Shagana JA. J Pharm Sci & Res 2016; 8:1117–1118.
Dikbas I et al. Int J Prosthodont 2006; 19:294–298.
Darvell BW, Clark RK. Br Dent J 2000; 189:248–252.
Llena-Puy C. Med Oral Patol Oral Cir Bucal 2006; 11:E449–455.
Kleinegger CL. J Calif Dent Assoc 2007; 35:417–424.
Sreebny LM, Vissink A. 2010. Dry mouth: The malevolent symptom: A clinical guide. Oxford: Wiley-Blackwell.
Nederfors T et al. Community Dent Oral Epidemiol 1997; 25:211–216.
Takayama Y et al. Nihon Hotetsu Shika Gakkai Zasshi 2005; 49:263–272.

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Dentures: Causes of problems faced by wearers

Designing dentures

Principles of good denture design

Three overarching principles form the foundation of good denture design

Restricted oral anatomy and denture retention/stability

Impact of oral anatomy

Poor denture hygiene can compromise oral health9–11

Poor denture hygiene can compromise oral health9–11

Hygiene-related design principles and the causes of problems faced by denture patients

Inadequate denture cleaning may lead to denture stomatitis19,20

Denture stomatitis

Medical conditions and hygiene proficiency affect denture performance

Polident - helping your patients on their journey to optimal denture care

Impact on patient quality of life

Diagnosis

Management

Denture care

The Polident range

Patient care resources

References

Poor denture hygiene can compromise oral health^9–11

Poor denture hygiene can compromise oral health^9–11

Inadequate denture cleaning may lead to denture stomatitis^19,20