EdenteV2, Istex, Corpus, bibRecord, 003F70

Clinical morbidity and sequelae of treatment with complete dentures

Identifieur interne : 003F70 ( Istex/Corpus ); précédent : 003F69; suivant : 003F71

Clinical morbidity and sequelae of treatment with complete dentures

Auteurs : Gunnar E. Carlsson

Source :

The Journal of Prosthetic Dentistry [ 0022-3913 ] ; 1998.

RBID : ISTEX:8034C69B6D215EB3A3ECA6D6F23B176BE0C0DFB5

English descriptors

KwdEn :
- Acta, Acta odontol scand, Angular cheilitis, Bone loss, Candida, Candida albicans infections, Carlsson, Clinical research, Combination syndrome, Community dent, Complete denture treatment, Complete denture wearers, Complete dentures, Dent, Dental implants, Dentistry, Denture, Denture adhesives, Denture quality, Denture stomatitis, Denture wearers, Disease entity, Edentulous, Edentulous condition, Edentulous patients, Edentulous people, Fitting dentures, Flabby ridge, Implant, Management strategies, Mandibular, Masticatory, Masticatory performance, Maxillary, Mouth syndrome, Mucosal, Mucosal reactions, Odontol, Oral pathol, Oral rehabil, Patient satisfaction, Prosthesis, Prosthet, Prosthet dent, Prosthetic, Prosthetic dentistry, Prosthodontic, Prosthodontic treatment, Prosthodontics, Psychologic, Psychologic factors, Removable dentures, Residual, Residual ridge resorption, Resorption, Ridge resorption, Scand, Stomatitis, Syndrome, Systemic factors, Temporomandibular, Temporomandibular disorders, Traumatic ulcers, Wearer, Zarb.
Teeft :
- Acta, Acta odontol scand, Angular cheilitis, Bone loss, Candida, Candida albicans infections, Carlsson, Clinical research, Combination syndrome, Community dent, Complete denture treatment, Complete denture wearers, Complete dentures, Dent, Dental implants, Dentistry, Denture, Denture adhesives, Denture quality, Denture stomatitis, Denture wearers, Disease entity, Edentulous, Edentulous condition, Edentulous patients, Edentulous people, Fitting dentures, Flabby ridge, Implant, Management strategies, Mandibular, Masticatory, Masticatory performance, Maxillary, Mouth syndrome, Mucosal, Mucosal reactions, Odontol, Oral pathol, Oral rehabil, Patient satisfaction, Prosthesis, Prosthet, Prosthet dent, Prosthetic, Prosthetic dentistry, Prosthodontic, Prosthodontic treatment, Prosthodontics, Psychologic, Psychologic factors, Removable dentures, Residual, Residual ridge resorption, Resorption, Ridge resorption, Scand, Stomatitis, Syndrome, Systemic factors, Temporomandibular, Temporomandibular disorders, Traumatic ulcers, Wearer, Zarb.

Abstract

Abstract: Wearing complete dentures may have adverse effects on the health of both the oral and the denture-supporting tissues. This article is a review of selected literature on the sequelae of treatment with complete dentures in the specific areas of residual ridge resorption, mucosal reactions, burning mouth syndrome, temporomandibular disorders, and patient satisfaction. Recent literature found with a Medline search from 1952 to 1996 is included in this review. Residual ridge resorption is an inevitable consequence of tooth loss and denture wearing, with no dominant causative factor having been found. Mucosal reactions have a multifactorial cause, most of which can be easily treated. Most patients are satisfied with their complete dentures. Correlations between anatomic conditions and denture quality and patient satisfaction are weak. Psychologic factors seem to be extremely important in the acceptance of and adaptation to removable dentures. There are still no reliable methods to predict the outcome of complete denture treatment and there are many problems related to treatment with complete dentures. Although the prevalence of an edentulous condition is decreasing, the great number of edentulous people warrants the continuing efforts of basic and clinical research on removable partial dentures. Complete denture prosthodontics will remain an important part of dental education and practice. In addition to clinical and technical skills, insight into patient behavior and psychology and communication techniques are also necessary. (J Prosthet Dent 1997;79:17-23.)

Url:

https://api.istex.fr/document/8034C69B6D215EB3A3ECA6D6F23B176BE0C0DFB5/fulltext/pdf

DOI: 10.1016/S0022-3913(98)70188-X

Links to Exploration step

ISTEX:8034C69B6D215EB3A3ECA6D6F23B176BE0C0DFB5

Le document en format XML

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<istex:document><article docsubtype="fla" xml:lang="en"><item-info><jid>YMPR</jid>
<aid>86941</aid>
<ce:pii>S0022-3913(98)70188-X</ce:pii>
<ce:doi>10.1016/S0022-3913(98)70188-X</ce:doi>
<ce:copyright type="other" year="1998">Editorial Council of The Journal of Prosthetic Dentistry.</ce:copyright>
</item-info>
<head><ce:article-footnote><ce:label>☆</ce:label>
<ce:note-para><ce:sup>a</ce:sup>
Professor Emeritus, Department of Prosthetic Dentistry.</ce:note-para>
</ce:article-footnote>
<ce:article-footnote><ce:label>☆☆</ce:label>
<ce:note-para>Reprint requests to: Dr. Gunnar E Carlsson, Department of Prosthetic Dentistry, Faculty of Odontology Medicinaregatan 12, S-413 90, Göteborg, Sweden</ce:note-para>
</ce:article-footnote>
<ce:article-footnote><ce:label>★</ce:label>
<ce:note-para><ce:bold>10/1/86941</ce:bold>
</ce:note-para>
</ce:article-footnote>
<ce:title>Clinical morbidity and sequelae of treatment with complete dentures</ce:title>
<ce:presented>Presented at the Academy of Prosthodontics Scientific Meeting, Halifax, Nova Scotia, Canada, May 1997.</ce:presented>
<ce:author-group><ce:author><ce:given-name>Gunnar E.</ce:given-name>
<ce:surname>Carlsson</ce:surname>
<ce:degrees>DDS, Odont Dr, Dr Odont hc<ce:sup>a</ce:sup>
</ce:degrees>
</ce:author>
<ce:affiliation><ce:textfn>Faculty of Odontology, Göteborg University Göteborg, Sweden</ce:textfn>
</ce:affiliation>
</ce:author-group>
<ce:abstract><ce:section-title>Abstract</ce:section-title>
<ce:abstract-sec><ce:simple-para>Wearing complete dentures may have adverse effects on the health of both the oral and the denture-supporting tissues. This article is a review of selected literature on the sequelae of treatment with complete dentures in the specific areas of residual ridge resorption, mucosal reactions, burning mouth syndrome, temporomandibular disorders, and patient satisfaction. Recent literature found with a Medline search from 1952 to 1996 is included in this review. Residual ridge resorption is an inevitable consequence of tooth loss and denture wearing, with no dominant causative factor having been found. Mucosal reactions have a multifactorial cause, most of which can be easily treated. Most patients are satisfied with their complete dentures. Correlations between anatomic conditions and denture quality and patient satisfaction are weak. Psychologic factors seem to be extremely important in the acceptance of and adaptation to removable dentures. There are still no reliable methods to predict the outcome of complete denture treatment and there are many problems related to treatment with complete dentures. Although the prevalence of an edentulous condition is decreasing, the great number of edentulous people warrants the continuing efforts of basic and clinical research on removable partial dentures. Complete denture prosthodontics will remain an important part of dental education and practice. In addition to clinical and technical skills, insight into patient behavior and psychology and communication techniques are also necessary. (J Prosthet Dent 1997;79:17-23.)</ce:simple-para>
</ce:abstract-sec>
</ce:abstract>
</head>
<body><ce:sections><ce:para>The wearing of complete dentures may have adverse effects on the health of both oral and denture-supporting tissues. These effects can be divided into direct and indirect sequelae. To the first group belong residual ridge resorption and mucosal reactions, such as denture stomatitis, denture irritation hyperplasia, traumatic ulcers, and “flabby ridges.” It has also been suggested that there might be an association between oral carcinoma and chronic denture irritation, but no indisputable evidence appears to exist. Other conditions related to the wearing of complete dentures include altered taste perception, burning mouth syndrome, and gagging. Indirect sequelae are related to the great changes in masticatory function in complete denture wearers compared with dentate subjects. Bite force is reduced with risk for atrophy of the masticatory muscles. The reduced masticatory ability may lead to changes in dietary selection with risks for an impaired nutritional status, especially in the elderly complete denture wearer.<ce:cross-ref refid="bib1"><ce:sup>1</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para>Today, prosthodontists' interests are very much focused on implant-supported prostheses, but the literature on complete dentures is still extensive. A search in Medline disclosed 173 references on complete dentures from January 1996 to May 1997 and similar numbers for preceding years. During the same period, there were 682 references on dental implants; 86 for dental implants and/or prosthodontics. By necessity, this review must be based on a difficult and subjective selection of the abundant literature.</ce:para>
<ce:para>This article reviews selected literature, both recent and older, on the sequelae of treatment with complete dentures, specifically residual ridge resorption, mucosal reactions, burning mouth syndrome, temporomandibular disorders, and patient satisfaction.</ce:para>
<ce:section><ce:section-title>Residual Ridge Resorption</ce:section-title>
<ce:section><ce:section-title>Impact and etiology</ce:section-title>
<ce:para>In an oft-cited article, Atwood<ce:cross-ref refid="bib2"><ce:sup>2</ce:sup>
</ce:cross-ref>
 called the continuous reduction of residual ridges in complete denture wearers “a major oral disease entity.” It appears to be a process encountered in all patients. Albeit, there is considerable interindividual variation in the rate of bone loss after tooth extraction and the wearing of complete dentures, residual ridge resorption may proceed throughout the lifetime of the denture wearer.<ce:cross-refs refid="bib2 bib3 bib4"><ce:sup>2-4</ce:sup>
</ce:cross-refs>
 It is accepted that resorption is a consequence of bone remodeling due to the altered functional stimulus on the jaw bone. However, the causes of the great individual variations are not well understood.<ce:cross-ref refid="bib5"><ce:sup>5</ce:sup>
</ce:cross-ref>
 Two decades ago, Woelfel et al.<ce:cross-ref refid="bib6"><ce:sup>6</ce:sup>
</ce:cross-ref>
 listed 63 factors that could possibly be related to bone resorption under removable dentures. In their analysis, they found no single dominant factor to explain the variability of bone loss. Even today, at the end of the 1990s, we must admit that little is known about which factors are most important for the observed variations in residual ridge resorption. Despite the large number of recent studies, a single dominant factor for residual ridge resorption has yet to be found. Factors often used in correlation analyses are gender, age, facial structure, duration of edentulousness, denture wearing habits, number of dentures worn, oral hygiene, oral parafunctions, occlusal loading, denture quality, nutrition, general health, medication, systemic diseases, and osteoporosis. Some studies have reported statistically significant correlations between residual ridge resorption and one such factor. However, a simple, probable association between duration of edentulousness and residual ridge resorption was not proven to be statistically significant in several cross-sectional studies.<ce:cross-refs refid="bib7 bib8 bib9 bib10 bib11 bib12 bib13 bib14 bib15 bib16"><ce:sup>7-16</ce:sup>
</ce:cross-refs>
 There are also contradictory reports on the influence of gender on residual ridge resorption: Most state that women have more advanced bone loss than men, but some have not found such a difference.<ce:cross-ref refid="bib5"><ce:sup>5</ce:sup>
</ce:cross-ref>
 One recent article found that the amount of residual ridge resorption was significantly correlated with the number of years women had been edentulous, but this relationship was not found in men.<ce:cross-ref refid="bib15"><ce:sup>15</ce:sup>
</ce:cross-ref>
 Probable explanations for these contradictions are, among other things, the enormous individual variation in the rate of bone loss and varying duration of the edentulous condition in the subjects examined.</ce:para>
<ce:para>The so-called combination syndrome can be mentioned as another example of this lack of unequivocal results. According to this concept, a patient who wears a maxillary complete denture and has reduced mandibular dentition with only anterior teeth (or a mandibular overdenture on anterior natural teeth or implants) runs the risk of an increased bone loss in the maxillary anterior ridge, among others.<ce:cross-refs refid="bib17 bib18"><ce:sup>17,18</ce:sup>
</ce:cross-refs>
 Even though the combination syndrome concept has been supported over the years by several anecdotal observations reported in the literature and by the clinical experience of many prosthodontists, there is a surprising lack of evidence for this opinion in controlled studies.<ce:cross-refs refid="bib4 bib19 bib20"><ce:sup>4,19,20</ce:sup>
</ce:cross-refs> Again, an explanation might be found in the fact that when results are presented as mean values, extensive bone loss in a few persons, due to the combination syndrome, is concealed. However, one must be careful when making general conclusions based on single observations. It is obvious that the combination syndrome does not occur in all patients (Fig. 1).
<ce:display><ce:figure><ce:caption><ce:simple-para><ce:bold>Fig.1.</ce:bold>
 Different patterns of residual ridge resorption in maxillae in relation to remaining anterior teeth in mandible during 20-year follow-up observation period. <ce:italic>Solid line</ce:italic>
 = 1 year; <ce:italic>thin line</ce:italic>
 = 21 years after original denture treatment. Large maxillary bone loss in <ce:bold>A</ce:bold>
 indicates “combination syndrome,” small one in <ce:bold>B</ce:bold>
 does not. (Modified from reference no. 4.)</ce:simple-para>
</ce:caption>
 <ce:link locator="gr1"></ce:link>
</ce:figure>
</ce:display>
In a Belgian study,<ce:cross-ref refid="bib20"><ce:sup>20</ce:sup>
</ce:cross-ref>
 patients had suffered an even greater mean bone loss in the maxilla in the group with mandibular complete dentures than in those with implant-supported overdentures or fixed prostheses. The combination syndrome is also contradicted by the successful long-term application of the shortened dental arch concept.<ce:cross-ref refid="bib21"><ce:sup>21</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para>Multivariate analyses related to residual ridge resorption are still rare. In a recent study applying such statistics, the female gender and systemic factors seemed to be of greater importance than oral and denture factors, especially in the mandible.<ce:cross-ref refid="bib22"><ce:sup>22</ce:sup>
</ce:cross-ref>
 It was also found that asthma was a significant risk factor for severe residual ridge resorption, the mechanism probably being the corticosteroid treatment of the asthmatic patients. On the other hand, alcohol intake was correlated to a lesser degree of maxillary residual ridge resorption. In a Finnish investigation<ce:cross-ref refid="bib23"><ce:sup>23</ce:sup>
</ce:cross-ref>
 that analyzed the effects of fluoridated drinking water and estrogen therapy on residual ridge resorption, it was found that persons who used fluoridated water for long periods (> 10 years) had higher residual ridges than those who had used fluoridated water for shorter periods. The results from studies of patients undergoing hormone replacement therapy were inconclusive. These researchers concluded, on the basis of this and other studies, that systemic factors control the final stage of residual ridge resorption, whereas local factors (surgical method, healing capacity, bite force) dominate the first phase after extraction.</ce:para>
<ce:para>The best explanation that can be offered today is that combinations of anatomic, metabolic, psychosocial, mechanical, and, most probably, unknown or yet-to-be-analyzed factors are of importance for residual ridge resorption. An example showing the influence of unexpected factors was the inclusion of smoking among conventional clinical variables in a multivariate analysis of peri-implant bone loss.<ce:cross-ref refid="bib24"><ce:sup>24</ce:sup>
</ce:cross-ref>
 When smoking was included in the analyses, it was found that smoking was of greater significance than any clinical factor in a long-term study of peri-implant bone loss. This does not indicate that smoking is of similar importance for residual ridge resorption, it only suggests, as do the previously mentioned Finnish studies, that new knowledge about the cause of residual ridge resorption may emerge when multivariate analyses are applied to research data and previously unanalyzed variables are included.</ce:para>
</ce:section>
<ce:section><ce:section-title>Epidemiology</ce:section-title>
<ce:para>More than 25 years after Atwood ́s statement, it remains that residual ridge resorption can be considered “a major oral disease entity.” On an individual level, it is true today, even though implant-supported prostheses provide a favorable solution for some edentulous patients who suffer from the consequences of residual ridge resorption. How is it on an epidemiologic level? The prevalence of the edentulous condition is rapidly decreasing in many countries, but great geographic and socioeconomic differences still exist (Fig. 2).<ce:cross-refs refid="bib25 bib26 bib27"><ce:sup>25-27</ce:sup>
</ce:cross-refs>
<ce:display><ce:figure><ce:label>Fig. 2</ce:label>
<ce:caption><ce:simple-para>National differences in edentulousness in various age groups in 1980s. [Modified from Carlsson GE, Käyser A, Öwall B. Prosthodontics: principles and management strategies. London: Mosby-Wolfe, 1996.]</ce:simple-para>
</ce:caption>
 <ce:link locator="gr2"></ce:link>
</ce:figure>
</ce:display>
Despite this beneficial improvement in oral health and the decline in the rate of the edentulous condition, there remains a substantial number of complete denture wearers among elderly people. A rough estimate indicates that, on a global level, only about one in every thousand totally and partially edentulous people have benefited from treatment with implant-supported prostheses.<ce:cross-ref refid="bib27"><ce:sup>27</ce:sup>
</ce:cross-ref>
 The number of edentulous elderly persons may even increase because of the current expansion of the oldest segment of the population.<ce:cross-ref refid="bib26"><ce:sup>26</ce:sup>
</ce:cross-ref>
 Treatment of edentulous people will therefore continue to be a challenge for the dental profession. In Sweden, where the prevalence of the edentulous condition has decreased more than in many other countries (Fig. 3), a majority of general practitioners no longer perform complete denture treatment because they have too little experience.<ce:cross-ref refid="bib28"><ce:sup>28</ce:sup>
</ce:cross-ref>
<ce:display><ce:figure><ce:label>Fig. 3</ce:label>
<ce:caption><ce:simple-para>Changes in edentulousness in men and women in Sweden in 1975 to 2000. Y axis denotes percentage (%); x axis represents age in years. [Modified from Österberg T, Carlsson GE, Sundh W, Fyhrlund A. Community Dent Oral Epidemiol 1995;23:232-6.]</ce:simple-para>
</ce:caption>
 <ce:link locator="gr3"></ce:link>
</ce:figure>
</ce:display>
What a few decades ago was everyday routine treatment in general practice in Sweden is now considered by several colleagues to be a specialist treatment. Current demographic trends, including the reduction of the edentulous condition, give rise to problems in planning dental curricula; for example, how to provide adequate education and training in complete denture prosthodontics for an aging population when so many new aspects of clinical dentistry require attention.<ce:cross-refs refid="bib1 bib6 bib29"><ce:sup>1,6,29</ce:sup>
</ce:cross-refs>
</ce:para>
</ce:section>
<ce:section><ce:section-title>Management</ce:section-title>
<ce:para>The consequences of residual ridge resorption are obvious, sometimes less so for the patient than for the prosthodontist who encounters increasing problems in the fabrication of well-functioning complete dentures. Many prosthodontic and surgical treatments have been attempted in situations of severe residual ridge resorption, but none has been completely predictable.<ce:cross-ref refid="bib1"><ce:sup>1</ce:sup>
</ce:cross-ref>
 The best treatment is to avoid total tooth extraction, preserve a few teeth, and make overdentures, which are associated with much lower rates of bone resorption.<ce:cross-refs refid="bib18 bib30"><ce:sup>18,30</ce:sup>
</ce:cross-refs>
 The placement of dental implants and the insertion of an implant-supported prosthesis have been shown to reduce substantially bone loss in the edentulous jaw, indicating the importance of altered functional stimulus to the bone tissue.<ce:cross-refs refid="bib24 bib31"><ce:sup>24,31</ce:sup>
</ce:cross-refs>
</ce:para>
</ce:section>
</ce:section>
<ce:section><ce:section-title>Mucosal Reactions</ce:section-title>
<ce:section><ce:section-title>Denture stomatitis</ce:section-title>
<ce:para>Many denture wearers develop an inflammatory reaction in the denture-bearing mucosa, most frequently in the palate. It is usually a benign disorder and most patients are unaware of their denture stomatitis. The lesions may be local or general in nature, and the surface may show small or more extended areas of erythema of a smooth or granular type. The prevalences reported for denture stomatitis vary greatly, with up to two thirds of the maxillary and one fifth of the mandibular mucosa diagnosed as inflamed in complete denture wearers.<ce:cross-refs refid="bib16 bib32"><ce:sup>16,32</ce:sup>
</ce:cross-refs>
 This is an indication that the diagnoses used have not been satisfactorily standardized.</ce:para>
<ce:para><ce:bold><ce:italic>Etiology</ce:italic>
</ce:bold>
. The predisposing factor for denture stomatitis is the presence of a denture, and denture-wearing habits are therefore correlated with denture stomatitis. Four to five decades ago, the most important etiologic factors were thought to be trauma from the dentures.<ce:cross-refs refid="bib32 bib33"><ce:sup>32,33</ce:sup>
</ce:cross-refs>
 Later, <ce:italic>Candida albicans</ce:italic>
 infections were considered to be the most important factors. Today, the multifactorial background of denture stomatitis is acknowledged. Poor oral hygiene that results in microbial plaque on the fitting surface of the denture and bacterial and <ce:italic>Candida albicans</ce:italic>
 infections appear to be of great etiologic importance.<ce:cross-refs refid="bib9 bib34 bib35"><ce:sup>9,34,35</ce:sup>
</ce:cross-refs>
 Traumatic factors such as mechanical, thermal, and chemical irritations and allergic reactions to components in the denture material may also be responsible for the development and maintenance of denture stomatitis.<ce:cross-refs refid="bib9 bib35 bib36"><ce:sup>9,35,36</ce:sup>
</ce:cross-refs>
 Recently, immunologic aspects have also been added to the multifactorial pathogenesis of the condition.<ce:cross-ref refid="bib37"><ce:sup>37</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para><ce:bold><ce:italic>Management.</ce:italic>
</ce:bold>
 The treatment is usually simple if the varying etiologic factor is acknowledged. Good oral hygiene, thorough denture cleaning, and an increased period of rest for the denture-bearing tissues are essential and, when indicated, may be combined with antifungal therapy and the correction of traumatizing factors associated with ill-fitting dentures. The use of antifungal drugs as the sole method of treatment is not recommended, because <ce:italic>Candida albicans</ce:italic>
 infections often recur if hygiene has not improved and the dentures have not been optimized. Surgical elimination of papillary hyperplasia in the granular type of denture stomatitis may be necessary to achieve optimal mucosal hygiene, but in mild cases, antifungal treatment without surgery may be an acceptable alternative.<ce:cross-refs refid="bib35 bib38"><ce:sup>35,38</ce:sup>
</ce:cross-refs>
</ce:para>
<ce:para>A simple treatment for reducing mucosal irritations is the use of denture adhesives. There have been conflicting opinions about this method in the prosthodontic literature over the years. However, negative attitudes have been based on claims that well-constructed dentures do not require adhesives to function properly and/or on proposed deleterious effects of adhesives. A more positive attitude has developed lately due to controlled studies that have demonstrated positive effects not only on mucosal irritations but also on denture stability, retention, and comfort.<ce:cross-refs refid="bib39 bib40 bib41 bib42"><ce:sup>39-42</ce:sup>
</ce:cross-refs>
</ce:para>
<ce:para>The nutritional status of an individual affects the health of the oral tissues. This implies that nutrition can influence the denture-bearing tissues and the adaptation to complete dentures, but this area needs more basic and clinical research. An excellent review of current knowledge and relevant recommendations regarding nutritional care for edentulous subjects has recently been published.<ce:cross-ref refid="bib43"><ce:sup>43</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para><ce:bold><ce:italic>Angular cheilitis.</ce:italic>
</ce:bold>
 An inflammation of the corners of the mouth is sometimes seen in cases of denture stomatitis and then often correlated with a <ce:italic>Candida albicans</ce:italic>
 infection. Earlier, it was often believed that a reduced vertical dimension of occlusion was the most important etiologic factor for angular cheilitis, but research has shown that general health factors such as nutritional deficiencies and immune dysfunction seem to be of greater importance. That antimicrobial treatment is often successful indicates that an infection is frequently present.<ce:cross-refs refid="bib35 bib44"><ce:sup>35,44</ce:sup>
</ce:cross-refs>
</ce:para>
</ce:section>
<ce:section><ce:section-title>Soft tissue hyperplasia</ce:section-title>
<ce:para><ce:bold><ce:italic>Flabby ridges</ce:italic>
</ce:bold>
. When hyperplastic tissue replaces the bone, a flabby ridge develops, which is often seen in long-term denture wearers and clearly related to the degree of residual ridge resorption. The reported prevalence for this condition also varies among investigators, but it has been observed in up to 24% of edentulous maxillae, and in 5% of edentulous mandible, and in both jaws most frequently in the anterior region.<ce:cross-refs refid="bib1 bib16"><ce:sup>1,16</ce:sup>
</ce:cross-refs>
 Even if surgical elimination of the flabby ridge is a logical treatment in many situations, care must be used when the ridge is extremely reduced. Although the flabby ridge may provide poor retention for the denture, it may still be better than no ridge at all.</ce:para>
<ce:para><ce:bold><ce:italic>Denture irritation hyperplasia</ce:italic>
</ce:bold>
. The mucosal response to chronic irritation from an overextended and/or ill-fitting denture may be a fibrous tissue hyperplasia. It has been reported to occur in 5% to 10% of jaws fitted with dentures, with the higher figure for the maxillae.<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup>
</ce:cross-ref>
 Healing is usually uneventful after reduction of the offending flanges and/or minor surgery.</ce:para>
<ce:para><ce:bold><ce:italic>Traumatic ulcers</ce:italic>
</ce:bold>
. Sore spots and ulcers are frequent findings the first few days after placement of new dentures. They are usually caused by overextended flanges and occlusal disturbances and can be expected to heal rapidly after the dentures have been modified. In cross-sectional studies of long-term denture wearers, traumatic ulcers in the mandible have been observed in up to 7% of the patients and in the maxillae in up to 1%.<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup>
</ce:cross-ref>
 Diseases that impair the resistance of the mucosa to mechanical irritation are predisposing to such lesions and make healing more difficult and recurrences more frequent. It is a well-established opinion that if a sore spot does not heal after correction of the denture, malignancy should be suspected and the patient should be immediately referred to a surgical specialist. However, there appears to be a lack of evidence that chronic irritation by dentures can cause oral carcinoma, although some anecdotal observations have been presented.<ce:cross-ref refid="bib35"><ce:sup>35</ce:sup>
</ce:cross-ref>
</ce:para>
</ce:section>
<ce:section><ce:section-title>Burning mouth syndrome</ce:section-title>
<ce:para>In contrast to denture stomatitis, which is often not painful, burning mouth syndrome (BMS) is a condition characterized by burning and painful sensations in a mouth with normal mucosa.<ce:cross-ref refid="bib45"><ce:sup>45</ce:sup>
</ce:cross-ref>
 It may occur in subjects with all types of dental status and is thus not limited to denture wearers. The tongue is reported to be the most frequent site of BMS, denture-bearing mucosa being another frequent location. It is most prevalent in middle-aged people and more frequent in women (4%) than in men (1%).</ce:para>
<ce:para>BMS has a multifactorial cause comprising local, systemic, and psychogenic factors. There are conflicting opinions about the importance of denture factors in BMS. Some investigators consider the causative factors such as local denture pressure, <ce:italic>Candida albicans</ce:italic>
 and bacterial infections, and allergic reactions to be the same for both denture stomatitis and BMS. In a recent study, it was observed that the dentures of patients with BMS revealed reduced tongue space, incorrect placement of the occlusal table, and increased vertical dimension of occlusion in comparison with control subjects.<ce:cross-ref refid="bib46"><ce:sup>46</ce:sup>
</ce:cross-ref>
 Others have not been able to corroborate these opinions and maintain therefore that dentures are an uncertain etiologic factor.<ce:cross-ref refid="bib47"><ce:sup>47</ce:sup>
</ce:cross-ref>
 In xerostomia, burning sensations in the oral mucosa may occur, but direct evidence of the relationship with BMS is lacking.</ce:para>
<ce:para>Among systemic factors of etiologic influence, hormonal, vitamin, and iron deficiencies have frequently been suggested, but the evidences of associations between such factors and BMS is not strong.<ce:cross-ref refid="bib35"><ce:sup>35</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para>Currently, great emphasis has been placed on psychologic factors. It has been found that anxiety and depression are frequent among patients with BMS, and their personality characteristics indicate that they are more concerned with their health and more socially isolated, depressed, anxious, distrustful, and easily fatigued than control subjects. Such findings have led some authors to suggest that the burning sensations are psychosomatic symptoms.<ce:cross-ref refid="bib48"><ce:sup>48</ce:sup>
</ce:cross-ref>
 Other authors warn against the conclusion that BMS is primarily a psychogenic disorder and maintain that changes noted in the psychologic profile may simply be a reaction to chronic pain conditions and not necessarily its cause.<ce:cross-refs refid="bib46 bib49"><ce:sup>46,49</ce:sup>
</ce:cross-refs>
</ce:para>
<ce:para>Optimizing deficient dentures is a natural first step in the management of BMS in complete denture wearers. However, if there are no obvious denture deficiencies, the prosthodontist should be careful and not escalate the prosthetic treatment until a psychologic evaluation has been performed and psychogenic causes have been ruled out. If psychologic and/or psychosocial disturbances are diagnosed, adequate treatment should be offered. Any extensive prosthodontic treatment, such as an implant-supported prosthesis, should be carried out as a collaborative effort between the psychologist/psychiatrist and the prosthodontist.<ce:cross-refs refid="bib35 bib48"><ce:sup>35,48</ce:sup>
</ce:cross-refs>
</ce:para>
</ce:section>
</ce:section>
<ce:section><ce:section-title>Temporomandibular Disorders</ce:section-title>
<ce:para>Complete denture wearers and people with other types of dentition can both be afflicted by temporomandibular disorders (TMD) in a similar way. However, it seems that severe signs and symptoms are rare, even in subjects with old dentures of poor quality. This can perhaps explain why in general there have been relatively few complete denture wearers in samples of patients with TMD.<ce:cross-ref refid="bib50"><ce:sup>50</ce:sup>
</ce:cross-ref>
 That differences in the prevalence of TMD, with respect to dental state, has not been well-established and the role of dental occlusion in the cause of TMD is still controversial.<ce:cross-ref refid="bib51"><ce:sup>51</ce:sup>
</ce:cross-ref>
 Some investigators have found correlations between signs and symptoms of TMD on one side, and the wearing of dentures, the quality of the dentures, and denture-wearing habits on the other,<ce:cross-refs refid="bib52 bib53 bib54"><ce:sup>52-54</ce:sup>
</ce:cross-refs>
 and others have not.<ce:cross-ref refid="bib55"><ce:sup>55</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para>Even if the multifactorial character of TMDs is acknowledged and the importance of occlusal factors is questioned by many experts, it appears sensible to combine the counseling, so essential in all management of TMDs,<ce:cross-ref refid="bib56"><ce:sup>56</ce:sup>
</ce:cross-ref>
 with correction of poor dentures when treating denture-wearing patients who have TMD. Positive effects on signs and symptoms of TMD have been shown in several studies by fitting new complete dentures.<ce:cross-refs refid="bib53 bib57"><ce:sup>53,57</ce:sup>
</ce:cross-refs>
</ce:para>
</ce:section>
<ce:section><ce:section-title>Satisfaction With Complete Dentures</ce:section-title>
<ce:para>Prosthodontists have rightly maintained that they have been able to successfully rehabilitate edentulous subjects with an artificial dentition, such as complete dentures. “Over the years, dentists have demonstrated considerable skill at replacing depleted dentitions and in compensating for the resultant deficit in periodontal support. Prosthetic care has...evolved into an applied clinical skill of variations on a theme of ingenious salvage.”<ce:cross-ref refid="bib58"><ce:sup>58</ce:sup>
</ce:cross-ref>
 The great majority (70% to 85%) of edentulous patients has also acknowledged the benefit of complete denture treatment and declared themselves satisfied with their dentures.<ce:cross-refs refid="bib59 bib60"><ce:sup>59,60</ce:sup>
</ce:cross-refs>
 Older patients have been found to be more satisfied with poorly fitting dentures and less prepared to seek denture improvement.<ce:cross-ref refid="bib61"><ce:sup>61</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para>Measurements of masticatory function, such as bite force and the ability to comminute a test food, are substantially reduced in complete denture wearers in comparison with people with natural dentitions, as well as with implant-supported prostheses.<ce:cross-ref refid="bib62"><ce:sup>62</ce:sup>
</ce:cross-ref>
 Nevertheless, studies have shown that only a small proportion of denture wearers (8%) consider their chewing ability to be poor<ce:cross-ref refid="bib63"><ce:sup>63</ce:sup>
</ce:cross-ref>
 or express a subjective need for dental implants. In a Swedish epidemiologic study, only 8% of the totally edentulous subjects would accept dental implants if available. The most important reason for declining implant treatment (83%) was that they were satisfied with their present dentures.<ce:cross-ref refid="bib59"><ce:sup>59</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para>Even if most edentulous people are satisfied with their complete dentures, there are some who have complaints that need to be addressed. The diagnosis is usually simple and the problems can, in most situations, be eliminated by counseling and either correction of the dentures or fabrication of new ones, provided that treatment is carried out on an individual basis.<ce:cross-refs refid="bib1 bib64"><ce:sup>1,64</ce:sup>
</ce:cross-refs>
 However, all who have worked with complete dentures know that patient satisfaction is not based solely on the technical quality of the dentures. Psychologic and emotional factors may be of great importance in maladaptive patients, even though they seek technical advice. To help such patients, the dentist must be able to listen and communicate effectively. The “iatrosedative interview” has been suggested to be an effective method of communication for helping patients who are unable to adapt to dentures for various reasons.<ce:cross-ref refid="bib65"><ce:sup>65</ce:sup>
</ce:cross-ref>
 Although this method has not been systematically evaluated, several studies have demonstrated the great impact of the dentist-patient relationship and psychologic factors on patient acceptance of new dentures.</ce:para>
<ce:para>The correlations between patients' satisfaction with their dentures and “objective” measurements of anatomic conditions, denture quality such as retention and stability, and masticatory performance are in general surprisingly weak and often statistically nonsignificant.<ce:cross-refs refid="bib15 bib66"><ce:sup>15,66</ce:sup>
</ce:cross-refs>
 Results from the evaluations of maxillary and mandibular dentures often differ, making “a total assessment” problematic. Improving denture quality has been shown to increase patient satisfaction but not to substantially alter the chewing ability of denture wearers.<ce:cross-refs refid="bib62 bib67 bib68"><ce:sup>62,67,68</ce:sup>
</ce:cross-refs>
</ce:para>
<ce:para>A number of assessment methods for measuring patient satisfaction with their complete dentures has been presented over the years. However, there does not seem to be any reliable means for predicting a patient's acceptance of new dentures. Work has been in progress to find better methods for studying these relationships.<ce:cross-refs refid="bib69 bib70 bib71 bib72"><ce:sup>69-72</ce:sup>
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 The complex nature of adaptation to and satisfaction with complete dentures must be acknowledged in the construction of such assessment methods.</ce:para>
</ce:section>
<ce:section><ce:section-title>Conclusions</ce:section-title>
<ce:para>There are many problems related to complete denture treatment. Several of them can be easily solved according to research and clinical experience; for others, there is a lack of evidence-based knowledge, making the prosthodontic service unpredictable. The prevalence of the edentulous condition is decreasing but there will remain a great number of edentulous people, a situation that will continue in the foreseeable future. Therefore continuing investments in basic and clinical research on removable dentures are warranted.</ce:para>
</ce:section>
</ce:sections>
</body>
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<mods version="3.6"><titleInfo lang="en"><title>Clinical morbidity and sequelae of treatment with complete dentures</title>
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<titleInfo type="alternative" lang="en" contentType="CDATA"><title>Clinical morbidity and sequelae of treatment with complete dentures</title>
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<name type="personal"><namePart type="given">Gunnar E.</namePart>
<namePart type="family">Carlsson</namePart>
<namePart type="termsOfAddress">DDS, Odont Dr, Dr Odont hca</namePart>
<affiliation>Faculty of Odontology, Göteborg University Göteborg, Sweden</affiliation>
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<dateIssued encoding="w3cdtf">1998</dateIssued>
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<language><languageTerm type="code" authority="iso639-2b">eng</languageTerm>
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<abstract lang="en">Abstract: Wearing complete dentures may have adverse effects on the health of both the oral and the denture-supporting tissues. This article is a review of selected literature on the sequelae of treatment with complete dentures in the specific areas of residual ridge resorption, mucosal reactions, burning mouth syndrome, temporomandibular disorders, and patient satisfaction. Recent literature found with a Medline search from 1952 to 1996 is included in this review. Residual ridge resorption is an inevitable consequence of tooth loss and denture wearing, with no dominant causative factor having been found. Mucosal reactions have a multifactorial cause, most of which can be easily treated. Most patients are satisfied with their complete dentures. Correlations between anatomic conditions and denture quality and patient satisfaction are weak. Psychologic factors seem to be extremely important in the acceptance of and adaptation to removable dentures. There are still no reliable methods to predict the outcome of complete denture treatment and there are many problems related to treatment with complete dentures. Although the prevalence of an edentulous condition is decreasing, the great number of edentulous people warrants the continuing efforts of basic and clinical research on removable partial dentures. Complete denture prosthodontics will remain an important part of dental education and practice. In addition to clinical and technical skills, insight into patient behavior and psychology and communication techniques are also necessary. (J Prosthet Dent 1997;79:17-23.)</abstract>
<note>aProfessor Emeritus, Department of Prosthetic Dentistry.</note>
<note>Reprint requests to: Dr. Gunnar E Carlsson, Department of Prosthetic Dentistry, Faculty of Odontology Medicinaregatan 12, S-413 90, Göteborg, Sweden</note>
<note>10/1/86941</note>
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<dateIssued encoding="w3cdtf">199801</dateIssued>
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<identifier type="ISSN">0022-3913</identifier>
<identifier type="PII">S0022-3913(05)X7048-2</identifier>
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<detail type="volume"><number>79</number>
<caption>vol.</caption>
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Clinical morbidity and sequelae of treatment with complete dentures

Clinical morbidity and sequelae of treatment with complete dentures

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