|Year : 2021 | Volume
| Issue : 2 | Page : 189-194
Problems faced with complete dentures by elderly people attending clinics in dental hospital, Peradeniya
Gayathiry Nesarajah1, R Manori Jayasinghe2, Sachith P Abeysundara3
1 Department of Nursing, Undergraduate Student, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka
2 Department of Prosthetic Dentistry, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
3 Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
|Date of Submission||11-Jan-2022|
|Date of Acceptance||17-Feb-2022|
|Date of Web Publication||26-Mar-2022|
Dr. R Manori Jayasinghe
Department of Prosthetic Dentistry, Faculty of Dental Sciences, University of Peradeniya, Peradeniya
Source of Support: None, Conflict of Interest: None
Purpose: This study aimed at assessing physical, social and psychological problems faced by complete denture wearers and to identify the association of socioeconomic factors of the individual with the problems related to complete denture-wearing for early identification and treatment planning to improve their oral health and wellbeing. Materials and Methods: This was a descriptive cross-sectional study conducted at the Dental Hospital, among 96 complete denture wearers, who were 60 years and above. A pre-tested and structured interviewer-administered questionnaire was used to collect data through telephone interviews. Descriptive statistics were obtained as frequencies and percentages. Chi-Square test was used to assess the association between selected demographic variables and denture information. Results: Most of the participants (71.9%) used their present dentures for 0-5 years. Gender and occupation significantly influenced the frequency of cleaning the mouth. The most common problems were loose dentures, longer time is taken to complete meals, consciousness while eating, difficulty in chewing and food accumulation beneath dentures. Occupation, family support and family income had significant associations with some problems related to complete dentures. Family support was the major factor that had significant association with social interactions such as difficulty in speaking, limitation in facial expression, avoiding going to parties and avoiding leaving home/resident environment. Most of the socioeconomic factors had a strong influence on participants' self-confidence. Conclusion: Complete denture prosthodontics should focus on patients' physical and psychosocial problems with their socioeconomic background to identify problems, to restore their confidence level and improve quality of life.
Keywords: Complete denture wearing, edentulism, elderly
|How to cite this article:|
Nesarajah G, Jayasinghe R M, Abeysundara SP. Problems faced with complete dentures by elderly people attending clinics in dental hospital, Peradeniya. Int J Community Dent 2021;9:189-94
|How to cite this URL:|
Nesarajah G, Jayasinghe R M, Abeysundara SP. Problems faced with complete dentures by elderly people attending clinics in dental hospital, Peradeniya. Int J Community Dent [serial online] 2021 [cited 2023 Jun 10];9:189-94. Available from: https://www.ijcommdent.com/text.asp?2021/9/2/189/340969
| Introduction|| |
Sri Lanka is a developing country with a rapidly growing elderly population. Currently, 12.4% of elders are among the total population which is appraised to be 25% by the year 2041. Particularly, Western and Central provinces comprise the majority of aging population. When oral health is considered, edentulousness is a common prevailing health problem among the elderly population. Particularly, physical and psychological dysfunction may occur as a result of tooth loss due to periodontal breakdown, coronal and root caries, tooth surface loss, and cusp fracture and all may be predisposed by aging-associated status of xerostomia. In order to overcome concerns of chewing, swallowing, esthetics, and social acceptance with tooth loss, more elderly people are likely to wear dentures as means of replacing lost natural tooth and their function. Complete denture provides replacement of entire dentition and associated structures of the maxilla or mandible. It is the final option for complete edentulous individuals after tooth-supported options are exhausted, but many complete denture wearers report various complaints which are directly or indirectly associated with denture wearing.
Direct adverse effects of dentures include trauma, mucosal reactions, burning mouth syndrome, gagging, residual ridge resorption, altered taste, altered speech, and angular cheilitis. Some denture wearers face gagging, when the denture is too loose, too thick, or extended too far posteriorly onto the soft palate. Furthermore, psychological gagging is also another entity which is challenging to manage by dentists. Microbial denture plaque retention may cause acute or chronic reactions in oral mucosa to lead to complaints such as bad odor in the mouth, inflammation of the mucosa, denture stomatitis, angular cheilitis, and even ulceration as a result of wearing complete dentures for a long period. The prevalence of oral mucosal lesions is influenced by the quality of the denture fitting surface, occlusal relations, age of the denture, and denture hygiene. Furthermore, atrophy of masticatory muscles and nutritional deficiencies are the indirect adverse impacts of complete denture wearing. An unsatisfactory denture can cause insomnia, pain, and other irritating changes in the behaviors of elders. That could cause reduced self-confidence levels in elderly denture wearers and they may become socially less active. Due to these changes, some elderly denture wearers avoid going or eating in outside and having social interactions. Psychosocial effects of these problems are crucial and have to be considered in people of all ages, although they are common in elderly people.
Multiple sociodemographic and socioeconomic conditions affect satisfactory denture wearing. Denture satisfaction is essential and influenced by various factors such as age, gender, socioeconomic, educational, and marital status. Therefore, identification of social conditions with the level of denture satisfaction is crucial when providing dental care and follow-ups to improve the quality of life in the elderly. Correcting socioeconomic background and increasing the access to oral health care will promote complete denture needs in the elderly population.
Particularly, some complete denture wearers face more difficulties such as reduced pleasure in eating due to difficulty to chew hard foods and poor-fitting dentures, interruption of meals due to food stuck, and reduced self-confidence level while eating in outside due to movement of dentures which minimize food choices and social interactions. Therefore, such problems could result in a negative impact on the psychosocial well-being of the elderly and affect their nutritional intake.
According to the results of the National Oral Health Survey 2015–2016, 3.1% of elders wear upper and lower full dentures and partial dentures were worn by 11.6% despite high percentage of individuals (97.5%) with missing teeth. Further, the need for dental care in 65–74 years aged people was the highest in Kandy District in the Central Province. A recent study in Sri Lanka revealed that pain, difficulty in eating, and dissatisfaction with food as the most common complaints among institutionalized elderly individuals in Central Province. Therefore, early identification of problems related to complete denture wearing is necessary to maximize the quality of life and well-being of elderly complete denture wearers and help dental professionals to plan prostheses and review appointments for them at an early stage. The null hypothesis indicated that there is no relationship between socioeconomic factors and complete denture-related problems among elders.
The general objective was to assess the physical, social, and psychological problems faced by elderly complete denture-wearing people attending clinics in Dental Hospital, Peradeniya. and the specific objective was to identify the association of socioeconomic factors of the elderly with physical, social, and psychological problems that occur due to wearing complete dentures.
| Materials and Methods|| |
A descriptive cross-sectional study was conducted among complete denture-wearing older individuals, who were 60 years and above attending the clinics at the Dental Hospital, Peradeniya. Complete denture-wearing elders who were very sick, bedridden, diagnosed with mental disorders or with hearing and speech impairments were excluded from the study. A sample size of 95 subjects was required to estimate the proportion of adults in Kandy District who suffered physical and psychosocial problems by wearing complete dentures with a 95% confidence interval and 10% margin of error (E). Participants' information was gained from the appointment book for complete dentures at the Department of Prosthetic Dentistry, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka. The purpose of the study, data collection method, time duration for data collection were explained to the participants and confidentiality of personal information, informed verbal consent was obtained from the respective elderly complete denture wearers prior to data collection. Data collection was carried out by the principal investigator using a pretested, structured questionnaire through telephone interviews. Ethical clearance for the study was obtained from the Ethical Review Committee of the Faculty of Allied Health Sciences, University of Peradeniya. (AHS/ERC/2021/022). Permission to collect data from the clinics of Dental Hospital, Peradeniya was received from the Deputy Director of Dental Hospital, Peradeniya. Privacy and confidentiality of the collected data were strictly maintained. Further, any personal or sensitive data was not collected from the participants throughout the study. The collected data were analyzed using the Minitab v18.0 statistical software. Descriptive statistics were presented as frequencies and percentages. The Chi-square test was used to assess the association between selected demographic variables and denture information and type. Further, the influence of socioeconomic factors on the physical, social, and psychological problems related to complete denture wearing was assessed.
| Results|| |
Data of socioeconomic status and problems related to complete denture wearing were collected from 96 participants. Among them, 51.04% were females and the majority of respondents lived in rural areas (55.21%). About 59.38% were unemployed, 20.83% were employed, and the rest were pensioners. More than half of the participants had their monthly income between Rs. 5000 and Rs. 10,000 and gained support from their family members as well [Table 1].
Most of the elderly male and female participants wore both upper and lower complete dentures. Elderly male patients wore lower complete dentures higher than elderly females. Among the patients, 71.9% of them used their dentures for 0–5 years and never changed them [Table 2].
No association was noted between selected demographic characteristics and the age of the present denture (P > 0.05). However, the gender and occupation level of the participants influenced the frequency of cleaning the mouth. The P values were 0.017 and 0.013, respectively. Further, none of the selected demographic factors were found to be associated with the number of times of change of the denture and frequency of cleaning them. [Table 3] shows that 37.5% of the participants had loose complate dentures and they had taken longer time to complete their meals due to the problem. The most revealed social problems were consciousness while eating (29.1%) and food accumulation beneath dentures (26.04%). Some denture wearers expressed that they avoided going to parties (13.54%) and leaving home/resident environment (10.42%) because of loose dentures (37.5%), limitation in facial expression (13.54%), difficulty in speaking (12.5%), and difficulty in laughing (11.46%). The majority of participants said that they had not lost their self-confidence (80.21%) and self-esteem (83.33%).
Female participants informed their dentists on difficulties related to denture wearing than males. Most of the population were educated by dentists regarding the problems related to denture wearing. Moreover, most of the complete denture wearers were satisfied with their dentures with female predominance.
The Chi-square analysis showed that gender of the participants was associated with response for none of the questions, did you inform your problems related to denture wearing to your dentist?, did your dentist inform you about the problems related to complete denture wearing at the time of denture treatment? and are you satisfied with your denture? [Table 4].
|Table 4: Association between gender of the participants to Q15, Q16, and Q17|
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Furthermore, the association of socioeconomic factors of the elderly with the problems that occur due to wearing complete dentures was assessed. However, educational qualifications and type of family of the participants were not associated with complete denture-related problems while occupation, family support, and family income had significant associations. Family support was the major factor that had a significant association with social interactions such as difficulty in speaking, limitation in facial expression, avoiding going to parties, and avoiding leaving home/resident environment. Furthermore, most of the socioeconomic factors had a strong influence on participants' self-confidence [Table 5].
|Table 5: Association between socioeconomic factors and complete denture related problems|
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| Discussion|| |
This study was carried out to identify the problems related to complete denture wearing and to assess the association of socioeconomic factors to those problems. Dental Hospital, Peradeniya is the only hospital and dental education institute in the country with undergraduates and postgraduates work, which accommodates patients from all over the country. Therefore, the current study sample consisted of residents from urban, rural, and estate areas with the highest proportion from rural areas. A similar study had been done in Jammu District, India. Therefore, our study would be helpful in comparing and assessing common problems and associated factors related to denture wearing.
According to the collected data in this study, most of the elders used present denture for 0–5 years. It could be related to that the patients were not properly educated about the importance of regular change of acrylic dentures. However, in a previous study, most of them had changed the denture multiple times and only 0.9% had kept same denture. Further, that study revealed that almost half of the patients regularly took care of their oral hygiene. Supporting to the fact, our study showed that a majority of people cleaned their mouth as well as dentures twice a day. Further, there was an association between gender and frequency of cleaning the mouth and the results revealed that occupation of the participants had an influence on frequency of cleaning mouth in elderly complete denture wearers. Those participants who were unemployed may had more time to maintain their oral hygiene well.
A recent study in Sri Lanka showed that the most commonly reported impacts of denture wearing were pain, discomfort while eating, and dissatisfaction. The findings of the present study also reported that pain and discomfort were identified in 18.75% of elderly people. Singh et al., 2014, also found that many people complained about difficulty in chewing, sore spots, and painful and swollen gums. Due to the difficulty in chewing, majority of people changed their meal composition, and many respondents apparently ate nothing because of discomfort leading to digestive problems. According to a similar study by Kamran Parvez, complete denture wearers experienced difficulties including pain and discomfort, difficulty in eating, and ill-fitting dentures. In the present study, majority of participants experienced loose dentures, which is identical to the survey done in Rajavithi Hospital, India. Due to the fact, they had difficulty in chewing, longer time taken to complete meals, and higher consciousness while eating which led to further discomfort. Wearing complete dentures still had a negative effect on social and emotional issues around eating. That affects nutritional intake of the elderly who were complete denture wearers.
Food accumulation was noted in this study as the major social impact on complete denture wearers. It may be due to loose-fitting dentures which lead elders to avoid parties and leaving home or resident environment. Zainab et al., 2008, also noted that food stuck in mouth was the most common impact reported by complete denture wearers. On the other hand, a descriptive study in India found that the greatest difficulty was speech (64%) with their poor-fitting dentures which affected satisfactory diet, talking clearly, and smiling clearly. However, in the current study, this percentage was found to be smaller. This was similar to the results of Bekiroglu et al. (19.3%). A main finding of the study was that family support was the strongest factor which helped the participants to overcome problems faced by them due to denture wearing. It could be explained as most of the people in the country live with their elderly parents and support them with living and medical expenses.
All these problems affected patients' self-confidence and self-esteem. The results of the study also found that there was a significant association between occupation, family income, and family support with low self-confidence level among the participants in Kandy District. Supporting this, more than half of the elderly people in India reported that they had lost self-confidence with complete denture wearing. Reduced self-confidence was increased with aging as noted in a similar study. Most participants were satisfied with their current dentures and the results were comparable to results of previous studies. A previous study stated that complete denture-wearing elderly patients' sociodemographic variables were influential factors on denture satisfaction.
Further, the study of Lee et al., 2012, reported that edentulous people who are satisfied with denture wearing showed the best daily living quality of life than edentulous without satisfaction in their denture wearing who had the highest total OHIP score (mean OHIP score is 60.00). Denture satisfaction was the strongest indicator of OHRQoL and aids to evaluate the impact of denture treatment on OHRQoL in elderly denture wearers as reported by Zainab et al., 2008. Therefore, identification of psychological effects of complete denture-related problems was essential and should be considered in elderly people to strengthen their social activities.
Although appropriate health education was given by the dentist at the time of denture treatment, many elderly denture wearers did not inform their complete denture-related problems to their dentists and especially elderly males reported their physical and psychosocial problems slightly lower.
Prosthetic considerations in geriatric dentistry should be focused on the socioeconomically deprived populations to improve their quality of life. Especially, knowledge on physical and psychosocial problems in complete denture wearing is essential when providing routine dental follow-up care for geriatric patients. Considering the results of the current study, family support, occupation, and family income play a major role in complete denture-related problems and deprivation could lead to further reduction of their quality of life.
The study has some potential limitations. The findings may not be generalized to the whole population as it was conducted only in the elders attending the clinics in Dental Hospital, Peradeniya. and living in Kandy District. Further, the psychological problems related to complete denture wearing were questioned through telephone interviews to minimize the contact in the COVID-19 pandemic situation.
| Conclusions|| |
Most of the elderly people had complaints of loose dentures, longer time taken to complete meals, consciousness while eating, difficulty in chewing, and food accumulation. Family support of the patient had a significant association with many denture-related physical, social, and psychological problems. Therefore, prosthetic considerations in geriatric dentistry should focus on the possible complaints, especially psychological aspects such as self-confidence, self-esteem and satisfaction, and socioeconomic status, as multiple socioeconomic factors affect the problems related to complete denture wearing which helps in restoring their confidence level and improving the quality of life.
Psychological aspects regarding complete denture-related problems are to be essentially considered when providing prosthetic care in elderly population. Dental health promotion services have to be widened to identify and treat complete denture-related problems after insertion of dentures through enhanced communication facilities. Further research is recommended on identifying the association between patients' reporting and the problems related to complete denture wearing to maintain oral health.
The authors would like to acknowledge the support provided by the academic and non academic members at the Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya and the study participants.
Financial support and sponsorship
Conflict of interest
The authors declare that they do not have any conflict of interest completely or partly toward the study.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]