FREQUENCY OF SHORT TERM POST-INSERTION COMPLAINTS IN CONVENTIONAL COMPLETE DENTURE WEARERS TREATED BY UNDERGRADUATE STUDENTS.
The objective of this study was to determine the frequency of various post-insertion complaints in patients wearing complete dentures that had been fabricated by undergraduate students of the institute. One hundred patients (66 males and 33 females) were included in the study who had been wearing their prostheses for more than 6 months. Details of age, gender, medical history and denture history were obtained. Post-insertion complaints, as reported by the patients, were recorded on a proforma. The collected data was statistically analyzed using SPSS version 23.
It was found that 60% of the subjects had complaint of their dentures being loose; 20% denture ulceration, 10% had pain and generalized discomfort, 25% reported that they had low masticatory efficacy, 8% of the patients had problems in speech while only 3% patients had fracture of denture bases. It was concluded that on the basis of frequency of occurrence, loss of retention, low masticatory efficiency and mucosal ulceration were the main complaints of the complete denture patients being treated by the undergraduate students.
Key Words: Complete dentures, complaints, undergraduate students.
Insertion of complete dentures should not be considered as the final step in the treatment of edentulous patients because patients will continue to visit their dentists long after this initial placement/treatment.1,2
Patients' acceptance and satisfaction with their replacement prosthesis is governed by different factors such as number of corrections after insertion, psychological characteristics of patients, self-evaluation of affective state or quality of life, demographic and socioeconomic factors, patient expectation of dentures, quality of denture construction and factors that are connected with anatomic and physiologic characteristics of the patient.3
All denture patients routinely expect their new dentures to fit and function better than their existing ones, that is, most patients anticipate that their new dentures will bring an improvement compared to their previous dentures. However, they remain resigned to understand that many a times some compromises may be necessary.4 For the first-time denture wearers, the experience can be totally unexpected and may need an initial period of adaptation and learning to control their prostheses in function. Likewise, all these patients present with post-insertion complaints which have to be managed on an as need basis.5
The most frequent short term complaints with complete dentures are those pertaining to loss of retention, poor esthetics, decreased chewing efficiency, discomfort under the denture (the pain and generalized discomfort), fracture of the denture bases.4 The most crucial time for the patient's perception of success or failure of the dentures is the adjustment period.6
The present clinical study was designed to collect information about various complaints associated with complete dentures fabricated by undergraduate students. This information may be used to improve upon the clinical and laboratory training being imparted to undergraduate students with an aim of ultimately decreasing the post-insertion complaints of the denture patients. In turn, it would be beneficial for both the patient and the undergraduate teaching program.
A descriptive study was conducted in the Department of Prosthodontics at a tertiary care dental hospital, through the months of March 2015 to August 2016. A convenience non-probability purposive sampling technique was used. The patients were thoroughly screened at the OPD and after complete extra oral and intra oral examination they were allocated to final year undergraduate students. All the steps of complete denture therapy were carried out by the undergraduate student to whom case was allocated. Only those male and female patients were included who had been wearing them for at least six months. Patients were excluded if more than one operator was involved in denture fabrication process. Patients presenting with any medical condition such as diabetes or high blood pressure were also excluded.
A verbal and written consent was obtained from each patient before enrolling them in the study. It was ensured that all clinical and laboratory steps of denture fabrication were carried out by the same student as part of their departmental quota. After insertion of the prostheses, every patient was given a uniform set of post-insertion instructions regarding denture use and hygiene maintenance. They were additionally required to visit the department for at least three regular intervals in which after complete intra oral examination and denture examination all the complaints were addressed. After the first six months of insertion in which patients complaints were addressed until the patients were satisfied and pain free.
In the later six months; any patient coming back for review or adjustments were asked about the following six complaints on a self-designed proforma: loss of retention, pain and/or generalized discomfort, denture ulceration/ mucosal ulceration under the dentures, fracture of the denture base, difficulty in eating and difficulty in speech. Each item was to be answered as either present or not present as per the response of the patients. The patient complaints were corroborated with the intraoral examination as well as and remedial action was provided. The findings of the intraoral examination and denture examination at the post insertion visits were analyzed and denture corrections were carried out. The study data was entered and analyzed in the SPSS software version 23. Descriptive statistics were used to describe the data.
A total of 115 patients were enrolled at the start of the study. However, only 99 patients reported back for regular follow up visits either voluntarily or when called upon. Therefore, these 99 individuals constituted the study sample. Hence the overall response rate remained at 86%.The sample only constituted of those patients who responded within six month to a year time after the denture has been inserted.
The final sample included 66 (66.7%) males and 33 (33.3%) females (Table 1) with a mean age of 64.74 years (Table 2). It was interesting to find that not a single patient was complaint free. All of the patients had some complaints. In order of frequency of occurrence, the incidences of the post-insertion complaints included in the study are presented in Table 3.
TABLE 1: FREQUENCY OF PATIENTS ACCORDING GENDER DISTRIBUTION
TABLE 2: FREQUENCY OF PATIENTS ON THE BASIS OF AGE
TABLE 3: INCIDENCE OF POST-INSERTION COMPLAINTS IN ORDER OF DECREASING FREQUENCY (N=99)
Post-insertion Complaints###Fre- Percent-
Loss of retention###60###60.60%
Difficulty in chewing###25###25.25%
Mucosal ulceration under the###20###20.20%
Pain and generalized discomfort###10###10.10%
under the denture
Difficulty in speech###8###8.08%
Denture base fracture###3###3.03%
The present study was conducted as part of an un- dergraduate research competition/ within the institute in an attempt to study the post-insertion complaints of complete denture wearers whose dentures had been fabricated by the final year students. A total of 115 patients were enrolled at the start of the study but only 99 of them reported back for follow up. This meant the response rate was 86% which was slightly more than what had been expected at the onset of the study. This relatively high response rate may have been due to the fact that all patients were from within the city limits and had agreed to revisit whenever called upon. The patients who were dropped could not be contacted successfully or were from surrounding rural areas.
In the present study, the most common complaint was looseness of the dentures, mostly of the mandibular complete dentures although some patients also complained of looseness of the maxillary complete denture. These complaints were addressed during the follow up visits by establishing the cause and then taking remedial measures. Most of the cases needed relining due to extremely short flanges. Some dentures had to be remade altogether due to multiple problems. A recent survey has reported almost 54% patients complaining of denture looseness or loss of retention after 6 months of insertion.7 Most of these patients were also found to be emotionally disturbed and generally dissatisfied with life. However, in the present study, emotional status of the patients was not taken into account and only healthy and emotionally stable patients were included.
The second most common complaint was decreased chewing efficiency especially while eating home-made bread or chappati. It was mostly related to unstable dentures secondary to loss of retention or incorrect tooth set up. Remedial actions included improving the denture retention and correcting the errors in tooth arrangement and occlusal balancing. Shetty et al7 have attributed this complaint to lack of patient education mostly. They have recommended that dentists must make their patients understand that the efficiency of the prosthesis is related to their alveolar ridge condition and attitudes to adapt to the prosthesis. However, Bilhan et al8 have actually used visual analog scores to rate chewing efficiency and found negative effects to it due to loss of retention, ulcerations and a high vertical dimension. In the present study, vertical dimension problems were not included at all as we are only concerned with the complaints as part of study design.
However, denture looseness and ulcerations were present in all patients complaining of inefficient chewing ability.
Ulceration of the denture-bearing mucosa was the third most common complain encountered in the study sample. It was mostly due to overextended flanges which were adjusted in accordance to the peripheral tissues. Discomfort under the dentures was also noted in about 10% of the subjects. All of these patients also had ulceration underneath the denture which was probably the main cause of their discomfort. Shetty et al7 reported discomfort values of upto 8% after 6 months of denture insertion, which are similar to our own results. Many factors have been suggested to play a role towards prosthesis comfort especially quality of the residual ridges and previous denture experience.
Problems with speech were reported in almost 8% patients even after 6 months of denture insertion. This may have been due to diminished ability of the patients to adapt to intra-oral changes. This condition may be explored through further research with a more controlled study sample. Lastly, denture base fracture was seen in 3% patients which were all due to dentures falling to the floor on repeated occasions. These dentures were repaired using self-cured acrylic resin and patients instructed to be more careful in handling them. In their study on various types of removable dentures, Bilhan et al8 have reported upto 26% patients with denture fractures which is a rather high number. This may have been due to the initial inclusion criteria which was limited to only healthy complete denture patients in our study.
The present study cannot be considered as a representative of the complete population of the region in general as it was conducted in one of the dental tertiary care hospital and only targeting patients being treated by undergraduate students. The results of this study can be helpful in inculcating a more supervised and clinically oriented undergraduate teaching and training program in order to reduce the dissatisfaction of patients related to complete denture therapy and improve the quality of treatment and services offered at any tertiary care facility.
Within the limitations of the present study, it can be concluded that the most common problems associated with complete dentures fabricated by undergraduate students are loss of retention, decreased chewing efficiency and mucosal ulceration. These complaints may influence other aspects of the denture function and need to be addressed promptly.
1 Sadr K, Mahboob F, Rikhtegar E. Frequency of traumatic ulceration and postinsertion adjustment recall visits in complete denture patients in an Iranian faculty of dentistry. J Dent Res Dent Clin Dent Prospects 2011; 5(2):46-50.
2 Hobkirk JA, Zarb GA. The edentulous state. In Zarb GA, Hobkirk JA, Eckert SF, et al., (Eds). Prosthodontic Treatment for Edentulous Patients. St. Louis: Mosby 2012:1-5.
3 Yoshinaka et AL. Factors associated with taste dissatisfaction in the elderly. J Oral Rehabil 2007; 34: 497-502.
4 Shah VR, Shah DN, Parmar CH. Prosthetic Status and Prosthetic Need Among the Patients Attending Various Dental Institutes of Ahmedabad and Gandhinagar District, Gujarat. J Indian Prosthodont Soc 2012;12(3):161-67.
5 Bekiroglu N, Ciftci A, Bayraktar K, Yavuz A, Kargul B. Oral complaints of denture-wearing elderlypeople living in two nursing homes in Istanbul, Turkey. Oral Health Dent Manag 2012;11(3):107-15.
6 Gosavi SS, Ghanchi M, Malik SA, Sanyal P. A survey of complete denture patients experiencing difficulties with their prostheses. J Contemp Dent Pract 2013;14(3):524-27.
7 Shetty MS, Panchaml GS, Shenoy KK. Denture acceptance among newly rehabilitated elderly population in old age homes in South India. Contemp Clin Dent 2015; 6(Suppl 1):S90-93.
8 Bilhan H, Erdogan O, Ergin S, Celik M, Ates G, Geckili O. Complication rates and patient satisfaction with removable dentures. J Adv Prosthodont 2012;4(2):109-15.
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|Author:||Sikander, Irum; Chaudhary, Muhammad Aamir Ghafoor; Ahmad, Salman; Kamran, Muhammad Farooq; Khan, Sar|
|Publication:||Pakistan Oral and Dental Journal|
|Date:||Dec 31, 2016|
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