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1. Assistant Professor of Removable Prosthodon tics, King Abdul Aziz University
. ABSTRACT
This study was conducted on a group of Saudi edentulous patients 65 years of age
and over. They were 135 males and 112 females having complete maxillary and/or
mandibular complete dentures. The interviews were done, followed by evaluation of
physical conditions of complete dentures in addition to intra-oral examination to assess the prosthetic
status and needs for these patients.
. INTRODUCTIONAging is a normal life process. Age itself is not
necessary a contra-indication for medical or dental
treatment. (1) The changes seen in the mouth as age
advances are partly the consequences of age itself, partly
the result of wear and tear on the tissues and partly the
consequences of the fact that certain diseases become
common as age advances. (2)
A number of studies have been conducted on the
dental status and oral health of the elderly. Most of
these studies revealed that the dental and oral health of
the elderly was very poor. (3) The attitude of the public to
old people, inspite of their considerable contribution to
society, remains unchanged. We continue to neglect and
ignore them. It is still bad news to be old. (4) The geriatric
patient generally needs most of the necessary dental
services in his life at any age when he is at least able totolerate and possibly afford them.
The geriodontist (generally the prosthodontist) is
in a strategic position to evaluate, correct and reduce
the number of prosthetic failures in aging patients by
a thorough understanding of the various oral changes
occurring during this period. (5)
We have little information on what dental treatment
this population might need and there is no published work
available in the dental literature concerning these points,especially in Saudi Arabia.
. THE AIM OF THIS STUDY WAS TO1. Assess the dental state and need for treatment of
Saudi geriatric edentulous patients in Faculty of
Dentistry King Abdulaziz University, Jeddah.
2. Evaluate the prosthetic needs for those individuals.
3. Provide a baseline data before establishment of
dental programs for people aged 65 years and overin the dental public health services.
Cairo Dental Journal (24)Number (3), 537:543September, 2008
PROSTHETIC STATUS AND NEEDS OF SAUDIGERIATRIC EDENTULOUS PATIENTS IN JEDDAH
Fahad H. Banasr 1
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Fahad H. Banasr (538) C.D.J. Vol. 24. No. (3)
. MATERIAL AND METHODS
Criteria of Patients Selection
Dental screening were conducted on a group of
Saudi edentulous individuals 65 years of age and over.
They were presented to the out-patient clinic, Faculty of
Dentistry, King Abdulaziz University, Jeddah. They had
complete maxillary and/or mandibular complete dentures
and were asking for denture adjustment or replacement.
Dental Examination Format
All individuals were given visual and digital
examinations Intra-oral examination of soft and hard
tissues were done. Areas suspected of being pathologic
were recorded and referred for further evaluation and
possible treatment. Other data collected for each subject
were demographic information, prosthetic status and
needs. Old complete dentures were examined intra
and extra-orally and evaluated as regards physical and
clinical ndings. All data were collected and recorded on
special prosthetic examination form.
Examination of Prosthetic Status
Clinical examination was conducted in three stages:
1. Intra-oral examination of oral mucosa and tongue.
2. Extra-oral examination of old dentures including
base, arti cial teeth and state of denture.
3. Intra-oral evaluation of dentures regarding stability,
retention, interocclusal space and centric relation.
Criteria for Diagnosis and Coding
The criteria for evaluating the complete dentures
were based on studies of Reddick and Grant. (6)
1. Denture stability: it was measured by applying
alternate pressure on occlusal surfaces of premolar
teeth, using the index nger of each hand.
Suf cient: the denture base demonstrated slight
or no rocking on its supporting structures underpressure.
Some stability : the denture base demonstrated
moderate rocking on its supporting structureunder pressure, but could be easily reseated.
No stability : the denture base exhibited extreme
rocking on its structures under pressure, so that
it was dif cult to reseat the denture.
2. Denture retention :
Good retention : the denture remained seated
on opening and offered maximal resistance to
vertical forces. Some retention : little resistance was offered to
vertical pull but the denture remained seated on
opening.
No retention : the maxillary denture dropped and
the mandibular denture unseated on opening, no
resistance was observable to vertical forces.
3. Interocclusal space : it was evaluated by measuring
the difference between the rest and occlusal vertical
dimension using Willis bite gauge. Measurements
were recorded where the space was less than 1 mm
and 6 mm and 7 mm or more.
4. Centric relation : the jaw relationship was deemed
unacceptable if the path of closure was interrupted or if an
uneven slide greater than one quarter of a cusp occurred.
5. State of the denture : as the dentures were removed
from the month, the subject was asked to place them
in a small dish. The cleanliness of the denture wasnoted and scoring was undertaken as clean or unclean
had either soft or hard debris.
Criteria for treatment needs
The criteria for treatment needs, easons for adjust-
ment or replacement of dentures, were based on criteria
described by Grabowski and Bertram. (7)
1. Cleaning : A denture was assessed as needs cleaning if
it had soft or hard deposits that could not be removedby rinsing under running water.
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PROSTHETIC STATUS AND NEEDS OF SAUDI (539)
2. Adjustment/easing/Selective grinding : A denture
was assessed as requiring adjustment to relievetrauma when it was associated with (a) localized
trauma, (b) ulceration or (c) irritation hyperplasia.
3. Repair : A repair was indicated when the jaw relation,
occlusion, vertical dimension, stability and retention
were satisfactory, but the denture was broken in a manner
that could be repaired without affecting these factors.
4. Reline : A denture reline was indicated where vertical
dimension, centric jaw relation and centric occlusion
were correct, but retention and stability were poor orthe patient was experiencing undue pain.
5. Replacement : A denture was considered to need
replacement in the following circumstances (a) denture
was inadequate because of breakage or deformation, (b)
denture was not anatomically satisfactory, (c) denture
had incorrect vertical dimension or incorrect centric
relation, (d) presence of irritation or in ammation
of the oral mucosa caused by dentures and did not
respond to simple adjustment and (e) an edentulouspatient had missed denture.
Data recorded in the prosthetic examination forms,
specially designed for this study, were collected, presented
and statistically analyzed using statistical package system
(SPSS). Prevalence gures and frequency distribution
tables were performed according to the need.
. RESULTSData collected in this study were obtained from
dental screening conducted on a group of Saudi geriatric
edentulous patients 65 years of age and over. They were
presented within the period of 01 January 2006 to 31
December 2007. This study included 135 males and 112
females having complete maxillary and / or mandibular
complete dentures and asking for adjustment of old
dentures or replacement by new ones.
TABLE (1) Characteristics of the study sample according to age and gender distribution
AgeMale Female
no. % no. %
65-69 107 79.3 96 85.7
70-74 22 16.3 14 12.5
75 and older 6 4.4 2 1.8
Total 135 100 112 100
TABLE (2) Distribution of completely edentulous individuals according to gender and their prosthetic status
Prosthetic StatusMale Female
no. % no. %
Maxillary and mandibular complete denture 102 75.6 92 82.1
Maxillary complete denture 23 17.3 14 12.5
Mandibular complete denture 10 7.1 6 5.4
Total 135 100 112 100
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Fahad H. Banasr (540) C.D.J. Vol. 24. No. (3)
This table shows that males with maxillary and/or
mandibular complete dentures represented 75.6, 17.3,and 7.1% of the total male sample respectively. The
corresponding percentage of females were 82.1, 12.5,
and 5.4%.
This table revealed that 74.8% of males and 81.2% of
females presented with no oral lesions. On the other hand,
traumatic ulcer, epulis ssuratum, in ammatory papillary
hyperplasia and denture stomatitis were detected in 8.9,
5.2, 6.6 and 4.5% of males. It was 8.3, 4.4, 2.6 and 3.5%
of females respectively.
Atrophic glossitis, white hairy tounge and ssured
tongue were found among 12.6, 11.1 and 6.7% of
examined males. Meanwhile these tongue lesions were
reported among 13.3, 9, and 1.8% of females sample
respectively.
Examination of the physical condition of the prosthe-
sis revealed that cracked or broken base, broken teeth,
teeth wear and unclean denture were diagnosed among
8.9, 4.4, 9.6 and 13.3 of males and 5.4, 4.5, 8.9 and 7.1%
of females respectively.
Intra-oral examination of the complete dentures
among males showed that 72.6% of the prosthesis had
suf cient stability 16.3% had good retention, 10.4% had
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PROSTHETIC STATUS AND NEEDS OF SAUDI (541)
Showed that 13.3, 20.7, 9.6, 23.7 and 32.6 of the
examined males had the need for cleaning, adjustment,
repair, reline and replacement of their dentures
respectively. Meanwhile these prosthetic needs accounted
for 7.1, 18.8, 6.3, 22.3 and 45.5 of the examinedindividuals respectively.
TABLE (6) Prosthetic status of the study sample
Clinical examinationMale Female
No. % No. %
Stability
Suf cient 98 72.6 88 78.6
Some stability 15 11.1 9 8
No stability 22 16.3 15 13.4
Retention
Good 86 63.7 73 65.1
Some retention 29 21.5 22 19.6
No retention 20 14.8 17 15.2
Inter-occlusal space
< 1 mm 14 10.4 12 10.7
2-6 mm 111 82.2 87 77.7
> 7 mm 10 7.4 13 11.6
Centric relationAcceptable 121 89.6 102 91.1
Unacceptable 14 10.4 10 8.9
TABLE (7) Prosthetic needs of the examined individuals
Male Female
no. % no. %
Cleaning 1.8 13.3 8 7.1
Adjustment 28 20.7 21 18.8
Repair 13 9.6 7 6.3
Reline 32 23.8 25 22.3
Replacement 44 32.6 51 45.5
Total 135 100 112 100
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Fahad H. Banasr (542) C.D.J. Vol. 24. No. (3)
. DISCUSSIONThis study was carried out as a survey of prosthetic
status and needs of Saudi geriatric edentulous patients
to out patient Clinics, Faculty of Dentistry, King Abdul
Aziz University. They were 65 years of age and over.
This is in accordance with de nition of geriatric patients
which is the cohort of people aged 65 years and older. (8)
The present study shows that a considerable number
of examined individuals has one form or another of oral
lesions. It was 25.2% in males and 18.8% in females.
The majority of these oral lesions (traumatic ulcer, epulisssuralum, in ammatory papillary hyperplasia or denture
stomatitis) was related to the prosthesis, which was
unsatisfactory in one way or another. These results are in
agreement with another. These results are in agreement
with other studies. Sheppard et al (9) reported that 46.1% of
denture wearers had oral lesions. Dorey et al (10) concluded
that tissue response to denture trauma was 17%. Other
problems were papillary hyperplasia 12%.
These oral lesions may be due to the soft tissue
beneath the denture is not readily displaced (11) and is often
subjected to higher levels of stress than it was designed
to bear. Also, the oral ora may be altered as a result of
food debris and plaque that collect beneath the mucosal
surface of the denture and palate. (12) In addition, dentures
may induce a proliferative or degenerative response in
the oral mucosa. (13)
Regarding tongue lesion, 30.4% of examined males
and 24.1% of females had one of the following lesions.
Atrophic glossitis was present in 12.6% and 13.3% ofexamined males and females respectively. These ndings
go in accord with study of Bhaskar. (14) While hairy tongue
was recorded in 12.6% of examined males and 9% of
female individuals. Fissured tongue was found in 6.7%
and 1.8% of males and females respectively. Bhaskar (14)
found the same condition in 6.5% of his examined
cases. El-Karanshawi (15) reported ssured tongue to be
present in 10% of his studied cases. Omar (16) found this
lesion in 11.9% and 11.5% of two studied groups. These
tongue lesions might be due to age changes or systemicconditions having oral manifestations.
On evaluation of the physical condition of examined
complete dentures were having either cracked of brokenbase, broken or wear teeth, or unclean dentures. These
ndings might be due to ill- tting dentures, accident
drop, prolonged use of dentures, poor oral hygiene or
improper denture construction.
A high percentage of examined dentures were found
unsatisfactory in one way or another on intra-oral
examination. There was no stability in 11.1% and 13.4%
of examined complete dentures in males and females
respectively. In a similar way, no retention was found
in 14.8% and 15.2% of dentures for males and females.
Interocclusal space was more than 7 mm in 7.4% for
males and 11.1% for females. Unacceptable centric
relation was recorded in 10.4 and 8.9%. Poor stability of
dentures might be due to severe residual ridge resorption
and/or teeth off the ridge. Loose dentures resulted from
poor tness as consequence of ridge resorption, over or
under extended borders or dry mouth. Reduced vertical
dimension (interocclusal space > 7mm) might be a result
of teeth wear and/or ridge resorption followed by settlingof dentures. Unacceptable centric relation resulted from
either incorrect registration of occlusal relationship or
teeth wear with resultant reduced vertical dimension.
As regards the prosthetic needs of examined
individuals, 32.6% and 45.5% of females need new
complete dentures. 67.4% and 54.5% of males and
females respectively were in need of other forms of
prosthetic treatments (cleaning, adjustment, repair and
reline). This is due to the fact that females cannot tolerate
any minor defects their dentures.
. THE STUDY CONDUDED THAT1. Most of oral lesions found in the geriatric edentulous
patients were related to unsatisfactory dentures.
2. Oral and tongue lesions must be diagnosed and
treated either locally or systematically at recall
appointments.
3. Geriatric edentulous patients must be checked regu-larly to evaluate their prosthetic status and needs.
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