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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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