Chewing alterations in removable dental prosthesis users: systematic review

Abstract:

In aging process, the tooth loss generates the need to use a dental prosthesis. Specific alterations in mastication process of denture-users can be considered a problem not only in relation to the morphofunctional structures modification, but also in personal satisfaction associated to chewing and its functionality. The proposal of this review is to compile and analyze scientific articles about the relation between chewing and removable dental prostheses in adults and older adult's users. An integrative search of all articles on data from SCIELO, PUBMED and LILACS databases selected articles published 2006 to 2014, whose topic focused mastication and removable dental prosthesis in adults. The search presented 21 potential articles and, after applying criteria of inclusion and exclusion, 11 were selected. The satisfaction, performance, efficiency and masticatory parameters were the variables, which found to be effected in users of removable dental prosthesis.

Keywords:
Aging; Dental Prosthesis; Mastication; Speech, Language and Hearing Science

Resumen:

Tras el paso de los años, la pérdida de dientes genera la necesidad de recurrir al uso de prótesis dental. Específicamente, las alteraciones en el proceso de masticación en usuarios de prótesis dental removible se consideran un problema no sólo en relación a las modificaciones a nivel morfofuncional, sino que también en la propia satisfacción en cuanto a la masticación y funcionalidad de este proceso. El propósito de esta revisión es compilar y analizar los artículos científicos sobre la relación de la masticación y prótesis dental removible en adultos y adultos mayores. Se realizó una búsqueda integrativa de artículos en las bases de datos SCIELO, LILACS y PUBMED, seleccionando artículos publicados entre el año 2005 a 2014. Los artículos de revisión incluyeron estudios que identificaran la relación entre el uso de prótesis dental removible y la masticación en adultos usuarios de dicha prótesis dental. En la búsqueda se encontraron 21 documentos para potencial revisión. Finalmente, aplicando criterios de inclusión y exclusión se seleccionaron11artículos, los cuales tomaban diferentes variables de estudio, entre ellas, nivel de satisfacción, rendimiento, eficiencia y parámetros masticatorios. La satisfacción, el rendimiento, la eficiencia y los parámetros masticatorios fueron las variables que se encontraban afectadas en usuarios de prótesis dental removible.

Palabras claves:
Envejecimiento; Prótesis Dental; Masticación; Fonoaudiología

Introduction

Aging is a dynamic process with morphological, biochemical, functional and psychological changes¹ that involves social and cultural variables². Such changes also occur in the oral cavity and interact with support tissues diseases and stomatognathic structures¹, affecting skull-cervical adaptation and development³.

Tooth loss is one of the causes of oral cavity alteration in senescence⁴, causing stomatognathic system homeostasis disruption due to changes in the facial skeleton, loss of alveolar bone and neuromuscular response, which interferes with chewing, swallowing and speech functions performance^{1 5 7}.

Removable denture serves to replace missing teeth in edentulous patients⁸. Authors ^{9 11}describe that the use of these elements as maybe cause of dental functional modifications, which generate chewing adaptation, and, in many cases, lead to prosthesis disuse. This is due to the fact that any type of denture might cause inevitable variations in oral environment, requiring tissue adaptation to a new condition. Oral prosthesis characteristics influence organism reaction mode and ability¹².

According to a study in the city of Santiago de Chile, the prevalence of edentulism in subjects over 65 years is 33.84%, a significant figure to be considered since in 2002 the public health services implemented oral rehabilitation with 18,245 removable prosthesis¹³. Other research verified that around 51.2% to 75.8% of older adults make use of some kind of dental prosthesis¹⁴.

Masticatory efficiency of removable dentures users reaches approximately 30% of chewing ability compared to natural dentition⁴and an investigation determined that removable dental prosthesis use leads to a low fiber and less nutritious diet ¹³. Studies concluded that the percentage of the masticatory performance achieved by subjects with complete tissue-borne dentures in relation to those with natural dentition was of 40% ¹⁵, 16% ¹⁶and 33.3 ¹⁷.

Given these data, it can be suggested there is a deficiency in functional effectiveness of the prosthesis compared to natural teeth. Tooth loss and changes in oral cavity status may affect chewing process in senior citizens. Most commonly unilateral chewing movements are perceived to have such consequences as poor denture retention and chewing inefficient caused by muscular flaccidity ¹⁸.

Considering the importance of this issue for adult and the elderly adult health and quality of life, this study aims to compile and analyze data from scientific papers on the relationship between chewing and removable dentures in adults and elderly adults in order to contribute to the prevention or intervention projects associated to this special population.

Methods

A systematic review of scientific literature on the relationship between mastication and removable dental prosthesis was performed and the initial search of descriptors was based on the question if there is a relationship between alterations in the chewing process is present in the use of removable dentures in adults and older adults.

The search was conducted with the key words aging, chewing, dental prostheses and speech, in Portuguese, English and Spanish, and were cross-linked for this purpose. An integrative search of SCIELO, PUBMED and LILACS databases was conducted during March to July 2014, covering a period from January 2006 to July 2014 for articles in Portuguese, English and Spanish.

Criteria for considering studies for this review

The revised studies included original qualitative and/or quantitative research articles with the purpose of identifying the relationship between the use of removable dentures and chewing in adult and elderly subjects users of removable dental prosthesis. Articles excluded were those related exclusively to the performance of mastication on implanted dental prosthesis users, surface electromyography studies about mastication muscles assessment and those which compared masticatory performance between removable and implantable dental prosthesis.

Literature Review

The search began considering key words and articles abstracts and the results indicated 21 abstracts for potential inclusion. After applying the inclusion and exclusion criteria, 11 articles were selected for full review.

The country of origin verification indicated that 55% of the articles were from Brazil, 9% from Japan, 9% from Bosnia, 9% from France, 9% from India and 9% from Thailand.

The eleven studies analyzed presented some degree of heterogeneity in relation to its objectives and methodologies so they were organized according to subject area.

Figure 1:
Reviewed articles according to author, sample, study objective, method and procedures for evaluating chewing on dentures users and results.

After content analysis it was not possible to compare the differences between sexes, because gender was not a variable considered in most study variables except for one¹⁹, which stated when considering partial denture users, male subjects generally showed less satisfaction with their chewing than female subjects though this result was not statistically significant. On the topic satisfaction, two articles^{20 21}, which applied questionnaires to edentulous subjects, verified that the use of the prosthesis improved the level of satisfaction when related to good levels of stability and comfort of the prosthesis. However, it was reported that 32.1% of users were satisfied with their prostheses and 39.3% were unsatiesfied²¹. When researching topics that associated variables as retention, aesthetics, speech, mastication and comfort, chewing was the lowest valued by partial dentures users¹⁹. An investigación²²comparing chewing level of satisfaction, amid subjects with natural teeth and edentulous denture users, attested levels of satisfaction of 99.5% and 67% respectively.

From a standpoint of preference and/or avoidance of certain foods, studies revealed interesting facts: 86% of respondents reported chewing difficulty and 27.9% reported certain foods avoidance in their diets, choosing the easiest aliment to process and masticate ²³; in a Thai investigation with complete denture users, 12.5% of adults did not chew food using their dental prosthesis²⁴.

Regarding the thematic area of masticatory parameters in denture users the data pointed to difficulties in food cutting along with weak masticatory muscles functioning that led to restraint or preference for determined foods. In a research ²⁵with a sample of Kennedy class I and III and dental prosthesis users, the results estimated a decrease in time, number of masticatory cycles and frequency when subjects used their prosthesis compared to when they did not, independently of the Kennedy class. In another article¹⁰users of partial and complete dentures had increased time and number of chewing cycles when compared to subjects with natural dentition, still a non-statistically significant data, and greater difficulties in cutting food, in a ratio of 71.9% for patients with prostheses and 9.5% for subjects with natural dentition. According to these authors, this may be due to masticatory muscles weakness (also evaluated in the study), which revealed evident alterations in the masseter muscle, significant correlation between cheeks and time prosthesis use, indicating that subjects with shorter time of upper prosthesis use had a higher number of cheeks alterations and a positive correlation between prosthesis use versus number of cycles and between time versus number of chewing cycles (the latter for dentures users and subjects with natural dentition).

In a masticatory movement's evaluation with a kinesiographic device²⁶, employing natural food (peanuts) and artificial food (Optacal) as test materials, in removable dentures and complete dentures users, it resulted that regardless ofc the test material, the group of removable dentures experienced faster chewing cycles with opening, closing and duration of total cycles reduced when compared to the other. Correlating masticatory efficiency with almonds and a system of sieves, in dentate subject with denture and with natural teeth it was verified a 67.5% less of masticatory efficiency in the first ones²².

Authors²⁰ confirm low masticatory performance between users of complete denture, when using as stimulus an average size particle of (±) 1.0 mm. This research corroborates the results found in dentate subjects and users of dental prosthesis which found out that prosthetic masticatory performance was 80% lower than those with natural dentition ²². A study ²⁷concluded that the type of prosthesis had influence on masticatory performance and greater efficiency was related to balanced bilateral occlusion when the focal point was on masticatory efficiency and type of full denture.

In a structural equation model study²⁸, the findings pointed to masticatory performance being a critical factor for the masticatory ability perception of prosthesis user and that it had a negative impact when related to quality of life and oral health among those subjects.

Due to the characteristics of chewing and the difficulty that most of these subjects face, it is suggested a follow up program that may include chewing process intervention by a speech and language pathologist since this professional can facilitate the adaptation process, aiming to ensure maximum efficiency and effective prosthesis usage by correlating different functions (phonoarticulatory, chewing and swallowing).

Thus, the is a need to inform about the relevance of the stomatognathic system, highlighting chewing system, as this allows the formulation of novel speech and language pathology practices which may provide solutions for current prosthesis users demands and encourage the creation of innovative public policies in the area of oral health.

Conclusion

Systematic review studies indicate that satisfaction, performance, efficiency and masticatory parameters are crucial variables related to users of removable dental prosthesis.

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Publication Dates

• Publication in this collection
  Aug 2015

History

• Received
  07 Feb 2015
• Accepted
  31 Mar 2015