Behaviors and Hygiene Habits of Complete Denture Wearers

The number of fully or partially edentulous patients is still large in present days. Dentures are used for replacing lost teeth and returning the functional and esthetic conditions to the patients. The literature shows that the presence of some diseases and the use of certain medications can affect the oral tissues and amount of saliva (1). Knowledge of these factors associated with the constant intraoral changes related to use of the dentures and the aging of the individuals is of paramount importance to the dentist for making an accurate diagnosis and promoting health. In addition, efficient and regular procedures for cleaning complete dentures are important for maintaining good oral health and greater longevity of the prosthesis (2). To minimize the prevalence of denture stomatitis, the dentist must instruct the patient in removing complete dentures 6 to 8 h per day (3). Behaviors and Hygiene Habits of Complete Denture Wearers


INTRODUCTION
The number of fully or partially edentulous patients is still large in present days.Dentures are used for replacing lost teeth and returning the functional and esthetic conditions to the patients.
The literature shows that the presence of some diseases and the use of certain medications can affect the oral tissues and amount of saliva (1).Knowledge of these factors associated with the constant intraoral changes related to use of the dentures and the aging of the individuals is of paramount importance to the dentist for making an accurate diagnosis and promoting health.
In addition, efficient and regular procedures for cleaning complete dentures are important for maintaining good oral health and greater longevity of the prosthesis (2).To minimize the prevalence of denture stomatitis, the dentist must instruct the patient in removing complete dentures 6 to 8 h per day (3).
The fitting of complete dentures should not be considered the final stage of treatment, but the beginning of a long relationship between patient and dentist in order to maintain the health of oral tissues (4).It is extremely important that patients return regularly to the dentist for oral health maintenance and for the evaluation of their dentures.
However, surveys have reported that complete denture wearers have difficulty in cleaning their dentures (5,6), and so preventive programs are effective in promoting good oral health.Patients do not return to the dentist for control and maintenance of their dentures generally at the appropriate intervals (7).Thus, it is up to the dentist to guide their patients properly about proper denture cleaning and the appropriate products to be used.
Using a specific questionnaire, the purpose of this study was to evaluate the hygiene methods and habits concerning the use of complete dentures, the age of dentures, and whether the patients have been instructed A. Peracini et al. on how to clean their dentures.One hundred and six patients of both genders from Ribeirão Preto Dental School, University of São Paulo, Brazil, were invited to participate in this survey.The patients were asked to fill out a questionnaire (Fig. 1) addressing denture wearing and denture cleansing habits.

RESULTS AND DISCUSSION
Nineteen patients were males (age range 45-80 years) but the majority (n=87; 82.08%) were females (age range = 37 to 92 years).The mean age of patients was 63.35 years.Among the male patients, 12 wore upper and lower complete dentures and 7 wore upper complete denture only.Among females, 72 wore upper and lower complete dentures, and 15 wore upper complete denture only.
Data referring to patient distribution according to time of edentulousness, time of denture use, age of current denture, previous information on denture cleansing, denture cleansing method used, frequency of cleaning of dentures, cleaned regions of the oral cavity, alleged difficulty on cleaning of dentures, use of some type of oral rinse, and continuous use of complete dentures, are presented in Tables 1-10.

DISCUSSION
Several factors that may be related to the occurrence of denture stomatitis were approached by the questionnaire: denture age, denture hygiene habits, and frequency of denture use and cleaning.
The results showed that 62.26% of the respondents had been using the same upper complete denture for over 5 years; 49.06% had been using the same lower complete denture for over 5 years; and 24.53% and 16.04% had been using the same upper and lower dentures, respectively, for more than 20 years (Table 3).Coelho et al. (8) also found that most patients wore their dentures for 20 years.
Previous studies (2,9) have reported that the majority of denture wearers do not know how to clean their dentures because they have never received instructions from their dentist.In this study, most patients (51.89%) reported never having been advised by their dentists as to how to clean their dentures (Table 4).Similar results were obtained by Dikbas et al. ( 2), Hoad-Reddick et al. ( 5) and Marchini et al. (7), who found that 82.9%, 86.3% and 77.5%, respectively, of the respondents did not receive proper denture cleaning instructions from their dentists.
Brushing with dentifrice was used by 84.91% of patients in the present study (Table 5), which is in agreement with the findings of a previous study (12).Dentifrice has the advantage of being simple to use and relatively inexpensive.However, if used with an improper brushing technique, dentifrice can damage the prosthesis material ( 2), due to the potential abrasive wear of the denture material (9).
Only 58.49% of the patients in present study reported the use of chemical solutions for cleaning by immersion.Among the substances used for immersion, of the dentures water was the most frequent (38.71%) followed by sodium hypochlorite (33.87%) (Table 5).In the study by Baran and Nalçaci (13), 42.9% of patients immersed their dentures in water and only 1.6% immersed then in a chemical (hypochlorite) solution.The use of chemical solutions for denture immersion is less frequently than manual brushing methods of cleaning (7).
Hoad-Reddick et al. (5) found that a combination of methods (brushing and soaking) was used more frequently.Veres et al. (11) found that the majority of patients (59%) brushed and immersed their dentures, whereas 36% only brushed their dentures, and only 5% used immersion as the only method of cleaning.
Chemical methods have the advantage of being simple to use (14)(15)(16).However, chemical methods have disadvantages such as high cost and metal corrosion as well as the bleaching of acrylic resin resulting in damage to the denture base (9,14).In relation to inflammation of the oral mucosa of the edentulous, Abelson (14), showed that one of the main etiological factors is the lack of denture hygiene.With regard to the frequency of denture cleaning, 99.06% of the study population said they clean their dentures at least once a day (Table 6).These results agree with those of Nevalainen et al. (17) and De Castellucci Barbosa et al. (12) (96.0% and 98.0%, respectively).Hoad-Reddick et al. ( 5) and Dikbas et al. (2) showed that only 79.1% of a sample of 233 patients and 70.0% of a sample of 234 patients, respectively, cleaned their dentures at least once a day.
In the present study, 73.58% of patients cleaned their dentures 3 or more times daily (Table 6).This frequency was higher than that of Dikbas et al. (2), where 25% of individuals, from a sample of 234, reported cleaning their dentures 3 times a day.However, according to Pietrokvoski et al. (18), 96% of patients reported cleaning their dentures 2 or more times per day.
Table 7 shows that the internal labial flange, inner surface, and the regions between the teeth were the most difficult regions to clean.Paranhos et al. (19) found that the greatest amount of biofilm was present on the internal labial flange.The dentist should also instruct the patient on how to clean the soft tissues of the oral cavity.Of the Internal and external borders 0 1 Between the teeth 0 5 Internal flanges 0 2 Labial flange 0 2 Posterior region 1 1 External surface of upper/lower molars 0 1 Removal of stains 0 1 Internal labial flange 0 6 Total inner surface 0 7 Nalçaci (13) also showed that 55.2% of patients slept with their dentures.Marcus et al. (20) found that nearly one third of the participants of their study slept with both dentures, and 12% slept with the lower denture only.Veres et al. (11) showed that 49% of the patients wore their dentures continuously.The use of dentures during the day by the patients might result in the accumulation of biofilm on their surface (5,7).Thus, the continuous use increases the prevalence of denture-induced stomatitis, which has the biofilm as its main etiological factor.According Zissis et al. (3), patients who wore dentures continuously (day and night) had a higher prevalence of denture stomatitis.
Similar result was reported by Jeganathan et al. ( 4), who found that denture-induced stomatitis was more common in patients with continued use of the dentures (61%) when compared to controls with healthy mucosa (18%).T h i s s u r v e y revealed the hygiene habits of 106 patients.Within the limitations of this study, it may be concluded that the interviewed patients had limited knowledge of denture cleansing and oral hygiene.Brushing was the method of choice for cleaning, most patients had been using the same complete dentures for more than 5 years, and were used to sleep with the dentures.

Table 1 .
Distribution of patients according to the time of edentulousness (in years) for each gender.

Table 2 .
Distribution of patients according to time of use (years) of complete dentures, for each gender.

Table 4 .
Distribution of patients according to instructions provided by the dentist on complete denture cleansing, for each gender.

Table 3 .
Distribution of patients according to the age (in years) of current complete dentures, for each gender.

Table 5 .
Distribution of patients according to the denture cleaning method used, for each gender.

Table 7 .
Distribution of patients according to the difficulty on cleaning of dentures, for each gender.

Table 8 .
Distribution of patients who cleaned regions of the oral cavity, for each gender.

Table 6 .
Distribution of patients according to the frequency of cleaning of dentures.

Table 10 .
Distribution of patients according to the continuous use of complete dentures.