Abstract
This study investigated denture care attitudes, dental visit habits, oral mucosal lesions, and hygiene levels in 118 complete denture users treated at a university dentistry faculty. Data on demographics, smoking, denture use duration, dentist visits, and hygiene habits were collected via a questionnaire. A specialist examined mucosal lesions and assessed denture hygiene level using the Budtz-Jorgensen and Bertram method. Categorical data were analyzed with Yates’s correction, Pearson’s chi-square, and Fisher–Freeman–Halton tests; multiple comparisons used the Bonferroni Corrected Z Test. Participants’ mean age was 51.61. Most were non-smokers (55.1%), visited dentists only for complaints (44.9%), cleaned dentures daily (70.3%), and removed them at night (56.8%). Good hygiene was observed in 40.68%. Females cleaned dentures more frequently than males, and 96.3% of those with poor hygiene reported bad denture odor. This study revealed significant deficiencies in denture care habits and inadequate hygiene practices of participants in a university dentistry faculty clinic. Most participants visited dentists only for complaints and had bad habits such as sleeping with their dentures at night and using inappropriate denture hygiene habits. Promoting proper denture hygiene habits and emphasizing the importance of regular dental visits can contribute to better oral health.
Keywords: Cross-sectional study, Denture care attitudes, Denture hygiene, Denture wearers, Oral mucosal lesions, Complete denture.
Subject terms: Health care, Medical research
Introduction
Edentulism, a common health issue in old age, is a multifactorial concept that adversely affects individuals’ psychological, aesthetic, and social lives, thereby reducing their quality of life1,2. Additionally, it disrupts individuals’ chewing function by influencing their dietary habits3. In today’s dental practice, removable dentures are commonly used to treat missing teeth. While their removability allows for easier cleaning procedures and presents a lower-cost treatment option compared to fixed prosthetics, it is known to exacerbate plaque accumulation in people with inadequate oral hygiene4. In such cases, increased intraoral plaque levels can lead to decay in the remaining natural teeth and intra-oral mucosal lesions. Bergman et al.5 reported in their study that removable dentures increase plaque accumulation, thereby increasing the risk of dental caries, gingivitis, and periodontitis.
If denture bases are not properly cleaned, plaque and calculus formation on the denture surfaces is observed. As a result, the dentures’ aesthetics are negatively affected, and unpleasant odors worsen. In addition, dentures that are not properly cleaned can cause oral mucosal diseases by causing microbial accumulation on the denture surfaces. There are various studies showing that the incidence of oral mucosal lesions increases, especially due to the use of removable dentures6,7. Removable denture-related oral mucosal lesions occur as a reaction to the biofilm formed on the surface of the denture material or the material from which the denture is made, or as a result of trauma to the tissue caused by faulty/incompatible dentures. Dentures covering the oral mucosa, trauma, incompatibility of dentures, inadequate hygiene, worn dentures, not removing the dentures at night, and prolonged use of dentures constitute risk factors for oral mucosal lesions8–10. Denture stomatitis is one of the most common oral mucosal lesions with a prevalence rate of 15–70% and can become chronic if left untreated11. Additionally, an increase in the microbial load in the mouth can have negative effects on systemic health. This can increase the risk of infection, especially in individuals with a weak immune system12–14. Other types of oral mucosal lesions include traumatic ulcers, angular cheilitis, epulis fissuratum, and unsupported ridge10,15.
Regular attention to oral hygiene and denture hygiene are vital in maintaining removable dentures’ long-term use16,17. Studies have revealed that individuals exhibit inadequate denture care practices and have inappropriate oral hygiene habits18–20. In a study conducted by Çankaya et al.,21 they stated that lack of knowledge about oral health care and infrequent dentist check-ups were effective in inadequate and inappropriate care habits. In a study by Algabri et al.,22 the hygiene habits and source of care of removable denture patients were examined. The findings showed that the majority of the participants (59%) did not go to the dentist for regular denture care or any denture-related problems. During the appointments where dentures are delivered to patients, dentists should provide detailed instructions on how to clean them properly23. In a study conducted by Gümüşok et al.24 which evaluated the hygiene, attitudes, and habits related to removable dentures, the findings revealed that their dentists did not inform 63% of the patients how to clean their dentures. In another study the average person remembers only about 15% of information provided verbally olduğu belirtilmiş olup; therefore, the need to provide both written and verbal information should not be overlooked to ensure a proper understanding and instructions’ retention25. In a study examining the effect of informing denture patients about denture hygiene, Peltola et al.26 concluded that providing education about denture hygiene and cleaning through dental hygienists or nurses significantly increased denture cleaning compared to a group of denture patients who did not receive any training.
Previous studies have focused on questioning the hygiene habits of patients using removable dentures, and our current study questions not only the hygiene habits of individuals but also the frequency of dental visits, the occurrence of oral mucosal lesions, and denture hygiene levels. In this context, this study aimed to investigate attitudes and behaviors toward denture care, dental-visit-related habits, the frequency of oral mucosal lesions observed during clinical examinations, and denture hygiene levels among patients with complete dentures treated at a single university dentistry faculty. Additionally, the study sought to explore potential relationships between these factors.
Materials and methods
Participants and settings
This cross-sectional study was conducted at the Bolu Abant İzzet Baysal University Faculty of Dentistry in Turkey between January 2022 and June 2023. Before the study, detailed information about the research was provided to the participants, and written, informed consent was obtained voluntarily from each participant. The research was initiated with the approval of the ethics committee at Abant İzzet Baysal University (Decision no: 2023/97) and conducted according to the principles of the Declaration of Helsinki. This study included only complete denture wearers who had been using their dentures for at least 6 months and were able to provide information about their denture hygiene practices. Participants with systemic diseases, those on regular medication, individuals following a special dietary program or with dietary restrictions, removable partial denture or implant-supported denture wearers, and those with cognitive impairments that prevented them from adequately responding to the research questions were excluded from the study.
Sample size calculation
A power analysis was conducted with a software program (G*Power version 3.0.10; Heinrich Heine University Düsseldorf). According to the analysis results, the minimum sample size was calculated as 117, based on a theoretical power of 0.95, an α value of 0.05, and a standardized effect size of 0.4419, derived from a similar study27. The current study involved 118 patients who were using complete dentures.
Data collection tools and procedures
In the first part of the study, responses to questions about variables such as gender, socio-economic status, education level, smoking status, duration of current denture use, and dental visit frequency were recorded. The socioeconomic levels of individuals are divided into three classes: less than minimum wage, at minimum wage, and more than minimum wage28. According to the Turkish minimum wage regulation, the minimum wage is the wage paid to workers for a normal working day and is sufficient to meet the worker’s essential needs such as food, housing, clothing, health, transportation and culture at a minimum level based on current prices29. Education levels are divided into four groups: illiterate, primary school, high school and university30. Smoking status was categorized into three groups, based on the study by Shurman et al.,31 with 0 cigarettes per day indicating non-smokers, 1–15 cigarettes per day indicating light smokers, and more than 15 cigarettes per day indicating heavy smokers. Denture use duration was categorized into three groups, following the classification used in the study by Cankaya et al.: < 1 year, 1–5 years, and ≥ 5 years21.
During the second part of the study, patients were questioned about their denture hygiene habits. These questions included whether they cleaned their dentures daily, whether they removed their dentures at night, whether they used denture adhesives, where they stored their dentures when not in use, whether they cleaned their dentures while wearing them or not wearing them, how they performed denture cleaning, which cleaning tools they used, where they acquired information about hygiene habits, and whether they experienced bad odor from their dentures.The questions asked to the participants and the relevant answer options are given in Table 1.
Table 1.
The questions directed to the participants and the corresponding answer options.
| Part of the study | Questions | Answer Options |
|---|---|---|
| First part |
Gender Socio-economic status Education level Smoking status Duration of current denture use Dental visit frequency |
Male/Female < min wage/ at min wage/ ˃min wage Illiterate/ Primary school/ High school/ University Not using/ 1–14 per day/ > 15 per day < 1 year/ 1–5 years / ≥ 5 years 1 time in 6 months/ Once a year/ 1 time in 2 years/ As many complaints/ None |
| Second part |
Do you clean your denture daily? Do you take your dentures off at night? Do you use denture adhesives? Where do you keep your dentures when it is not in your mouth? Do you take your denture out of your mouth to clean it? What do you use to clean your dentures? Where did you learn about denture care? Have you ever experienced bad odor from your dentures? |
Yes/ No Yes/ No/ Sometimes Yes/ No In water/ In bag/ Wrapped in cloth or napkin Yes/ No Baking soda and toothbrush/ Tooth paste and toothbrush/ Mouthwash/ Bleach/ Only water/ Soap and toothbrush/ Cleaning tablet/ Nothing Verbal from dentist/ Written form dentist/ From a non-dentist source/ No information given Yes/ No |
| Third part | Oral mucosal lesions | Traumatic Ulcer |
| Denture Stomatitis | ||
| Epulis Fissuratum | ||
| Unsupported Ridge | ||
| Angular Cheilitis | ||
| Oral Candidiasis | ||
| Final part | Denture hygiene level |
Good Fair Poor |
In the third part, detailed intraoral examinations were conducted by a single specialist B.T. (a prosthodontist) to evaluate oral mucosal lesions. The presence of denture-related oral mucosal lesions—including denture stomatitis, traumatic ulcers, epulis fissuratum, unsupported crest, angular cheilitis, and oral candidiasis—was assessed based on clinical appearance. After the diagnosis of mucosal lesions was made, the patients were explained what caused the lesions and what should be done for their treatment.
In the study’s final part, the hygiene levels of patients’ existing dentures were evaluated by B.T. using the Budtz-Jorgensen and Bertram method32. According to this method, if no plaque or calculus was present, the patient’s hygiene was classified as good. If plaque or calculus covered less than one-third of the denture, their hygiene was classified as fair. Finally, if plaque and calculus covered one-third or more of the denture, their hygiene was classified as poor.
The collected data were analyzed using IBM SPSS software (version 23). The data were presented as frequencies (n) and percentages (%) relative to the general population. Yates’s correction, Pearson’s chi-square test, and the Fisher–Freeman–Halton test were employed to compare categorical data, and multiple comparisons were conducted using the Bonferroni Corrected Z Test. The significance level was set to p < 0.05.
Results
Demographic characteristics
Of the participants, 60 were male (50.8%), and 58 were female (49.2%), while the majority had a minimum wage socioeconomic status (40.7%). When the level of education was examined, primary school graduates were in the majority (33%), while university graduates were at the lowest rate (17%). While the majority of the participants reported not smoking (55.1%), 31.4% reported smoking 1–14 cigarettes per day, and 13.6% reported smoking more than 15 cigarettes per day. Of the participants, 37.28% had used dentures for more than five years, 34.74% had used dentures for 1–5 years, and 27.96% had used dentures for less than one year. Finally, the majority of participants reported visiting a dentist when they had a complaint (44.9%), while 18.64% visited a dentist once a year, 16.10% every 6 months, 12.71% never, and 7.62% every two years (Table 2).
Table 2.
Distribution of demographic data.
| Frequency | Percentage | ||
|---|---|---|---|
| Gender | Male | 60 | 50.8 |
| Female | 58 | 49.2 | |
| Socio-economic status |
< min wage At min wage > min wage |
30 48 40 |
25.4 40.7 33.9 |
| Education level |
Illiterate Primary school High school University |
22 39 37 20 |
18.7 33 31.3 17 |
| Smoking | Not using | 65 | 55.1 |
| 1–14 per day | 37 | 31.4 | |
| > 15 per day | 16 | 13.6 | |
| How long have you been using dentures? |
< 1 year 1–5 years ≥ 5 years |
33 41 44 |
27.96 34.74 37.28 |
| How often do you visit the dentist for routine checkups? |
1 time in 6 months Once a year 1 time in 2 years As many complaints None |
19 22 9 53 15 |
16.10 18.64 7.62 44.9 12.71 |
| Total | 118 | 100 | |
Denture hygiene habits
From the data related to denture hygiene habits, it was observed that the majority of patients cleaned their dentures daily (70.3%). Data analysis revealed that 56.8% of the participants removed their dentures at night, that 24.6% sometimes removed them, and that 18.6% wore their dentures while sleeping. A significant portion (74.6%) did not use denture adhesive, while 25.4% preferred to use it. The majority of participants (73.72%) stored their dentures in water when not in use, and a large proportion (78.8%) cleaned the prostheses when they were not worn. The responses concerning the denture cleaning agents used varied: 28.65% of the respondents used toothpaste, 21.35% soap, 11.9% bleach, 11.45% cleaning tablets, 9.89% mouthwash, 3.12% baking soda, and 2.60% nothing. The respondents were also questioned about their sources of denture care education. The majority (44%) received verbal information from dentists versus 20.8% from non-dentist sources, and 15.2% received written information from dentists. However, 20% received no information about denture care. A large proportion of patients (64.4%) reported not experiencing bad odor from their dentures (Table 3).
Table 3.
Distribution of participants based on the questions about denture care habits.
| Frequency | Percentage | ||
|---|---|---|---|
| Do you clean your denture daily? | Yes | 83 | 70.3 |
| No | 35 | 29.7 | |
| Do you take your dentures off at night? | Yes | 67 | 56.8 |
| No | 22 | 18.6 | |
| Sometimes | 29 | 24.6 | |
| Do you use denture adhesives? | Yes | 30 | 25.4 |
| No | 88 | 74.6 | |
| Where do you keep your dentures when it is not in your mouth? |
In water In bag Wrapped in cloth/napkin Outside/outdoors |
87 17 14 0 |
73.72 14.40 11.86 0 |
| Do you take your denture out of your mouth to clean it? |
Yes No |
93 25 |
78.8 21.2 |
| What do you use to clean your dentures? |
Baking soda and toothbrush Toothpaste and toothbrush Mouthwash Bleach Only water Soap and toothbrush Cleaning tablet Nothing |
6 55 19 23 21 41 22 5 |
3.12 28.65 9.89 11.9 10.93 21.35 11.45 2.60 |
| Where did you learn about denture care? |
Verbal from dentist Written from dentist From a non-dentist source No information Given |
55 19 26 25 |
44 15.2 20.8 20 |
| Have you ever experienced bad odor from your dentures? | Yes | 42 | 35.6 |
| No | 76 | 64.4 | |
| Total | 118 | 100 |
Oral mucosal lesions and denture hygiene levels
According to the findings obtained from the intraoral examinations for oral mucosal lesions, the following results were obtained, in descending order: traumatic ulcers were observed at a rate of 22.80%, followed by denture stomatitis at 18.64%, epulis fissuratum at 16.95%, an unsupported crest at 15.25%, and angular cheilitis at 9.32%, while oral candidiasis was observed at the lowest rate (5.08%). For 11.86% of participants, no oral mucosal lesions were found (Fig. 1). During denture hygiene examinations, a significant majority of the participants were noted to have good hygiene (40.68%). The participants’ hygiene levels were fair in 36.44% of cases, while 22.88% had poor hygiene levels (Fig. 2).
Fig. 1.
Percentage of oral mucosal lesions in participants.
Fig. 2.
Percentage of denture hygiene level in participants.
When the relationship between gender and denture hygiene habits was examined, the participants who cleaned their dentures daily were found to be significantly more female than male (p = 0.021). Additionally, a statistically significant difference was observed between gender and sources of information about denture care; the female participants predominantly obtained verbal information from dentists (p = 0.010). However, no significant difference was found between gender and other data regarding denture hygiene habits (p > 0.05) (Table 4). Ayrıca oral mucosal lesions ve denture hygiene levels ile cinsiyet arasındaki karşılaştırmalarda da istatistiksel olarak anlamlı bir fark gözlenmemiştir (p > 0.05).
Table 4.
Examination of the relationship between gender and denture care habits.
| Gender | Test Statistics | p | ||
|---|---|---|---|---|
| Male | Female | |||
| Do you clean your denture daily? | ||||
| Yes | 36 (60) | 47 (81) | 5.287 | 0.021** |
| No | 24 (40) | 11 (19) | ||
| Do you take your dentures off at night? | ||||
| Yes | 34 (56.7) | 33 (56.9) | 3.308 | 0.191* |
| No | 8 (13.3) | 14 (24.1) | ||
| Sometimes | 18 (30) | 11 (19) | ||
| Do you use denture adhesives? | ||||
| Yes | 20 (33.3) | 10 (17.2) | 3.224 | 0.73** |
| No | 40 (66.7) | 48 (82.8) | ||
| Where do you keep your dentures when it is not in your mouth? | ||||
| In water | 43 (71.7) | 44 (75.9) | 0.322 | 0.851* |
| Wrapped in Cloth/Napkin | 9 (15) | 8 (13.8) | ||
| In bag | 8 (13.3) | 6 (10.3) | ||
| Do you take your denture out of your mouth to clean it? | ||||
| Yes | 48 (80) | 45 (77.6) | 0.009 | 0.924** |
| No | 12 (20) | 13 (22.4) | ||
| What do you use to clean your dentures? | ||||
| Baking soda | 2 (3.3) | 4 (6.9) | 9.159 | 0.329* |
| Toothpaste | 23 (38.3) | 32 (55.2) | ||
| Mouthwash | 12 (20) | 7 (12.1) | ||
| Bleach/Detergent | 15 (25) | 8 (13.8) | ||
| Only water | 10 (16.7) | 11 (19) | ||
| Soap | 23 (38.3) | 18 (31) | ||
| Denture cleaning tablet | 10 (16.7) | 12 (20.7) | ||
| Nothing | 3 (5) | 2 (3.4) | ||
| Where did you learn about denture care? | ||||
| Verbal from dentist | 21 (35)a | 34 (58.6)b | 13.265 | 0.010* |
| Letter from dentist | 13 (21.7) | 6 (10.3) | ||
| From a non-dentist source | 14 (23.3) | 12 (20.7) | ||
| No information given | 17 (28.3) | 8 (13.8) | ||
| Have you ever experienced bad odor from your dentures? | ||||
| Yes | 22 (37) | 20 (33) | 0.003 | 0.956** |
| No | 38 (63) | 38 (67) | ||
Significant values are in bold.
*Pearson Chi-Square Test **Yates Correction; a-b: There is no difference between groups with the same letter.
No statistically significant difference was found between socioeconomic status and denture care habits and oral mucosal lesions. However, the difference between denture hygiene levels and socioeconomic status was found to be statistically significant (p < 0.001). The rate of having good denture hygiene levels was found to be lower in individuals whose socioeconomic status was less than minimum wage compared to individuals whose socioeconomic status was at or more than minimum wage (13.3%). On the other hand, it was found that the rate of having poor denture hygiene levels was lower in individuals whose socioeconomic status was more than minimum wage compared to individuals whose socioeconomic status was at or less than minimum wage (0%). While the denture hygiene levels of individuals whose socioeconomic status was more than minimum wage were mostly at a good level, the denture hygiene levels of individuals whose socioeconomic status was less than minimum wage were mostly at a poor level (Table 5).
Table 5.
Comparison of the relationship between socioeconomic status and denture care habits, oral mucosal lesions, and denture hygiene levels.
| Socio-economic status | Test Statistics | p | |||
|---|---|---|---|---|---|
| < min wage | At min wage | ˃ min wage | |||
| Do you clean your denture daily? | |||||
| Yes | 17 (56.7) | 38 (79.2) | 28 (70) | 5.221 | 0.073* |
| No | 13 (43.3) | 10 (20.8) | 12 (30) | ||
| Do you take your dentures off at night? | |||||
| Yes | 20 (66.7) | 22 (45.9) | 24 (60) | 9.307 | 0.054* |
| No | 2 (6.7) | 16 (33.3) | 5 (12.5) | ||
| Sometimes | 8 (26.7) | 10 (20.8) | 11 (27.5) | ||
| Do you use denture adhesives? | |||||
| Yes | 10 (33.3) | 8 (16.6) | 12 (30) | 3.161 | 0.206* |
| No | 20 (66.7) | 40 (83.4) | 28 (70) | ||
| Where do you keep your dentures when it is not in your mouth? | |||||
| In water | 23 (76.7) | 32 (66.6) | 32 (80) | 2.595 | 0.654** |
| Wrapped in Cloth/Napkin | 4 (13.3) | 8 (16.6) | 5 (12.5) | ||
| In bag | 3 (10) | 8 (16.8) | 3 (7.5) | ||
| Do you take your denture out of your mouth to clean it? | |||||
| Yes | 24 (80) | 38 (80.9) | 30 (75) | 0.485 | 0.785* |
| No | 6 (20) | 9 (19.1) | 10 (25) | ||
| What do you use to clean your dentures? | |||||
| Baking soda | 1 (3.3) | 4 (8.5) | 1 (2.5) | 22.174 | 0.138* |
| Toothpaste | 9 (30) | 20 (42.6) | 25 (62.5) | ||
| Mouthwash | 8 (26.7) | 5 (10.6) | 5 (12.5) | ||
| Bleach/Detergent | 8 (26.7) | 8 (17) | 7 (17.5) | ||
| Only water | 6 (20) | 11 (23.4) | 4 (10) | ||
| Soap | 14 (46.7) | 13 (27.7) | 14 (35) | ||
| Denture cleaning tablet | 6 (20) | 9 (19.1) | 7 (17.5) | ||
| Nothing | 1 (3.3) | 1 (2.1) | 3 (7.5) | ||
| Where did you learn about denture care? | |||||
| Verbal from dentist | 8 (26.7) | 26 (55.3) | 20 (50) | 15.003 | 0.059* |
| Letter from dentist | 8 (26.7) | 4 (8.5) | 6 (15) | ||
| From a non-dentist source | 6 (20) | 10 (21.3) | 10 (25) | ||
| No information given | 10 (33.3) | 9 (19.1) | 6 (15) | ||
| Have you ever experienced bad odor from your dentures? | |||||
| Yes | 12 (40) | 10 (25) | 4.158 | 0.125* | |
| No | 18 (60) | 12 (40) | 30 (75) | ||
| Oral mucosal lesions | |||||
| Traumatic Ulcer | 7 (29.2) | 11 (28.9) | 9 (33.3) | ||
| Denture Stomatitis | 7 (29.2) | 9 (23.7) | 6 (22.2) | ||
| Epulis Fissuratum | 3 (12.5) | 9 (23.7) | 8 (29.6) | ||
| Unsupported Ridge | 5 (20.8) | 11 (28.9) | 2 (7.4) | 9.271 | 0.680* |
| Angular Cheilitis | 3 (12.5) | 4 (10.5) | 3 (11.1) | ||
| Oral Candidiasis | 2 (8.3) | 1 (2.6) | 3 (11.1) | ||
| Denture hygiene level | |||||
| Good | 4 (13.3)a | 19 (39.6)b | 25 (62.5)b | ||
| Fair | 12 (40)a | 16 (33.3)a | 15 (37.5)a | 117.887 | < 0.001** |
| Poor | 14 (46.7)a | 13 (27.1)a | 0 (0)b | ||
Significant values are in bold.
*Pearson Chi-Square Test; **Monte Carlo Corrected Fisher’s Exact Test; ~ Multiple Response; a-c: There is no difference between groups sharing the same letter.
When the relationship between education level and denture care habits, oral mucosal diseases and denture hygiene levels was examined, a statistically significant relationship was found between the participants’ education level and the rate of experiencing a bad odor from their dentures (p = 0.034). The rate of experiencing a bad odor from their dentures was found to be 45.5% in those with a literate level of education, 12.8% in primary school graduates, 24.3% in high school graduates and 35% in university graduates. In addition, a statistically significant relationship was found between the participants’ education level and denture hygiene level (p < 0.001). While the good denture hygiene rate was the lowest in those with a literate level of education (18.2%), the highest good denture hygiene rate was seen in university graduates (100%). While the poor hygiene rate was the highest in those with a literate level of education (81.8%), the lowest poor hygiene rate was obtained in high school and university graduates (0%). No statistically significant difference was found between education level and other variables (p > 0.050) (Table 6).
Table 6.
Comparison of the relationship between education level and denture care habits, oral mucosal lesions, and denture hygiene levels.
| Education level | Test Statistics | p | ||||
|---|---|---|---|---|---|---|
| Illiterate | Primary school | High school | University | |||
| Do you clean your denture daily? | ||||||
| Yes | 15 (68.2) | 28 (71.8) | 29 (78.4) | 11 (55) | 3.49 | 0.322* |
| No | 7 (31.8) | 11 (28.2) | 8 (21.6) | 9 (45) | ||
| Do you take your dentures off at night? | ||||||
| Yes | 11 (50) | 24 (61.5) | 21 (56.8) | 11 (55) | 13.626 | 0.060** |
| No | 3 (13.6) | 9 (23.1) | 10 (27) | 0 (0) | ||
| Sometimes | 8 (36.4) | 6 (15.4) | 6 (16.2) | 9 (45) | ||
| Do you use denture adhesives? | ||||||
| Yes | 7 (31.8) | 8 (20.5) | 6 (16.2) | 9 (45) | 6.667 | 0.083* |
| No | 15 (68.2) | 31 (79.5) | 31 (83.8) | 11 (55) | ||
| Where do you keep your dentures when it is not in your mouth? | ||||||
| In water | 15 (68.2) | 30 (76.9) | 24 (64.9) | 18 (90) | 10.955 | 0.073** |
| Wrapped in Cloth/Napkin | 2 (9.1) | 8 (20.5) | 6 (16.2) | 1 (5) | ||
| In bag | 5 (22.7) | 1 (2.6) | 7 (18.9) | 1 (5) | ||
| Do you take your denture out of your mouth to clean it? | ||||||
| Yes | 17 (77.3) | 32 (82.1) | 31 (83.8) | 13 (65) | 3.025 | 0.389** |
| No | 5 (22.7) | 7 (17.9) | 6 (16.2) | 7 (35) | ||
| What do you use to clean your dentures? | ||||||
| Baking soda | 1 (4.5) | 3 (7.7) | 2 (5.4) | 0 (0) | 26.568 | 0.325* |
| Toothpaste | 8 (36.4) | 13 (33.3) | 23 (62.2) | 11 (55) | ||
| Mouthwash | 6 (27.3) | 4 (10.3) | 6 (16.2) | 3 (15) | ||
| Bleach/Detergent | 7 (31.8) | 5 (12.8) | 5 (13.5) | 6 (30) | ||
| Only water | 3 (13.6) | 10 (25.6) | 6 (16.2) | 2 (10) | ||
| Soap | 9 (40.9) | 12 (30.8) | 11 (29.7) | 9 (45) | ||
| Denture cleaning tablet | 5 (22.7) | 8 (20.5) | 6 (16.2) | 3 (15) | ||
| Nothing | 1 (4.5) | 0 (0) | 3 (8.1) | 1 (5) | ||
| Where did you learn about denture care? | ||||||
| Verbal from dentist | 5 (22.7) | 22 (56.4) | 19 (51.4) | 9 (45) | 15.366 | 0.222* |
| Letter from dentist | 6 (27.3) | 4 (10.3) | 5 (13.5) | 4 (20) | ||
| From a non-dentist source | 4 (18.2) | 8 (20.5) | 8 (21.6) | 6 (30) | ||
| No information given | 8 (36.4) | 8 (20.5) | 6 (16.2) | 3 (15) | ||
| Have you ever experienced bad odor from your dentures? | ||||||
| Yes | 10 (45.5)a | 5 (12.8)b | 9 (24.3)ab | 7 (35)ab | 8.682 | 0.034* |
| No | 12 (54.5) | 34 (87.2) | 28 (75.7) | 13 (65) | ||
| Oral mucosal lesions | ||||||
| Traumatic Ulcer | 4 (25) | 11 (35.5) | 8 (28.6) | 4 (26.7) | ||
| Denture Stomatitis | 6 (37.5) | 6 (19.4) | 6 (21.4) | 4 (26.7) | ||
| Epulis Fissuratum | 3 (18.8) | 7 (22.6) | 5 (17.9) | 5 (33.3) | ||
| Unsupported Ridge | 3 (18.8) | 8 (25.8) | 6 (21.4) | 1 (6.7) | 10.438 | 0.917* |
| Angular Cheilitis | 1 (6.3) | 5 (16.1) | 4 (14.3) | 1 (6.7) | ||
| Oral Candidiasis | 0 (0) | 2 (6.5) | 2 (7.1) | 2 (13.3) | ||
| Denture hygiene level | ||||||
| Good | 4 (18.2)a | 13 (33.3)b | 11 (29.7)b | 20 (100)b | ||
| Fair | 0 (0)a | 17 (43.6)b | 26 (70.3)b | 0 (0)a | 229.495 | < 0.001** |
| Poor | 18 (81.8)a | 9 (23.1)b | 0 (0)c | 0 (0)c | ||
Significant values are in bold.
*Pearson Chi-Square Test; **Monte Carlo Corrected Fisher’s Exact Test; ~ Multiple Response; a-c: There is no difference between groups sharing the same letter.
The effect of participants’ smoking status on oral mucosal lesions was not statistically significant (p = 0.902). Similarly, the impact of smoking status on dental hygiene level was also not statistically significant (p = 0.447) (Table 7).
Table 7.
Examination of the relationship between smoking status, oral mucosal diseases, and denture hygiene levels.
| Smoking | Test Statistics | p | |||
|---|---|---|---|---|---|
| Not using | 1–14 per day | > 15 per day | |||
| Oral mucosal lesions | |||||
| Traumatic Ulcer | 17 (39.5) | 6 (18.8) | 4 (26.7) | 6.273 | 0.902* |
| Denture Stomatitis | 9 (20.9) | 8 (25) | 5 (33.3) | ||
| Epulis Fissuratum | 9 (20.9) | 7 (21.9) | 4 (26.7) | ||
| Unsupported Ridge | 7 (16.3) | 7 (21.9) | 4 (26.7) | ||
| Angular Cheilitis | 6 (14) | 3 (9.4) | 2 (13.3) | ||
| Oral Candidiasis | 3 (7) | 2 (6.3) | 1 (6.7) | ||
| Denture hygiene level | |||||
| Good | 29 (57.9) | 19 (42.1) | 0 (0) | 5.765 | 0.447** |
| Fair | 24 (60.5) | 11 (23.7) | 8 (15.8) | ||
| Poor | 12 (43.67) | 7 (42.25) | 8(14.08) | ||
*Pearson Chi-Square Test; **Fisher Freeman Halton Test.
Comparisons between the responses to the question “Do you take your dentures off at night?” and denture hygiene levels were found to be statistically significant (p < 0.01). Among the patients with good denture hygiene, 93.8% removed their dentures at night; meanwhile, among those with poor denture hygiene, 59.3% did not remove their dentures at night (Table 8).
Table 8.
Examining the relationship between taking their dentures off at night and the level of denture hygiene.
| Taking dentures off at night | Total | |||||
|---|---|---|---|---|---|---|
| Yes | None | Sometimes | ||||
| Denture hygiene level | Good | Count | 45 | 1 | 2 | 48 |
| % within | 93.8% | 2.1% | 4.2% | 100.0% | ||
| Fair | Count | 14 | 5 | 24 | 43 | |
| % within | 32.6% | 11.6% | 55.8% | 100.0% | ||
| Poor | Count | 8 | 16 | 3 | 27 | |
| % within | 29.6% | 59.3% | 11.1% | 100.0% | ||
| Total | Count | 67 | 22 | 29 | 118 | |
| % within | 56.8% | 18.6% | 24.6% | 100.0% | ||
Comparisons between experiencing bad odor from dentures and denture hygiene levels were found to be statistically significant (p < 0.01). While 95.8% of patients with good denture hygiene reported not experiencing bad denture odors, 96.3% of patients with poor denture hygiene reported experiencing such odors (Table 9).
Table 9.
Examining the relationship between experiencing bad denture odor and denture hygiene level.
| Bad denture odor | Total | ||||
|---|---|---|---|---|---|
| Yes | No | ||||
| Denture hygiene level | Good | Count | 2 | 46 | 48 |
| % within | 4.2% | 95.8% | 100.0% | ||
| Faır | Count | 14 | 29 | 43 | |
| % within | 32.6% | 67.4% | 100.0% | ||
| Poor | Count | 26 | 1 | 27 | |
| % within | 96.3% | 3.7% | 100.0% | ||
| Total | Count | 42 | 76 | 118 | |
| % within | 35.6% | 64.4% | 100.0% | ||
No statistically significant difference was found in comparisons made between oral mucosal lesions and denture hygiene levels (p > 0.05).
Discussion
This study aimed to evaluate attitudes and behaviors toward denture care, dental-visit-related habits, the frequency of oral mucosal lesions observed during clinical examinations, and denture hygiene levels among patients with complete dentures treated at a single university dentistry faculty. Moreover, this cross-sectional study investigated whether a significant relationship could be found between oral mucosal lesions, denture hygiene levels, and denture care attitudes. Many authors have reported in their studies that patients lack denture cleaning33,34.
Regular dentist visits can help in diagnosing diseases early and beginning appropriate treatments. Questions about dentist visit frequency, similar to those in many studies, revealed that patients do not comply with periodic dentist visits35,36, or visit dentists for check-ups when they have no complaints24. In the current study, the majority of patients did visit dentists for check-ups when they lacked complaints (44.9%). Dental fear affects a wide population and is observed in almost every individual. For this reason, there are possible reasons why patients in most of society do not acquire the habit of visiting the dentist, such as the cost of dental treatment and dental fear37. This problem may cause patients to postpone their appointments for dental treatments, attend check-ups irregularly, or not attend them at all38.
It has been stated that daily hygiene plays a fundamental role in preventing mucosal inflammation39. Moreover addressing deficiencies in denture care habits can play a significant role in potentially increasing dentures’ survival rates. The current study’s results show that the majority of patients clean their dentures daily (70.3%). In the studies of Marchini et al.40, de Castellucci Barbosa et al.41, and Nevalainen et al.42 it was observed that individuals cleaned their dentures daily, which is consistent with the current study. Grant et al.43 recommend that dentures should not be used at night or should be removed for a certain period during the day so that the supporting tissues can recover from the trauma caused by physical contact. In our study, the majority of individuals take their dentures off at night (56.8%). This result is consistent with similar studies’ findings40,41,44.
Garg et al.45 and Markovic et al.46 reported that wearing dentures at night is associated with denture stomatitis. In the current study, no significant relationship was found between sleeping with dentures at night and oral mucosal lesions. This difference in findings may have occurred because the majority of the patients had a good level of denture hygiene and therefore, they cleaned their dentures effectively. The etiology of oral mucosal diseases is multifactorial. Factors contributing to the prevalence of lesions include not only hygiene but also the quality of denture-fitting surfaces, occlusion relationships, and denture age47.
Denture adhesives are materials used to increase the retention and comfort of dentures48. On the other hand, it has also been stated that the prosthesis does not improve fit or chewing ability49. In this respect, while the use of adhesives may be beneficial in the process of getting used to the prosthesis, they may also cause an increase in the dependency of patients on adhesives. In addition, adhesives used in large amounts have the disadvantage of masking the incompatibility of the prosthesis41. In the current study, it was reported that the adhesive use rate of individuals was very low (25.4%).
According to guidelines provided by the American College of Prosthodontists in 2011, it is recommended that dentures be stored in water after cleaning and when not in use50. In our study, the majority of the participants store their dentures in water when not in the mouth (73.72%). In a study by Algabri et al.22 which is consistent with the findings of the current study, the majority of the participants store their dentures when not in use inside a container with water.
In the current study, the preferred cleaning methods include mechanical approaches such as using toothpaste and soap (50%). This result is consistent with the studies by Ogunrinde et al.36 and Takamiya et al.51 Similarly the findings of a study by Gümüşok et al.24, this study found that immersing dentures in chemical solutions were preferred less than manual brushing techniques (denture cleaning tablet: 11.45%; mouthwash: 9.89%). Mechanical methods are often preferred because most people use toothbrushes and toothpaste during dental cleaning52, so they continue this habit even if they lose their teeth. Interestingly, cleaning agents such as bleach or detergent are reportedly used at a significant rate in denture cleaning (11.9%). It is very important to take the necessary steps to eliminate this wrong habit.
On the other hand, no significant difference was found between denture care methods and denture hygiene levels in the current study. This result is thought to be due not only to the agents used in brushing to remove plaque from denture surfaces but also to the fact that cleaning times and effectiveness differ among patients. Additionally, as Shay et al.53 stated in their study, although denture brushing is recommended for daily cleaning, brushing is reported to be insufficient to ensure denture disinfection.
Once denture arrangements have been completed and appropriate denture care instructions have been given, it is important to provide information on future care to support long-term oral health54. One reason for poor denture hygiene may be that patients are not adequately informed by their dentists55. Both verbal and written instructions have been reported to be effective for patient education, and it is recommended that a written copy of this information be provided to patients56. In the current study, 44% of the participants stated that they received verbal information about denture care from their dentists, while 15.2% received written information. This finding of our study is consistent with the study of Ferruzzi et al.57 In the study in question, it was stated that information about denture care was largely provided verbally by dentists (70%).
This study revealed that incorrect care habits and incomplete information are common among complete denture users. The fact that a large portion of the participants only consulted the dentist in case of complaints, that they slept with their dentures at night, and that inappropriate cleaning methods (e.g., using bleach) were used for denture hygiene indicate that there are significant deficiencies in denture care habits. In addition, the significantly higher rate of bad odor coming from dentures in patients with poor denture hygiene and the habit of not removing their dentures at night emphasize the negative effects of poor hygiene on oral health. These findings highlight the importance of awareness programs and encouraging regular dental check-ups among individuals using dentures. Improvements in public health policies and regular training provided by dentists can aim to improve denture care and improve oral health outcomes. It may be beneficial to inform patients about the importance of regular dentist visits through public service announcements on television and digital platforms (internet, social media, etc.), even if they do not have complaints.
Limitations of the study include the inability to fully control for potential confounding factors such as diet, general health status, and other oral hygiene habits. The fact that the study was conducted at a single university center may limit the generalizability of the results. The study included only patients with complete dentures; therefore, variables such as the number and location of missing teeth were excluded from the evaluation. Since not all of the dentures included in the study were manufactured by our research team, detailed information on denture dimensions, instructions given during denture delivery, and whether they had regular check-ups or received specific treatment was not available. Considering these limitations, prospective studies with larger participant groups, multicenter studies, and more comprehensive control of potential confounding factors (e.g. diet, general health status, oral hygiene habits, instructions given to patients during denture delivery, and denture-related problems such as pain or mobility) are needed. In addition, studies evaluating the effects of denture dimensions, number of missing teeth, and instructions given during denture delivery may contribute significantly to better understanding the experiences of denture users.
Conclusions
It was determined that most patients only consulted the dentist in case of complaints and acquired inappropriate habits such as sleeping with their dentures at night. The use of harmful cleaning agents such as bleach and the fact that toothpaste is the most frequently preferred cleaning method despite its abrasive properties are noteworthy results. In addition, it was observed that a large portion of the participants did not have sufficient information about denture care. The findings emphasize that appropriate habits regarding denture hygiene should be encouraged. In this context, targeted training programs should be developed to promote the importance of regular dentist visits and correct cleaning methods.
Author contributions
Study design: B.T. and N.U. Experimental and data analysis: B.T. Drafed the manuscript: B.T. and N.U. Reviewed the manuscript: B.T. and N.U. All authors have contributed signifcantly and are in agreement with this article.
Data availability
The data will be made available by the corresponding author upon reasonable request.
Declarations
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data will be made available by the corresponding author upon reasonable request.