XEROSTOMIA IN COMPLETE

DENTURE WEARERS: PREVALENCE,

CLINICAL FINDINGS AND IMPACT ON
ORAL FUNCTIONS

Sahana.R
 INTRODUCTION
• Saliva plays an important role in the preservation and the maintenance of
oral health and function. Saliva is important in preparing food for
mastication, for swallowing and for normal taste perception.

• Diminished salivary output from the major and minor glands is called
“salivary hypofunction,” and the subjective complaint of a dry mouth is
termed “xerostomia.”

• Dehydration, medications, head and neck radiotherapy, diabetes mellitus

and other specific diseases such as Sjogren’s syndrome have been
suggested as the most common causes for a reduction in salivary flow
rate1,5,6 and have been associated with dental caries, candidiasis, dental
erosion and ulceration of mucosal tissues, dysgeusia, dysphagia, gingivitis,
halitosis and impaired use of removable prosthesis.
 AIM

• The aim of this study is to investigate the prevalence of dry mouth, its
association with age,gender,Clinical findings and its impact on oral
functions in a selected sample of edentulous elderly South indian
population.
 STUDY DESIGN

• The study includes 220 simple random sample aged 40 -80 yrs
 MATERIALS AND METHODS
• All participants underwent a thorough history and examination. The denture status
of the participants was classified into:

1. Maxillary and mandibular complete dentures (C/C).

2. Single complete denture in the maxillary arch (C/).
3. Single complete denture in the mandibular arch (/C).

• The study included questionnaire which recorded the socio-demographic data

including age, gender and the presence of medical conditions that have been
proposed in the literature to have an association with Xerostomia,Diagnosis of
xerostomia, drug history,habits and radiation therapy.

• Those who gave atleast one affirmative response were clinically examined to
confirm the diagnosis of xerostomia.

• It also included questionnaire to evaluate the patient’s satisfaction with their

dentures and complete denture functions. Furthur Objective evaluation of complete
denture was done under the criteria such as Retention and Stability
 An affirmative response to at least one of the following questions about
symptoms was considered in this study to be diagnostic of Xerostomia

• Does your mouth feel dry at night or on awakening? (YES/NO)

• Does your mouth feel dry at other times of the day? (YES/NO)
• Do you keep a glass of water by your bed? (YES/NO)
• Do you sip liquids to aid in swallowing dry foods? (YES/NO)
• Does your mouth feel dry when eating a meal? (YES/NO)
• Do you have difficulties swallowing any foods? (YES/NO)
• Do you chew gum daily to relieve oral dryness? (YES/NO)
• Do you use hard candies or mints daily to relieve oral dryness? (YES/NO)
• Does the amount of saliva in your mouth seem to be too little, too much, or
you don’t notice it. (YES/NO)

Fox PC, Busch KA, Baum BJ. Subjective reports of xerostomia and objective measures of salivary gland
performance. J Am Dent Assoc 1987; 115: 581–584.
 The clinical diagnosis of Xerostomia was based on clinical signs as follows
:
 
• Clinical examination revealed an erythematous pebbled oral mucosa or
cobblestoned or fissured tongue or atrophy of the filiform papillae.

• Light palpation of the oral mucosa resulted in the examiner’s finger

adhesion to the mucosal surfaces instead of readily sliding over the tissues.

• Delayed or lack of salivary flow from the duct orifices of the parotid and
submandibular glands after drying using cotton wool rolls, and the glands
could be subsequently milked.

Guggenheimer J, Moore PA.Xerostomia: etiology, recognition and treatment. JADA 2003; 134: 61–69.
 Satisfaction with complete denture function was evaluated by the
response to the following questions:

• Are you satisfied with your ability to chew?

a) Satisfied b) Fairly satisfied c) Dissatisfied
• Are you satisfied with your ability to speak clearly?
a) Satisfied b) Fairly satisfied c) Dissatisfied
• Are you satisfied with your ability to taste foods?
a) Satisfied b) Fairly satisfied c) Dissatisfied
• Can you chew apples, nuts, or hard rice crackers without difficulty?
a) Satisfied b) Fairly satisfied c) Dissatisfied
• The complete denture was evaluated under the following criteria such as
Stability, Retention.

• Professional based assessment of denture retention and stability was

carried out by following the CU (Chulalongkorn University ) modified
Kapur method and criteria.

• The applied force was calibrated with a digital luggage scale (GLUN
HOOKTYPE 50K DIGITAL) before each evaluation.
 Chulalongkorn University (CU)-modified Kapur  

RETENTION

• 3(good): Maximal resistance to vertical pulling and lateral

forces (>10 N for dislodgement)

• 2(moderate): Moderate resistance to 5 N vertical pulling and/ or

lateral force (5 to 10 N for dislodgement)

• 1 (minimum): Slight resistance to 2.5 N vertical pull and/ or lateral

force (2.5 to 5 N for dislodgement)

• 0 (No): Displaced itself when seated

 STABILITY

• 2 (sufficient): Slightly/no rocking or horizontal movement (1 to 2mm)

• 1 (some): Moderate rocking or horizontal movement (2 to 4 mm)

• 0 (no): Extreme visible rocking or horizontal movement (> 4 mm)

 
 STATISTICAL ANALYSIS

• Evaluations of distribution tables were followed by the chi-square test of

independence.

• Values of p < 0.05 were considered statistically significant.

 RESULTS

• Of the total 220 recruited participants,123 ( 55% ) were men and 97

( 45% ) were women aged between 40-80years.

• 150 participants (68%) had reported a subjective feeling of dry mouth

with a prevalence of ( 60% ) in men and (40%) in women . Upon clinical
examination, all 150 participants participants with fairly satisfactory
dentures showed one or more signs suggestive of Xerostomia.
Individuals who were completely satisfied with their chewing function were found to have good
retention and stability of their complete denture whereas those who were dissatisfied have poor
retention and stability.
Patients who were satisfied with their ability to speak are found to have good retention and stability of complete
denture whereas those who were dissatisfied have poor retention and stability.
Individuals who had satisfactory dentures had good retention whereas those who were dissatisfied had poor
retention
 DISCUSSION

• Edentulism and dry mouth are considered prominent problems in older adults that
have a considerable impact on their quality of life.

• This study, was based on a multiple-item questionnaire and detailed history and
clinical examination, provides data about the dry mouth condition of a selected
sample of an edentulous South Indian population .

• There have only been a few investigations of the relationships between the
perception of dry mouth and oral functions.

• Narhi reported that dry mouth was significantly associated with subjective
difficulties in speaking and tasting food.

• Foerster et al.indicated a significant relationship between dry mouth and self-

assessed chewing difficulty
• The results of the present investigation revealed a significant impact of subjective dry
mouth on oral functions in complete denture wearers.

• There are a host of treatments for dry mouth, although remedies usually are
palliative.

• Initial therapy begins with a thorough assessment of the underlying medical problems
and medications, in addition to assessment of the denture and the denture-bearing
mucosal surface.

• Close attention should be given to clinical and laboratory procedures aimed at

optimising denture retention and stability, and patients should be reviewed at regular
intervals to help prevent and problems associated with denture wear.

• Salivary substitutes, artificial saliva and salivary stimulants can be beneficial for the
denture-wearing patient in terms of helping with adhesion and cohesion and,
subsequently, prosthesis retention.

• During mealtime, greater intake of liquids, and of water in particular, is

recommended. Increasing the wetting of the prosthesis enhances retention and
stability during function, and this will aid in mastication and swallowing
 CLINICAL IMPLICATION

• This study includes both subjective and objective evaluation of xerostomia

and complete denture functions compared to other studies where only
subjective/questionnaire method was adopted.

• Xerostomic patients were moderately satisfied with their dentures in this

study compared to previous studies done in Japan,Turkey and Korea where
patients were completely dissatisfied.
 CONCLUSION

• It may be stated that dry mouth constitutes an important medical problem

for older adults in South india , and must be aware of the contributing
factors when investigating an older Dry mouth in complete denture
wearers patient suffering from such a symptom.

• In addition, prosthodontists should be able to diagnose a dry mouth

disorder in their older patients and manage the oral health care for these
patients to achieve acceptable levels of comfort and function