Клинички и параклинички наоди кај пациенти со тотални протези

Abstract

Introduction: A considerable number of complications are associated with complete denture wearing patients, some occuring immediately after fitting of the dentures, while others later on, following a time period of wearing them. Immediate complications may be corrected within a few weeks of wearing the dentures, in contrast to later complications that are more difficult to predict and treat. These complications mostly impact the long-term success of complete dentures. Most common group of complications include: denture stomatitis, xerostomia, traumatic ulcers and mucosal cysts. Denture stomatitis is an inflammatory condition of oral cavity occurring in complete denture wearing patients commonly related to the presence of Candida Albicans. Disruption of oral health and occurrence of yeast infections are assumed to progress over age. However, significantly higher rates and increased number of Candida spp. may be detected in the oral cavity of complete denture wearing patients in contrast to non-wearers. Complete denture wearing represents a consistent contributing factor to the oral health status of patients. This should be considered when planning and assessing oral health management in middle and older aged individuals. Salivary secretion in complete denture wearing patients influences both the quality and quantity of oral microbial flora. Objectives: The objective of this study was to determine the changes that occur in the oral environment of complete denture wearing individuals by following clinical findigs on the oral mucosa in close contact with removable complete dentures, microbiological findings, cytology findings, salivary flow and saliva quality characteristics. Material and method: To achieve set objectives, 30 patients (Investigated Group), removable complete denture wearers, were studied at the Department of Prosthetic Dentistry, University Dentistry Clinical Center of Kosovo, in Prishtina. Criteria for inclusion of the patients in the study were as follows: 1. Patients wearing dentures for at least one year. 2. The dentures were fabricated at the same laboratory (at the forementioned clinical center), from the same technician and under consistent conditions. 3. Patients older than 50 years of age. In addition, a control group of 30 patients older then 50 years of age was sampled, that did not wear removable complete dentures and did visit the University Dentistry Clinical Center of Kosovo, in Prishtina, for other reasons. History data were recorded for both experimental and control groups including: Medical and pharmacological history, duration of denture wearing (Investigated Group), subjective history related to the wearing of complete dentures. Special questionnires were developed to determine the rate of expression of xerostomia. In the study we used the questionnaire published by Carda. Hygiene practices were evaluated using a special questionnaire developed by Peracini et al. Clinical changes in the oral mucosa were evaluated with comprehensive extra/intra-oral examination with the emphasis on the presence of possible alterations in the oral mucosa in contact with the dentures. These examinations also included the Control Group. On the clinical aspect, all patients with prosthetic stomatitis were grouped according to Newton classification. Aiming to determine the influence of retention and stability of the dentures on the occurrence of oral changes in patients with complete dentures, these two parameters were also determined. In all patients, both Control and Investigated Groups, total non-stimulated and stimulated saliva was collected according to the recommendations of Nevzash for the duration of 10 minutes. Collecion of non-stimulated saliva was performed using the Spitting method. For measuring of the pH of saliva, we utilized an elecrometric method with the help of a pH-meter. Salivary biochemical analysis was performed using a biochemical analyzer INTEGRA 400 – Roche at the diagnostic center “Li-ori”, in Prishtina, namely: Salivary glucose – Enzymatic method with hexokinaze (mmol/l); Salivary urea – kinetic method with ureaze and glutamate hydrogenaze (mm0l/l); Total salivary protein – Biuret reaction (g/l); Albumin – modified brom crezole test (g/l); Calcium – Schwarzenbach method with o-kresolphtalein complex (mmol/l); sodium and potassium – ion selective electrode method with automatic dilution (mmol/l). In both groups, Investigated and Contol, swabs were taken for testing of possible presence of Candida. To isolate Candida spp., the samples were streaked in Saboraud medium at 35 degrees Celsius for the duration of 48 hours and the identification of Candida spp., was compared against its biochemical characteristics. Swabs were taken from oral mucosae in close contact with denture base with a plastic instrument excerting moderate force. Swabs were then streaked on a glass slab and fixed with 96% alcohol spray for 15 minutes and then sent for the pathology laboratory to be tested with Papanicolau testing. The number of total keratinized cells was compared to the total number of epithelial cells. The results were statistically processed using a computer program, Statistica for Windows 7. Results and discussion: Oral mucosal lesions are significantly present in patients with complete dentures. That is especially true for angular cheilitis and traumatic ulcer. In our patients with complete dentures, we recorded statistically significant higher representation of oral candida infection compared to patients with natural teeth. In the oral mucosa, in close contact with the base of the complete denture, higher expression of keratinization was found. In 34% of complete denture wearers we recorded xerostomia and in the control group only 22%. We recorded an association between xerostomia and denture wearing for p<0.05 (Pearson Chisquare: 9.60649, p=.022225). In complete denture wearing patients with diabetes as a single comorbidity, oral complications like xerostomia, prosthetic stomatitis and candida infections were recorded. During the course of our study, in patients that seldom or never brushed their dentures, a higher percentage of prosthetic stomatitis was found (59,4%), compared to patients that regularly cleaned their dentures (40,6%). However, there was no statistically significant difference. Prosthetic stomatitis, traumatic ulcer and angular cheilitis were significantly more present in patients with poor retention and stability of dentures. A unique positive association was recorded between the duration of denture wearing and oral complications, namely prosthetic stomatitis, p<0.05(Pearson Chi-square: 13.7188, p=.000212). Results analysis for all the salivary components that we determined in our patients showed that the quality composition of saliva was not significantly different between the groups. Conclusion: Most significant oral changes in complete denture wearers are prosthetic stomatitis, xerostomia and decreased salivary flow, candida infections, traumatic ulcer and angular cheilitis. Prosthetic stomatitis is frequently related to Candida albicans infection. In view of prosthetic stomatitis being the most common inflammatory reaction in complete denture wearers and the vast majority of cases being asymptomatic, frequent dental examinations in patients wearing complete dentures are recommended.