RESTORATIVE STATUS AND PREVALENCE OF CARIES IN PATIENTS WITH REMOVABLE PARTIAL DENTURE
HTML Full TextRESTORATIVE STATUS AND PREVALENCE OF CARIES IN PATIENTS WITH REMOVABLE PARTIAL DENTURE
L. Sri Varsha * and S. Jayalakshmi
Saveetha Dental College, Velappanchavadi, Chennai - 600077, Tamil Nadu, India.
ABSTRACT: Aim: To study the status of restoration and prevalence of caries in patients witha removable partial denture. Materials and Method: Case sheets of 100 RPD (removable partial denture) patients were collected, and the prevalence of caries and restorative status were assessed from it. Results: From the 100 subjects, 36% of the RPD patients had caries. Based on the restorative status, 12 subjects did not undergo any restorative treatment, while the rest had undergone restoration. Conclusion: The prevalence of caries in patients with RPD was found to be higher than that of patients with a fixed partial denture (FPD). Therefore, alterations can be made in the design of RPD such that it will reduce the incidence of caries in RPD wearers. Awareness of oral hygiene should be given to patients with RPD.
Keywords: Caries, Biofilm, Restorative material, RPD patients
INTRODUCTION: Dental caries, otherwise known as tooth decay, is one of the most common chronic diseases worldwide. Dental caries forms through a complex interaction over time between acid-producing bacteria and fermentable carbohydrates, and many host factors, including teeth and saliva 1. A removable partial denture (RPD) is a denture for a partially edentulous patient who desires to have replacement teeth for functional or aesthetic reasons where conditions do not permit to give FPDs.
Indications of RPD: 2
-
- Reduced periodontal support of remaining teeth.
- Cross arch stabilization of teeth.
- Lengthy edentulous span.
- Lack of teeth to support as an abutment.Excessive alveolar bone loss.
The risk of caries in patients with RPD is much higher than in fixed partial denture patients 3, 4. Tomlin and Osborne (1961) reported carious lesions in teeth supporting RPDs and other teeth in the mouths of RPD patients 5. This study aims to observe the restorative status and prevalence of caries in patients wearing the removable partial denture.
FIG. 1: PREVALENCE OF CARIES IN RPD PATIENTS
TABLE 2: TYPES OF RESTORATIVE MATERIAL USED
Restorative materials | No. of restorations done |
LCR | 13 |
Amalgam | 10 |
GIC | 3 |
Inlay | 4 |
FIG. 2: RESTORATIVE STATUS OF RPD PATIENTS
From the case sheets collected, 36% of the RPD patients had caries, while the rest 64% of the RPD patients were free of caries (refer Table 1). When the restorative status of the patients was observed, it was found that 12 of the patients (out of 36) did not undergo any restoration. In the other 24 patients, there were 34% amalgam restorations, 45% LCR restorations, 10% GIC, and 11% inlay restorations. Fig. 1 and 2 show the presence of caries in RPD (removable partial denture) patients.
DISCUSSION: In this study, 36% of the RPD patients had dental caries, and 64% of RPD patients did not have dental caries. Carlsson et al., 6 (1961) analyzed periodontal health, tooth mobility, recession, tissue inflammation, and caries incidence in patients with RPDs (48 patients with a complete maxillary denture and a mandibular RPD class I) 15 months after placement. The authors observed a high prevalence of periodontal disease and caries, both in teeth supporting the RPD and other teeth. In a follow-up study, the authors 7 observed progressions of the disease, including tooth extraction and caries more strongly associated with RPD support teeth.
Rocha et al., 8, Mihalow, and Tinanoff 9 (2003) observed an increase in Streptococcus mutans in the saliva of RPD patients after prosthesis placement. This finding suggests that chemo-prophylactic strategies need to be established for patients receiving RPDs to control and reduce biofilm formation and caries development, and thereby help to maintain the patient’s oral health 10, 6. Rocha et al., 11 observed alterations in the caries index in RPD users with a higher caries index even in patients with a high level of cooperation and motivation for performing proper oral hygiene.
P. Tuominen and K. Ranta 12 (1988) found that 60.5% of single RPD patients had one or more carious teeth and 62.7% among patients wearing RPDs in both jaws. In another study, 11 S. mutans levels in saliva increased significantly 48 days after prosthesis placement, with levels above 106 UFC/mL of saliva.
The biofilm accumulation and carries index are influenced by the increase in hard surfaces in the mouth following the placement of an RPD. There is an increase in microorganism-retentive areas with the presence of an oral prosthesis, specifically the acrylic resin base and metal structure of the RPD. Further, the consumption of fermentable carbohydrates can lead to an increased caries incidence.
Using a diet diary, one study observed that RPD users had high sugar consumption in addition to what was consumed in meals, making it difficult to control biofilm accumulation by conventional methods 11. This is a particular concern in elderly patients, where the presence of gingival recession favors the development of root caries. The etiology of root caries is related to Lactobacillus species, and indeed, one study observed that Lactobacillus was present in high numbers in patients with RPDs 13. The situation will be aggravated if biofilm control is not effective, with reduction of the intraoral pH, placing the patient at risk for development of caries 14.
Prevention of Caries in RPD Patients:
- RPD design should be as simple as possible, without affecting the basic principles of retention, stability, and reciprocity, and causing problems due to mechanical inefficiency.
- Prevention must be incorporated into the patient’s daily routine. RPD users often have difficulty removing the biofilm, even under the supervision and after being instructed in the correct use of a toothbrush and dental floss. Thus, diet modifications should be made, and awareness about oral hygiene should be given.
- It is believed that the use of chlorhexidine gel, proposed by Maltz et al., 15 (1981), should be incorporated into the clinical protocol during RPD treatment. This gel is inexpensive, practical, and effective for caries reduction, and it can reduce biofilm accumulation.
Nevertheless, there are data showing the success of RPD treatment without chemical plaque control.
CONCLUSION: Based on the result of this study, we conclude that caries occurrence in patients after wearing removable partial dentures (RPD’S) is more than that in patients wearing a fixed prosthesis. This problem can be overcome by some technical improvements in the denture like better adaptation and prevention of increased biofilm formation. Traditionally, treatment planning for RPD has been based on biomechanical factors, with priority given to principles such as stability and retention. Nevertheless, RPD planning cannot be focused only on mechanical concerns because this will not guarantee a successful outcome. The RPD design should avoid food retention and biofilm formation.
Considering the strong association between the use of RPDs, biofilm accumulation, and caries, oral hygiene concerns must be incorporated into the treatment plan 16. Awareness on oral hygiene maintenance should be created among RPD patients. Periodic check-ups should be done by the dentist to check the fit ofa denture, health of the oral cavity and any occurrence of caries.
ACKNOWLEDGEMENT: Nil
CONFLICT OF INTEREST: Nil
REFERENCES:
-
- Selwitz RH, Ismail AI and Pitts NB: Dental caries. The Lancet 2007; 369(9555): 51-9.
- Wöstmann B, Budtz-Jørgensen E, Jepson N, Mushimoto E, Palmqvist S, Sofou A and Öwal B: Indications for removable partial dentures: a literature review. Inter Journal of Prosthodontics 2005; 18(2): 139-45.
- Reintsema H: Removable partial dentures in maxillo-facial prosthetics. Nederlands tijdschriftvoortandheelkunde 2009; 116(12): 677-85.
- Jorge JH, Quishida CC, Vergani CE, Machado AL, Pavarina AC and Giampaolo ET: Clinical evaluation of failures in removable partial dentures. Journal of Oral Science 2012; 54(4): 337-42.
- Budtz-Jørgensen E and Isidor F: A 5-year longitudinal study of cantilevered fixed partial dentures compared with removable partial dentures in a geriatric population. The Journal of Prosthetic Dentistry 1990; 64(1): 42-7.
- Tomlin HR: Cobalt-chromium partial dentures. A clinical survey. Br Dent J 1961; 111: 307-10.
- Carlsson GE, Hedegård B and Koivumaa KK: Studies in partial dental prosthesis. II An investigation of mandibular partial dentures with double extension saddles. Acta Odontologica Scandinavica 1961; 19(2): 215-37.
- Rocha EP, Francisco SB and Del Bel Cury AA: Longitudinal study of the influence of removable partial denture and chemical control on the levels of mutans in saliva. J Oral Rehabil 2003; 30: 131-138.
- Mihalow DM and Tinanoff N: The influence of removable partial dentures on the level of Streptococcus mutans in saliva. Journal of Prosthetic Dentistry 1988; 59(1): 49-51.
- Keltjens HM, Schaeken MJ, Van der Hoeven JS and Hendriks JC: Effects of chlorhexidine gel on periodontal health of abutment teeth in patients with over dentures. Clinical Oral Implants Research 1991; 2(2): 71-4.
- Bergman B, Olsson CO and Hugoson A: Periodontal and prosthetic conditions in patients treated with removable partial dentures and artificial crowns: a two-year longitudinal study. Acta Odontologicascandinavica 1971; 29(6): 621-38.
- Tuominen P, Ranta K and Paunio I: Wearing of removable partial dentures in relation to dental caries. Journal of Oral Rehabilitation 1988; 15(6): 515-20.
- Närhi TO, Ainamo A and Meurman JH: Mutans Streptococci and Lactobacilli in the elderly. European Journal of Oral Sciences 1994; 102(2): 97-102.
- Davenport JC, Basker RM, Heath JR, Ralph JP and Glantz PO: Prosthetics: Need and demand for treatment. British Dental Journal 2000; 189(7): 364.
- Maltz M, Zickert I, Krasse B. Effect of intensive treatment with chlorhexidine on number of Streptococcus mutans in saliva. European J of Oral Sciences 1981; 89(6): 445-9.
- Rocha EP, Luvizuto ER and Sabotto SF: Biofilm formation and caries incidence with removable partial dentures. Dentistry Today 2008; 27(12): 60-2.
How to cite this article:
Varsha LS and Jayalakshmi S: Restorative status and prevalence of caries in patients with removable partial denture. Int J Life Sci & Rev 2018; 4(9): 151-54. doi: 10.13040/IJPSR.0975-8232.IJLSR.4(9).151-54.
All © 2015 are reserved by International Journal of Life Sciences and Review. This Journal licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.