LETTER TO EDITOR
Year : 2014 | Volume
: 3 | Issue : 4 | Page : 285--286
Factors affecting denture acceptance in institutionalized elderly
Mallika S Shetty1, Ganesh Shenoy Panchaml2, K Kamalakanth Shenoy1,
1 Department of Prosthodontics, Yenepoya Dental College, Deralakatte, Mangalore, Karnataka, India
2 Department of Public Health Dentistry, Yenepoya Dental College, Deralakatte, Mangalore, Karnataka, India
Mallika S Shetty
Department of Prosthodontics, Yenepoya Dental College, Deralakatte, Mangalore, Karnataka
|How to cite this article:|
Shetty MS, Panchaml GS, Shenoy K K. Factors affecting denture acceptance in institutionalized elderly.Int J Health Allied Sci 2014;3:285-286
|How to cite this URL:|
Shetty MS, Panchaml GS, Shenoy K K. Factors affecting denture acceptance in institutionalized elderly. Int J Health Allied Sci [serial online] 2014 [cited 2020 Mar 29 ];3:285-286
Available from: http://www.ijhas.in/text.asp?2014/3/4/285/143078
Ageing is a normal life process. Age itself is not a contraindication for medical or dental treatment. Unfortunately, circumstances around elderly individuals make treatment more difficult to accept.
Oral diseases are progressive and cumulative. They compromise chewing and eating abilities, there by affecting the nutritional status in the elderly. Among the many diseases and disabilities that the elderly suffer from, diseases related to the oral cavity especially the loss of teeth in the elderly is a major concern. The problems found in them are due to a lack of treatment facilities, financial constraints, reduced mobility and lack of awareness toward treatment which exerts a negative impact on the quality of life of geriatric population.  Improvement in oral health in institutionalized elderly will make their later life productive and enjoyable.
There are several factors which affect the acceptance of dentures among institutionalized elderly and it is important to consider them before deciding the treatment.
Few studies have been conducted among institutionalized elderly and according to a study by Minakuchi et al.  50% of institutionalized elderly lacked dentures. The reason was related to the number of remaining teeth and to the disability of hand and oral functions.
According to Catovic et al.,  functionally dependent elderly patients correlate with poorer condition of the prostheses and greater need of prosthodontic treatment.
According to Zainab et al.  the common impacts reported by denture wearers and nondenture wearers were functional limitation, physical pain, psychological discomfort, and physical disability.
A study by Shenoy and Hegde  revealed that 88% of the total population in an old age home did not have any prosthesis. The low proportion may be due to the fact that older people underuse dental facilities.
During clinical examination of the elderly patient, the following systemic and local factors and conditions should be considered.
The systemic factors which affect the acceptance of dentures among institutionalized elderly are: 
Nutrition: The institutionalized elderly live under circumstances like isolation, inadequate facilities, and high prevalence to diseases thus predisposing them to malnutrition. It is essential for the geriatric patient to retain an interest in food as adequate nutrition plays a part in the health of the ageing oral tissues, which in turn influences the prognosis of any prosthetic treatmentDebilitating disease: The institutionalized elderly are disadvantaged physically and emotionally and may be described as handicapped, chronically ill and disabled. They have poor resistance to disease and cannot with stand the stresses of lifeNeurophysiological changes: It is unfortunate that the geriatric patient generally needs most of the necessary dental and medical services at an age when they are least able to tolerate. They tend to have poor motor coordination and weak muscles, thus adaptation to prosthetic treatment is achieved very slowlyPsychic changes: Psychologically the thought of impending medical and dental care or the experience itself can affect the mind and personality of an elderly. For institutionalized elderly it is more agonizing as they have to bear the psychological trauma of rejection from dear ones. They feel that their ambitions and hopes can never be attained and they resist change and become withdrawn, depressed and dependent.
Local factors which affect the acceptance of dentures are: 
Health of the oral mucosa: The oral mucosal lining becomes more susceptible to stress, pressure and disease as a result of thinning and loss of resiliency of the oral mucosa. When the tissue resistance becomes poor, they become more vulnerable to traumaQuantity and quality of saliva: Saliva act as a lubricant and as a chemical buffer to enhance the comfort and function of the mouth. Prolonged use of multiple medications for depression, sleep disorders, hypertension, heart problems and other problems encountered in old age results in regressive changes in the salivary glands causing decrease in the salivary flow. Decreased salivary flow results in dryness of the oral cavity referred to as xerostomia, which results in abnormal taste sensations, burning of the oral tissues and tongue, cracking of the lip. There is a higher risk of tooth decay and gum disease in people with dry mouth due to the lack of cleansing effect from the saliva. Disturbances to the quality or quantity of saliva affects the complete denture wearer as it plays a central role in retaining and stabilizing the denturesCondition of the alveolar ridge: The quality of the ridge decreases with age. Resorption of greater degree results in discomfort due to compression of nerve endings between sharp vertical bony projections and thin mucosal covering by a hard denture baseOral hygiene habits: Those individuals who are dependent on others usually have poor oral hygiene.
It is a challenging task to achieve patient satisfaction among institutionalized elderly as the acceptance of removable dentures is related to several factors such as their mental status, adaptive abilities, tolerance level, appropriate education and awareness regarding denture use and maintenance among the subjects and their caretakers. Prosthodontic management of the elderly patients requires constant sensitivity and an accurate diagnosis of systemic and local factors.
|1||Shenoy RP, Hegde V. Dental prosthetic status and prosthetic need of the institutionalized elderly living in geriatric homes in Mangalore: A pilot study. ISRN Dent 2011;2011:987126.|
|2||Minakuchi S, Takaoka S, Ito J, Shimoyama K, Uematsu H. Factors affecting denture use in some institutionalized elderly people. Spec Care Dentist 2006;26:101-5.|
|3||Catovic A, Bergman V, Catic A. Qualitative evaluation of elderly home residents′ fixed and removable prostheses in relation to the ADL index. J Dent 2003;31:3-8.|
|4||Zainab S, Ismail NM, Norbanee TH, Ismail AR. The prevalence of denture wearing and the impact on the oral health related quality of life among elderly in Kota Bharu, Kelantan. Arch Orofac Sci 2008;3:17-22.|
|5||George B. Geriatric considerations in prosthetic dentistry. In: Jain V, editor. Textbook of Complete Denture Prosthodontics. 1 st ed. New Delhi: CBS Publishers; 2006. p. 354.|