Oral Hygiene Status among Denture and Non-denture Wearers in a Tertiary Health Care Centre: An Analytical Cross-sectional Study

Introduction: Establishing good oral hygiene has been essential in achieving and maintaining overall physical and emotional well-being throughout life. With the use of dentures, it is believed to worsen the health of the oral cavity if not properly maintained. Objective: To compare the oral hygiene status among denture wearers and non-denture wearers. Methods: An analytical cross-sectional study was conducted from September to October 2023 in the outpatient department of the Dental Department in Dhulikhel. Convenience sampling method was used. A sample of 120 patients was divided into two groups: denture wearers and non-denture wearers. Data were collected and entered into the Microsoft excel and further analysis was done in the SPSS v20. Oral hygiene status, halitosis, and tongue coating were evaluated and compared between the groups. Results: The Simplified Oral Hygiene Index (OHI-S) scores were comparatively higher among denture wearers (3.09±0.92) as compared to non-denture wearers (2.47±0.82). The majority of the denture wearers 26 (43.3%) had poor oral hygiene status. Tongue Coating Index (TCI) scores were almost similar among both groups. The organoleptic score was higher among denture-wearer participants (1.35±0.51) as compared to the non-denture wearers (1.15±0.44). Conclusions: Wearing a denture has an impact on the oral hygiene status and halitosis of an individual. Post-denture delivery instructions and regular follow-ups are recommended to maintain proper oral health.


INTRODUCTION
Dentures allow patients to perform many functions like speech, mastication, and maintaining facial aesthetics.Studies have shown that bacterial growth starts on dentures within a few hours of insertion. 1ntures comprise of metallic components and acrylic resins, both of which are plaque retentive Dr. Swagat Kumar Mahanta, 1 Dr. Dilip Prajapati, 1 Dr. Kripa Gurung, 2 Dr. Rajmee Shrestha, 2 Dr. Smriti KC, 3 Dr.Arjun Hari Rijal, 4 Dr. Bhoj Raj Adhikari, 5 Dr. Simant Lamichhane 4 Since there is limited data present on this topic in Nepal, the present study aimed to compare the Oral hygiene status, halitosis scores, and tongue coating among denture wearers and non-denture wearers.Sample size was calculated based on the formula of mean difference:

METHODS
The notation for the formulae is:

DISCUSSION
The present study was conducted to assess denturewearing status and oral hygiene.It was observed that denture wearers had significantly poorer oral hygiene status as compared to non-denture wearers.
Research has shown that wearing dentures leads to increased plaque accumulation which in turn leads to poorer oral hygiene status. 1 The current findings are in accordance with the findings of Oremosu and Soroye. 6 reduce plaque accumulation and improve oral health, regular examinations must be done, and reinstructions and timely reinforcement should be done. 10gher plaque retention was observed in the present study among denture wearers (3.09+0.9)as compared to non-denture wearers (2.47±0.82)with higher oral hygiene index scores which measure debris and calculus.Similar results were found by Ryniewicz et al. 1 Studies have shown that regardless of patients' education levels and profession, they do not know the maintenance of oral hygiene while wearing dentures. 11Along with this, the proper construction of dentures is important since they consist of both acrylic and metallic components which act as plaqueretentive elements. 12e present study showed that halitosis was significantly higher among denture wearers

CONCLUSIONS
The presence of removable dentures leads to increased debris and calculus accumulation levels.
This in turn laed to increased OHI-S scores.Among the denture wearers, the majority fell in the fair and The present analytical cross-sectional study was conducted from September to October 2023 in the outpatient department (OPD) of the Department of Dentistry of Dhulikhel Hospital, Kathmandu University, School of Medical Sciences (KUSMS), Dhulikhel, Kavrepalanchok, Nepal.Ethical approval was obtained from the Institutional Review Committee -KUSMS (Ref.149/23).Convenience sampling technique was used.

Ratio of sample size was set at 1 : 1 .
The minimum sample size obtained was 36 per group which was rounded off to 60 per group.Hence, final sample size taken was 120 at 95% CI.Participants were informed about the study and written consent was obtained before the oral examination of the participants.Denture-wearing patients and other patients visiting the dental OPD who provided written consent were included in the study.Patients suffering from systemic conditions like Diabetes, Anaemia, and Hypertension, and those taking medications such as antihistamines, anti-depressants, long-term muscle relaxants which could lead to dryness of mouth, and increased plaque accumulation were excluded from the study.Various indices were used to check the oral health status.Oral Hygiene Index-Simplified (OHI-S, Greene and Vermilion 1964) 7 was used for the assessment of oral hygiene status.Tongue Coating Index (TCI, Miyazaki et al. 1995) 8 was used to evaluate the amount of tongue coating among study participants.Oral malodour was assessed using Organoleptic Intensity Scale (OLS Scale, Rosenberg et al.). 9The primary investigator was pre-trained on the indices by subject experts.Intra-examiner reliability was tested.The scoring for the indices was done as described by the respective authors.Data were collected and entered in Microsoft Excel sheet.The Statistical software (IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, N.Y., USA) was used for the analysis of the data.Descriptive statistics and unpaired t-test were used for the comparison of mean values among denture wearers and non-denture wearers.Chi-square test was used for the comparison of categorical variables.Statistical significance was set at P <0.05.

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35±0.51) as compared to non-denture wearers (1.15±0.44).These findings are consistent with the studies done by Costacurta et al., and Nalaci and Baran.2,14Wearing of dentures can lead to food stagnation and in turn lead to halitosis.This causes an increased gram-positive bacterial β-galactosidases activity that synergically works with gram-negative volatile sulfur compound production.12Increased halitosis and poorer oral hygiene may also be linked to the increased surface area of the dentures.The resin part of the dentures acts as a harbour for bacteria and fungi which could lead to halitosis.
Mahanta et al: Oral Hygiene Status among Denture and Non-denture Wearers in a Tertiary Health Care Centre: An Analytical Cross-sectional Study These differences were found to be statistically significant (P <0.05) (Table1).scale scoring as compared to non-denture wearers (1.15±0.44).Tongue coating was almost similar among both groups as demonstrated by TCI scores.

Table 1 :
Oral hygiene status among study participants.