Gender difference in prevalence and incidence of mucosal lesions associated with wearing removable dentures

Anirudh BVM1, Keerthi Sasanka L*2, Venkatesh K2, Nivethigaa B3 1Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 77, Tamil Nadu, India 2Department of Prosthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 77, Tamil Nadu, India 3Department of Orthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 77, Tamil Nadu, India


INTRODUCTION
Dentures are appliances which replace the lost natural tooth or teeth with arti icial teeth. Dentures, when used for a period of time, causes changes in the oral cavity, like lesions related to dentures such as denture stomatitis, traumatic ulcers, epulis issuratum etc. These lesions might be associated with systemic disease also (Márton et al., 2004;Kivovics, 2007;Ali et al., 2015). Studies showed that Diabetes is one of the risk factors for denture stomatitis and hyperplasia due to denture (Dundar and Kal, 2007). The prevalence of mucosa lesions is increased with an increase in an age where studies have proven it (Corbet et al., 1994). One of the causes of oral lesions due to dentures is not replacing old or wornout dentures (Moskona and Kaplan, 1992;Ashok et al., 2014). The prevalence of females being affected with oral lesions more than men is seen in a few studies as well as in the current study (Dorey et al., 1985;Firoozmand et al., 2006;da Silva et al., 2011). Previous literature suggested that defective dentures, improper cleaning techniques of denture cleaning affect the condition of denture which can induce the lesions (Budtz-Jorgensen, 1981;Peltola et al., 2008;Sesma et al., 1999;Jyothi et al., 2017).
Proper oral hygiene and health care has to be maintained for preventing these lesions (Selvan and Ganapathy, 2016;Subasree et al., 2016;Vijayalakshmi and Ganapathy, 2016;Basha et al., 2018). Denture stomatitis/ denture sore mouth is characterized by in lammatory changes and which is most frequently seen in the maxilla. Females are more prone to denture stomatitis (Love et al., 1967;Chrigström et al., 1970). Traumatic ulcers occur due to newly itted dentures, ill-itting dentures, overextend denture langes which frequently occur in the irst ive years  of denture use (Coelho et al., 2004). Angular cheilitis affects the angles of the mouth with an ulcerated appearance (Jones, 1976). Studies suggest that it's caused due to loss of vertical height (Moskona and Kaplan, 1992). Angular cheilitis is directly not caused by dentures, and it is not taken into consideration in this study. (Venugopalan et al., 2014;Ashok and Suvitha, 2016;Ganapathy, 2016;Ajay et al., 2017) Epulis issuratum is caused due to chronic irritation due to unstable denture, overextended denture langes. This study does not involve FPD and implant-supported denture Ranganathan et al., 2017;Kannan and Venugopalan, 2018;Duraisamy et al., 2019). The aim of this study is to ind out the gender difference in prevalence and incidence of mucosal lesions associated with wearing a removable denture.

MATERIALS AND METHODS
It is a retrospective cross-sectional study done under a university setting. Case records were collected and analyzed the data of 41000 patients between June 2019 and March 2020. A total of 249 cases were recorded with patients who had a removable denture. The case sheets were cross-veri ied.
The data is tabulated under parameters such as age, gender, type of lesion, size of the lesion, type of dentures. Data were then imported to spss for statistical analysis where descriptive statistics and chi-square test were done for further analysis.

RESULTS AND DISCUSSION
Total of 249 patients was recorded in which 55% were male, and 45% were female. Out of 249 patients, only 40% (n=100) had oral lesions in which 53% were females, and 47% were males Figure 1Table 1. In this study, The prevalence of females being more affected was seen, which is 53% (n=100). Some studies have also shown the same results (Dorey et al., 1985;Firoozmand et al., 2006;da Silva et al., 2011). It wasn't well understood, but it has been suggested that women tend to overuse dentures while not needed, such as during sleeping (Cutright, 1974).
The most affected age group in this study were 51-60 years (29%) and 61 to 70 years (29%) while the least affected was 31-40 years Figure 2Table 2. Several authors claim that with an increase in age, there is a decrease in the salivary low which makes them prone to these lesions (Canger et al., 2009;Filgueiras et al., 2016). In this study, Denture Stomatitis was the most commonly seen lesion, which is 83% out of 100 patients and 33.3% out of 249 patients Figure 3. Some studies showed a high prevalence of denture stomatitis such as 65%-463 students and low prevalence rate -3.3% out of 210 cases (Budtz-Jorgensen, 1974;Ali et al., 2015). This could be the fact that patients were maintaining oral hygiene properly recommended by the dentist.
Most prevalent type of denture used was TPD (52.2% -249 patients, 73% -100 patients) in which 67% cause denture stomatitis Figure 3Table 3. Most of the studies show that CD is one of the causes of   (Ali et al., 2015). This might be due to the fact that people in this region are not aware of proper oral hygiene maintenance. Maxilla was the most prevalent site of lesions (34.9% -249 patients, 87% -100 patients) Figure 4Table 4 due to denture stomatitis mostly affecting maxilla (Budtz-Jorgensen, 1974;Ariga et al., 2018). Chi-square test was done with the type of lesion present and with the type of denture used, P<0.05, which was statistically signi icant Figure 3. Another positive correlation was found between the type of lesion present and site of the lesion, P<0.05, which was statistically signi icant Figure 4. Figure 1 shows that the X-axis represents lesions present, and Y-axis represents the number of patients affected by lesions. Green color indicates females and blue indicates males. According to this graph, the prevalence of these lesions was similar in both the genders. (Pearson chi-square value-8.961, p-value-0.062, p.0.05 which is statistically not signi icant). Figure 2 shows that the X-axis represents lesions present, and Y-axis represents the number of patients affected by lesions. Blue color indicates 18-30 years, green indicates 31-40 years, black indicates 41-50 years, purple indicates 51-60 years, yellow indicates 61-70 years and red indicates 71 and above years. The igure explains that patients above 50 years had a higher prevalence, making them prone to these lesions, statistically not signi icant (Pearson chi-square value-24.103, p-value-0.238, p>0.05 which is statistically not signi icant). Figure 3 shows that the blue color indicates CD and green indicates TPD. The X-axis represents lesions present, and Y-axis represents the number of patients affected by lesions. Denture stomatitis was the most common lesion seen mostly in TPD users (Pearson chi-square value-42.629, pvalue-0, p<0.05, which is statistically signi icant). Figure 4 X-axis represents lesions present, and Yaxis represents the number of patients affected by lesions. Blue color indicates maxilla, green indicates mandible, black indicates both maxilla and mandible and purple indicates no lesion. This graph shows that maxilla had a high occurrence of the denture-related lesion which was mostly seen in cases of denture stomatitis (Pearson chi-square value-526.4, p-value-0,p<0.05 which is statistically signi icant). Short sample size, single centered study and absence of different ethnic populations were the limitations of this study. Studying for a larger population with different ethnic populations and making it a multi-centred study can be done in the future.

CONCLUSIONS
Within the limits of the study, Prevalence of mucosal lesions due to dentures was almost similar in both the genders. TPD users were most commonly affected with the denture-related lesions with denture stomatitis being the most common among the lesions associated with dentures. The prevalence of these lesions can be reduced by giving strict and proper instructions about the maintenance of dentures as well as oral hygiene.

Funding Support
The authors declare that they have no funding support for this study.