Assessment of the Effect of Complete Dentures on Respiratory Performance: A Spirometric Analysis.

BACKGROUND: Among the vital functions, respiration can be claimed to be one of the most important. A thorough understanding of the patient should be an important aspect a prosthodontist should dwell into so as to predispose patients to acknowledge the kind of prosthesis they require. Hence, the present study was conducted for assessing the effect of complete dentures on respiratory performance.
MATERIALS AND METHODS: Fifty patients with the presence of complete edentulous arch and who had a history of complete denture usage for at least 5 years were enrolled. All the spirometric procedures were performed by trained technicians. A diagnostic spirometer was employed for performing the spirometric test. Testing was carried out in the following steps: Stage 1: testing in the absence of denture, Stage 2: testing in the presence of both dentures, Stage 3: testing in the presence of maxillary denture only, and Stage 4: testing in the presence of mandibular dentures only. Forced vital capacity (FVC) value, peak expiratory flow (PEF) value, forced expiratory volume in 1 s (FEV1) value, and forced expiratory flow 25%-75% (FEF25-75) value were recorded with the spirometric test. Analysis of all the results was done by SPSS software.
RESULTS: The spirometric value of FVC, PEF, FEV1, and FEF25-75 in the absence of both maxillary and mandibular dentures (Stage 1) was found to be 3.18, 5.83, 2.44, and 2.80, respectively. The spirometric value of FVC, PEF, FEV1, and FEF25-75 in the presence of both maxillary and mandibular dentures (Stage 2) was found to be 3.09, 5.67, 2.41, and 2.67, respectively. While analyzing statistically, it was seen that there was a significant decrease in the value of spirometric variables in the presence of dentures.
CONCLUSION: Chronic denture wearer edentulous patients are subjected to the risk of development of spirometric alterations. Hence, these patients should be given timely instructions about the various respiratory exercise protocols. Copyright:

INTRODUCTION

Among the vital functions, respiration can be claimed to be one of the most important. It can be considered to be an exchange of air or gases between a living being and the outside atmosphere in order to fulfill the metabolic requirements of the body. In the course of this respiring process, the oral tissues and the prosthetic dentures are basically the first structures that come in contact with the air moving up the airways.[123]

Several variables can be attributed to the success of an artificial denture. Some of them may include technique sensitivity during procedures, the functional variables, the role of esthetics, the biological factors, and the psychological makeup of the patient. Psychology of the patient encompasses the readiness of the patient and his/her mental attitudes for artificial teeth, his/her trust and relationship with the dentist, his/her basic intellect and the ability to cope up with the usage of new dentures, and most importantly his/her inherent personality. A thorough understanding of the patient should be an important aspect a prosthodontist should dwell into so as to predispose patients to acknowledge the kind of prosthesis they require.[4567] Hence, the present study was conducted for assessing the effect of complete dentures on respiratory performance.

MATERIALS AND METHODS

The present study was planned with the aim of analyzing the effect of complete dentures on respiratory performance. Fifty patients with the presence of complete edentulous arch and who had a history of complete denture usage for at least 5 years were enrolled. Furthermore, only those patients were enrolled that were completely satisfied with their dentures. Asthmatic patients and patients with a history of any other respiratory illness were excluded from the present study. Patients were strictly instructed not to do any type of physical activity for a minimum of 3 to 4 h before the spirometric test. Complete demographic, clinical, and personal details of all the patients were recorded. Furthermore, a pro forma was made and the weight, height, and body mass index of all the patients were recorded. All the spirometric procedures were performed by trained technicians. A diagnostic spirometer was employed for performing the spirometric test. Testing was carried out in the following steps: Stage 1: testing in the absence of denture, Stage 2: testing in the presence of both dentures, Stage 3: testing in the presence of maxillary denture only, and Stage 4: testing in the presence of mandibular dentures only. Forced vital capacity (FVC) value, peak expiratory flow (PEF) value, forced expiratory volume in 1 s (FEV1) value, and FEF25–75 value were recorded with the spirometric test. Analysis of all the results was done by SPSS software SPSS software version 16.0 (IBM, Armonk, New York), followed by the assessment of level of significance with Chi-square test and Student's t-test.

RESULTS

In the present study, assessment of fifty patients with the presence of complete edentulous arch and who had a history of complete denture usage for at least 5 years was done. The mean age recorded among the patients of the present study was 59.1 years. Majority of the patients of the present study (70%) were male, whereas the remaining were female. The spirometric value of FVC, PEF, FEV1, and FEF25–75 in the absence of both maxillary and mandibular dentures (Stage 1) was found to be 3.18, 5.83, 2.44, and 2.80, respectively, as shown in Table 1. The spirometric value of FVC, PEF, FEV1, and FEF25–75 in the absence of both maxillary and mandibular dentures (Stage 1) was found to be 3.18, 5.83, 2.44, and 2.80, respectively. The spirometric value of FVC, PEF, FEV1, and FEF25–75 in the absence of both maxillary and mandibular dentures (Stage 1) was found to be 3.18, 5.83, 2.44, and 2.80, respectively. The spirometric value of FVC, PEF, FEV1, and FEF25–75 in the presence of both maxillary and mandibular dentures (Stage 2) was found to be 3.09, 5.67, 2.41, and 2.67, respectively. The spirometric value of FVC, PEF, FEV1, and FEF25–75 in the presence of maxillary denture only (Stage 3) was found to be 2.84, 5.58, 2.42, and 2.62, respectively. The spirometric value of FVC, PEF, FEV1, and FEF25–75 in the presence of maxillary denture only (Stage 4) was found to be 2.96, 5.51, 2.37, and 2.65, respectively. While analyzing statistically, it was seen that there was a significant decrease in the value of spirometric variables in the presence of dentures [Table 2].

Table 1

Spirometry values

Spirometric values	Mean value
Stage 1
FVC	3.18
PEF	5.83
FEV1	2.44
FEF25-75	2.80
Stage 2
FVC	3.09
PEF	5.67
FEV1	2.41
FEF25-75	2.67
Stage 3
FVC	2.84
PEF	5.58
FEV1	2.42
FEF25-75	2.62
Stage 4
FVC	2.96
PEF	5.51
FEV1	2.37
FEF25-75	2.65

FVC: Forced vital capacity, PEF: Peak expiratory flow, FEV1: Forced expiratory volume in 1 s, FEF25-75: Forced expiratory flow 25%-75%

Table 2

Comparison of spirometric values

Comparison	P
Stage 1 - FVC
Stage 2 - FVC	0.01*
Stage 3 - FVC	0.00*
Stage 4 - FVC	0.02*
Stage 1 - PEF
Stage 2 - PEF	0.11
Stage 3 - PEF	0.00*
Stage 4 - PEF	0.36
Stage 1 - FEV1
Stage 2 - FEV1	0.00*
Stage 3 - FEV1	0.01*
Stage 4 - FEV1	0.04*
Stage 1 - FEF25-75
Stage 2 - FEF25-75	0.03*
Stage 3 - FEF25-75	0.12
Stage 4 - FEF25-75	0.00*

*Significant. FVC: Forced vital capacity, PEF: Peak expiratory flow, FEV1: Forced expiratory volume in 1 s, FEF25-75: Forced expiratory flow 25%-75%

DISCUSSION

Development of a correct occlusal vertical dimension (OVD) is the most important factor in the fabrication of a new set of complete denture, which is in optimum harmony with the temporomandibular joint (TMJ) and masticatory apparatus of the patient. However, prolonged use of old dentures may inadvertently result in jaw shifting due to frictional abrasion of the denture teeth and also resorption of the residual alveolar ridge. Both these situations lead to a reduction in OVD. A reduced OVD can lead to poor esthetics and morphologic variations in the patients, such as over or underactivity of the muscles of mastication, variations in the masticatory forces, problems of TMJ, reduction in facial height, downward and forward rotations of the mandible, as well as appearance of pseudo-prognathism. All these can invariably influence the function, comfort, speech, and even the appearance of the patient.[678] Hence, the present study was conducted for assessing the effect of complete dentures on respiratory performance.

In the present study, the spirometric value of FVC, PEF, FEV1, and FEF25–75 in the absence of both maxillary and mandibular dentures (Stage 1) was found to be 3.18, 5.83, 2.44, and 2.80, respectively. The spirometric value of FVC, PEF, FEV1, and FEF25–75 in the absence of both maxillary and mandibular dentures (Stage 1) was found to be 3.18, 5.83, 2.44, and 2.80, respectively. The spirometric value of FVC, PEF, FEV1, and FEF25–75 in the presence of both maxillary and mandibular dentures (Stage 2) was found to be 3.09, 5.67, 2.41, and 2.67, respectively. The spirometric value of FVC, PEF, FEV1, and FEF25–75 in the presence of maxillary denture only (Stage 3) was found to be 2.84, 5.58, 2.42, and 2.62, respectively. Piskin et al. evaluated the effects of complete dentures on spirometric variables in patients without teeth. This study incorporated 46 edentulous patients wearing complete dentures. Respiratory functions of the patients were assessed by spirometric tests which were carried out in four separate oral conditions, namely without dentures, with dentures, lower denture only, and upper denture only. They concluded that undesirable changes may appear in the spirometric parameters as a result of complete dentures.[9]

In the present study, the spirometric value of FVC, PEF, FEV1, and FEF25–75 in the presence of maxillary denture only (Stage 4) was found to be 2.96, 5.51, 2.37, and 2.65, respectively. While analyzing statistically, it was seen that there was a significant decrease in the values of spirometric variables in the presence of dentures. Indrakumar et al. evaluated the effect that the complete dentures may have on the functioning of the respiratory system. The study evaluated the role of complete dentures in influencing the respiratory performance of the patient as measured by a spirometric assessment. A total of 100 patients were evaluated in this study. They concluded that that undesirable changes may appear in the spirometric parameters of respiratory functions as a result of complete dentures.[10] Iinuma et al. assessed the correlation between oral health behaviors and incident pneumonia in the geriatric population. They observed that denture wearers, specifically during night, were more likely to have tongue and denture plaque. They concluded that denture wearing during sleep is significantly correlated with incident pneumonia, highlighting the potential implications of oral hygiene programs for pneumonia prevention in the community.[6]

CONCLUSION

From the above results, the authors conclude that chronic denture wearer edentulous patients are subjected to the risk of development of spirometric alterations. Hence, these patients should be given timely instructions about the various respiratory exercise protocols.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.