Denture hygiene awareness, attitude and practice among complete denture wearers during COVID-19 lockdown Pandemic: A questionnaire based survey.

OBJECTIVE: To determine the denture hygiene habits in complete denture wearers during Covid-19 lockdown in Assam state.
MATERIALS AND METHODS: In this study, a self-administered structured questionnaire was developed to know the attitude of the patients regarding denture hygiene. The study sample consisted of 150 subjects, which included 63 (42%) males and 87 (58%) females.
RESULTS: 50.7% of individuals said that they have knowledge about denture cleansing methods, while only 40% individuals clean their dentures once daily. After education through an online survey, most individuals started practicing three times or at least two times. After educating two members in the same family, all subjects were cleaning either twice or thrice. All subjects were either using brushing or combination methods.
CONCLUSION: Poor condition of complete dentures seen in the population is mainly due to lack of knowledge and irregular cleansing habits. Dentists must give proper instructions and do regular follow-up regarding maintenance of denture hygiene. Copyright:

INTRODUCTION

The loss of natural teeth is a common health problem and various attempts have been made to replace the lost dentition with artificial teeth (prosthesis) that can fulfill the functional and esthetic requirements of the patients. However, the awareness and knowledge about proper hygiene and maintenance of dentures is still lacking to the general population of our Assam state and we, dental professionals, owe a huge responsibility toward spreading it to the community and nationwide. For any professional community, it is important to assess whether the patient understands and executes the hygiene protocol in their daily regime.

Removable dentures are often aggregated with dental plaque which exhibits bacterial growth in tiny pores of the dentures leading to foul odour, un-aesthetic appearance, denture stomatitis and finally may result in denture fracture.[1] Research has shown micro-organism associated with unhygienic dentures can even lead to various systemic ailments like endocarditis and diabetes.[2] Hence regular denture hygiene practice is recommended throughout life not only for function and esthetic purpose but for the wellbeing of the surrounding periodontal status.[34] Public health awareness programmes should be conducted for patient awareness towards denture hygiene.[5]

The purpose of this study was to evaluate the differences in denture hygiene knowledge and practice among different age, gender, level of education as similar studies has not been performed previously in the population of Assam.

MATERIALS AND METHODS

A descriptive, cross-sectional survey was conducted in complete denture wearers visiting the outpatient department (OPD) of Government Dental College and various private clinics of Assam, India. The study was approved by an institutional ethical committee. The subjects enrolled in the study were explained the nature and procedure of the study and informed consent was obtained.

A self-administered questionnaire consisting of 19 closed ended questions including an educational poster was designed to gather the demographic information (level of education) and assess the level of awareness, attitude and practice towards denture hygiene. The questions were related to denture storage medium, nocturnal denture wearing habits, and denture hygiene practices. A sample size of 150 subjects was taken by consecutive sampling method. The questionnaire validation was done after performing pilot study on 10 subjects. This study included male and female subjects of age group 45-85 years wearing complete denture prosthesis.

Due to COVID-19 pandemic, it was not possible to recall patients in dental clinics and college so it was decided to conduct online survey and the participants were asked to fill the questionnaire through Google form, keeping the words simple to ease in understanding. After evaluating the survey form, a video conference meet was organised to educate and motivate them through a good YouTube video having 20 subjects per meet. After one month of motivation through Google meet, a second round of online survey with the same questionnaire was conducted and the result was evaluated. Those whose denture hygiene practice had still not improved. They were educated separately with a family member again through Google meet followed by a third round of online questionnaire after a month only on those subjects and the result was analysed.

RESULTS

A total of 150 individuals were approached for participation in our survey, out of which 63 (42%) were males and 87 (58%) were females. Education wise, 62 (41.3%) subjects were either uneducated or educated below high school, 40 (26.7%) were graduate, and 48 (32%) were postgraduate [Table 1].

Table 1

Demographic distribution according to gender and education level

Education level	Male	Female	Total (%)
No education	11	51	62 (41.3)
Under graduate	17	23	40 (26.7)
Graduate or above	35	13	48 (32)
Total (%)	63 (42)	87 (58)	150

Regarding denture hygiene practice, 18.7% of males and 20% of females store their dentures in normal water, while the rest of the subjects in open air or wrapped in cloth or plastic bags. 31.3% slept with dentures in mouth, 12.7% of individuals did not clean their dentures even once daily. 58% of subjects never used mouthwash [Table 2a].

Table 2a

Effect of gender on denture hygiene practices

Questions	Options	Gender		Total 150 (%)
		Male 63 (42%)	Female 87 (58%)
Storage of denture after removing from mouth	Normal water	28 (18.7)	30 (20)	58 (38.7)
	Wrapped in cloth, plastic bag, or open air	35 (23.3)	57 (38)	92 (61.3)
Removal of dentures while sleeping	Yes	48 (32)	55 (36.7)	103 (68.7)
	No	15 (10)	32 (21.3)	47 (31.3)
Frequency of denture cleansing per day	Once daily	47 (31.3)	13 (8.7)	60 (40)
	Twice daily	25 (16.7)	23 (15.3)	48 (32)
	Three times daily	5 (3.3)	18 (12)	23 (15.3)
	None	11 (7.3)	8 (5.3)	19 (12.7)
Methods of cleaning	Brushing only	24 (16)	54 (36)	78 (52)
	Soaking in denture cleansers only	12 (8)	5 (3.3)	17 (11.3)
	Combination	23 (15.3)	22 (14.7)	45 (30)
	Others	4 (2.7)	6 (4)	10 (6.7)
Use of mouthwash to clean denture	Yes	26 (17.3)	37 (24.7)	63 (42)
	No	37 (24.7)	50 (33.3)	87 (58)

52% of individuals experienced bad smell from their denture, 50.7% of individuals told that they have knowledge about denture cleansing methods, 12.7% of individuals did not know about any consequence [Table 2b].

Table 2b

Knowledge regarding denture hygiene according to gender

Questions	Options	Male 63 (%)	Female 87 (%)	Total 150 (%)
Ever experienced bad smell from dentures	Yes	56 (37.3)	22 (14.7)	78 (52)
	No	7 (4.7)	65 (43.3)	72 (48)
Knowledge about denture cleansing methods	Yes	37 (24.7)	39 (26)	76 (50.7)
	No	26 (17.33)	48 (32)	74 (49.3)
Consequence of improper denture cleaning	Bad smell	13 (8.7)	28 (18.7)	41 (27.3)
	Denture can crack	2 (1.3)	1 (0.7)	3 (2)
	Mouth infection	7 (4.7)	8 (5.3)	15 (10)
	All	41 (27.3)	42 (28)	83 (55.3)
	Nothing	10 (6.7)	9 (6)	19 (12.7)

After this survey (66%) were willing to clean dentures daily, and 31.3% evaluated as unsatisfactory [Table 2c].

Table 2c

Review of a patient after knowledge given by this survey on denture hygiene practice

Questions	Options	Gender		Total (%)
		Male (%)	Female (%)
Willing to clean dentures daily	Yes, definitely	43 (28.7)	56 (37.3)	99 (66)
	May be if I get time	11 (7.3)	7 (4.7)	18 (12)
	Not satisfied	9 (6)	24 (16)	33 (22)
Self- denture evaluation	Excellent	4 (2.7)	10 (6.7)	14 (9.3)
	Good	30 (20)	24 (16)	54 (36)
	Average	20 (13)	15 (10)	35 (23.3)
	Unsatisfactory	9 (6)	38 (25.3)	47 (31.3)

After educating through Google meet, 78.7% started keeping their denture in water, while all individuals started removing dentures during sleeping. Most subjects started denture cleaning two to three times daily, 21.3% were still cleaning it only once. 39.3% subjects were now cleaning with tooth brush and water, 60.7% were using combination method and 92.7% were now willing to clean dentures daily [Table 3a and b].

Table 3a

Effect of gender on denture hygiene practices 1 month after educating online through Google Meet

Questions	Options	Gender
		Male 63 (42%)	Female 87 (58%)	Total 150 (%)
Storage of denture after removing from mouth	Normal water	32 (21.3)	86 (57.3)	118 (78.7)
	Wrapped in cloth, plastic bag, or in open air	31 (20.7)	1 (0.7)	32 (21.3)
Frequency of denture cleansing per day	Once daily	13 (8.7)	0	13 (8.7)
	Twice daily	45 (30)	9 (6)	54 (36)
	Three times daily	5 (3.3)	78 (52)	83 (55.3)
	None	0	0	0
Methods of cleaning	Brushing only	38 (25.3)	21 (14)	59 (39.3)
	Soaking in denture cleansers only	0	0	0
	Combination	25 (16.7)	66 (44)	91 (60.7)
	Others	0	0	0
Use of mouthwash to clean denture	Yes	28 (18.7)	76 (50.7)	104 (69.3)
	No	35 (23.3)	11 (7.3)	46 (30.7)

Table 3b

Review of a patient after knowledge given by this survey, on denture hygiene practice after educating online through Google Meet

Question	Options	Gender		Total (%)
		Male (%)	Female (%)
Willing to clean dentures daily	Yes, definitely	54 (36)	85 (56.7)	139 (92.7)
	May be if I get time	9 (6)	2 (1.3)	11 (7.3)

After educating two members in the same family, all subjects were cleaning either twice or thrice. All subjects were either using brushing or combination methods. Most of the subjects were using mouthwash now [Table 4].

Table 4

Effect of gender on denture hygiene practices 1 month after educating two members of same family including one female

Questions	Options	Gender		Total 67 (%)
		Male 58 (%)	Female 9 (%)
Frequency of denture cleansing per day	Once daily	0	0	0
	Twice daily	12 (17.9)	1 (1.5)	13 (19.4)
	Three times daily	46 (68.7)	8 (11.9)	54 (80.6)
Methods of cleaning	Brushing only	32 (47.8)	8 (11.9)	40 (59.7)
	Soaking in denture cleansers only	0	0	0
	Combination	26 (38.9)	1 (1.5)	27 (40.3)
Use of mouthwash to clean denture	Yes	49 (73.1)	1 (1.5)	50 (74.6)
	No	9 (13.4)	8 (11.9)	17 (25.4)

DISCUSSION

It has also been observed that the majority of denture wearers do not pay the necessary attention toward the denture hygiene. This may be due to the denture wearer's negligence or lack of dentist to provide denture-cleaning instructions.[36]

According to Shankar et al.[1] 64.8% subjects stored their dentures in normal water whereas 38.9% was found in this study. 31.3% subjects were wearing their dentures during sleep while Shankar et al.[1] and Baran and Nalçaci[7] reported 13.2% and 55.2%. This may be due to negligence in listening, understanding and following post denture delivery instructions.

40% subjects cleaned their dentures at least once daily which was in agreement with Apratim et al.[8] 44%, Ozcan et al.[9] 45.7% but was lower as compared to Aoun G and Gerges E.[2] 93.1% and Peracini et al.[10] 99.06%. In the present study 52% subjects used brushing their dentures with water only which was in congruence with Aoun G and Gerges E.[2] 45.4%, Dikbas et al.[6] 40.59%, Kulak-Ozkan et al.[11] 57.1% however Patel et al.[12] reported 100% and Ogunrinde and Opeodu[13] 90.9%. The high values of mechanical brushing techniques found in most studies reflects the consistent habit of brushing teeth prior to becoming edentulous. In the present study 30% used combination method which was in line with Aoun G and Gerges E.[2] 25.75%. In this study, 42% subjects used mouthwash for cleaning dentures while in Aoun G and Gerges E.[2] study, antiseptics were not used for denture immersion by any of their participants due to their high cost and un-esthetic brown stains on the acrylic resin [Table 2a].

52% of subjects experienced bad smell. In this study, 49.3% subjects don't have knowledge about denture cleansing methods while Shankar et al.[1] reported 10.2%, Dikbas et al.[6] 82.9%, Peracini et al.[10] 51.89%, Evren et al.[14] 82.9% Hoad Reddick et al.[15] 86.3% and Marchini et al.[16] 77.5%, of subjects were never advised denture cleaning methods by their dentist [Table 2b].

In the present study, 12% subjects were willing to clean dentures if they get time whereas 22% were not satisfied with the information provided through this survey [Table 2c].

After one month of Google meet, second round questionnaire survey result showed that 78.7% subjects started storing their denture in water. All subjects were removing their dentures while sleeping. Most of the subjects started denture hygiene practice two to three times daily using combination method and 92.7% were now willing to clean dentures daily. After reviewing this survey, a pattern was observed that female denture hygiene performance has increased more than Males [Table 3a and 3b].

After analysing the result, 67 subject's denture hygiene had still not improved, were educated again with a family member and after one month, a third round questionnaire survey was conducted only on them. As each participant was removing denture during sleep therefore, this question was omitted from this survey. As compared to individual education, if males are educated along with female family member, their denture cleaning practice improved tremendously. Now every subject was storing dentures in water and frequency of denture cleaning increased two to three times daily. The use of denture cleanser along with brushing and mouthwash also increased [Table 4].

The limitations of this study were small sample size due to inclusion of only those subjects having smart phones. Secondly, the knowledge and practice of denture hygiene could have been compared after the physical evaluation of their dentures. Participants purposely try to give expected answers during the survey is one of the major drawbacks of a questionnaire survey.

CONCLUSION

Further research is suggested for a thorough understanding of denture hygiene, attitude of denture wearers, and soft tissue changes. motivation through video conferencing has greater impact than questionnaire survey alone. In addition, when dual member of same family including one female are educated together, compliance is better. Dentist must spend time in providing post denture delivery hygiene instructions to each patient and recall visits should be done to evaluate denture status.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.