Tooth loss and prosthetic rehabilitation are integral issues in geriatric dentistry. With global aging, the prevalence of complete or partial edentulism remains significant [1]. Removable dentures remain the most common rehabilitation method due to affordability and accessibility [2]. However, prolonged use of dentures predisposes oral mucosa to mechanical, microbial, and chemical insults, leading to denture-related oral lesions (DROLs) [3].

DROLs include denture stomatitis, traumatic ulcers, angular cheilitis, inflammatory papillary hyperplasia, and epulis fissuratum [4]. Factors such as poor denture hygiene, continuous wearing, systemic diseases (e.g., diabetes), xerostomia, and ill-fitting prostheses contribute to lesion development [5].

Epidemiological studies worldwide report prevalence of DROLs ranging from 25–70% [6,7]. In India and other developing countries, lack of regular dental check-ups and delayed denture replacement further exacerbate the problem [8]. Early diagnosis and management are essential since chronic mucosal trauma may predispose to premalignant or malignant conditions [9].

The present study retrospectively analyzed five years of clinical records to evaluate the prevalence, types, and risk factors of DROLs among elderly denture wearers.

Study Design

This research was designed as a retrospective, cross-sectional observational study. The purpose was to determine the prevalence and associated risk factors of denture-related oral lesions (DROLs) among elderly patients. A retrospective design was chosen to utilize existing clinical records over a five-year period, allowing for an adequate sample size and reliable prevalence estimation.

Study Setting and Population

The study was conducted in the Department of Prosthodontics, at a tertiary referral center catering to a large geriatric population. Clinical records between January 2015 and December 2020 were screened. A total of 1,200 patient records that met the eligibility criteria were included. Patients aged 60 years and above who were wearing removable complete or partial dentures were considered for inclusion.

Inclusion and Exclusion Criteria

Inclusion criteria:

1. Patients aged 60 years and above.

2. Wearers of removable complete dentures or partial dentures.

3. Records containing complete clinical examination details and denture history.

Exclusion criteria:

1. Patients below 60 years of age.

2. Records of patients with oral mucosal lesions of non-denture origin, such as lichen planus, leukoplakia, or malignant lesions.

3. Patients with a history of maxillofacial trauma, surgery, or radiotherapy affecting the oral mucosa.

4. Incomplete or illegible case records.

Data Collection

All case records were retrieved from the departmental archives and systematically reviewed. Demographic data such as age, gender, and medical history were recorded. Detailed prosthetic history, including type of denture (complete or partial), duration of denture use, frequency of denture wearing, and denture hygiene status, was noted.

The oral mucosa was evaluated based on the clinical findings documented by the attending faculty and postgraduate students. Lesions were identified and classified according to the World Health Organization (WHO) guidelines for epidemiological studies of oral mucosal diseases [10]. The categories included denture stomatitis, traumatic ulcers, angular cheilitis, epulis fissuratum, and inflammatory papillary hyperplasia.

Ethical Considerations

Ethical clearance for the study was obtained from the Institutional Ethics Committee prior to commencement. Since the study was retrospective in nature, informed consent from patients was not required; however, strict confidentiality of patient data was maintained throughout.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including frequencies and percentages, were calculated to determine the prevalence of lesions. The Chi-square test was applied to compare categorical variables such as gender, age groups, and denture hygiene status. Logistic regression analysis was employed to evaluate potential risk factors associated with the presence of lesions, including denture hygiene, duration of denture use, frequency of wearing, and systemic conditions like diabetes mellitus. Statistical significance was set at p < 0.05.

Table 1 (Demographic Distribution):

Out of 1,200 elderly denture wearers included in this study, the majority belonged to the age group of 60–69 years (45.0%), followed by 70–79 years (35.0%), while those aged 80 years and above constituted the smallest proportion (20.0%). Gender distribution showed a higher number of female patients (57.5%) compared to males (42.5%). This indicates that denture usage is more prevalent among younger elderly and female subjects.

Table 2 (Prevalence of Denture-Related Oral Lesions):
A total of 502 cases of denture-related oral lesions were documented, yielding a prevalence of 41.8%. Denture stomatitis was the most frequent lesion (52.4%), followed by traumatic ulcers (26.8%) and angular cheilitis (12.6%). Less frequent lesions included epulis fissuratum (5.6%) and inflammatory papillary hyperplasia (2.6%). The findings indicate that inflammatory and traumatic lesions dominate the spectrum of denture-related mucosal pathology.

Table 3 (Risk Factors Associated with DROLs):
Logistic regression analysis revealed that poor denture hygiene (OR=2.34, p=0.001), continuous denture wearing for more than 20 hours per day (OR=1.89, p=0.004), and long-term denture use exceeding 10 years (OR=2.76, p=0.000) were significantly associated with DROLs. Although diabetes mellitus showed a higher prevalence among affected patients, the association did not reach statistical significance (p=0.072). This highlights behavioral and prosthesis-related factors as stronger determinants compared to systemic conditions.

Table 4 (Gender Distribution of DROLs):
Lesions were more frequent among females (46.3%) than males (35.7%), a difference that was statistically significant (p=0.021). This gender disparity may be attributed to longer life expectancy, greater denture dependency, and possible variations in hygiene practices among elderly women.

Table 1. Demographic Distribution of Study Population (n=1200)

Table 2. Prevalence of Denture-Related Oral Lesions

Table 3. Risk Factors Associated with DROLs

Table 4. Gender Distribution of DROLs

This study revealed a 41.8% prevalence of DROLs, consistent with international findings [11,12]. Denture stomatitis was the most common lesion, in agreement with studies from Brazil and Turkey [13,14]. Candida colonization, poor oral hygiene, and continuous denture use explain its predominance [15].

Traumatic ulcers were the second most common lesion, attributed to mechanical trauma from ill-fitting dentures [16]. Angular cheilitis was found in 12.6% of cases, often coexisting with stomatitis and linked to nutritional deficiencies [17].

Female predominance may reflect higher life expectancy and greater denture use among women [18]. Poor denture hygiene and long-term use were significant risk factors, corroborating previous reports [19]. Interestingly, diabetes did not show a significant association, although other studies suggest increased susceptibility [20-25].

Clinical implications: Dentists should emphasize regular denture maintenance, hygiene education, and periodic replacement (every 5–8 years). Elderly patients must be motivated for annual oral mucosal screening to prevent chronic trauma and potential malignant transformation.

This retrospective study highlights that denture-related oral lesions (DROLs) are a common problem among the elderly, with an overall prevalence of 41.8%. Denture stomatitis was the most frequently encountered lesion, followed by traumatic ulcers and angular cheilitis. The findings emphasize that poor denture hygiene, continuous denture wearing, and prolonged duration of use were the most significant risk factors, whereas systemic conditions such as diabetes showed weaker associations. The higher prevalence in females underscores the influence of demographic and behavioral factors. Given the chronic nature of these conditions, untreated mucosal trauma may predispose to secondary infections and, in rare cases, malignant transformation. Regular clinical follow-ups, timely replacement of dentures, reinforcement of hygiene practices, and patient education are essential preventive strategies. Incorporating routine screening of elderly denture wearers into community dental programs may significantly reduce the burden of DROLs, thereby improving overall oral health and quality of life in this population.

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