Oral health in the elderly population is an important determinant of general well-being, yet it remains a neglected aspect of geriatric care. With the increasing use of removable prostheses, denture-related oral mucosal lesions are among the most prevalent clinical conditions encountered in older adults [1]. The common denture-associated lesions include denture stomatitis, traumatic ulcers, epulis fissuratum, inflammatory papillary hyperplasia, and angular cheilitis [2]. These lesions often arise from chronic mechanical irritation, poor denture hygiene, nocturnal denture use, and ill-fitting prostheses [3]. Denture-related stomatitis (DRS) is the most common lesion, affecting 35–70% of complete denture wearers in various populations [4]. Candida albicans infection, in combination with mechanical trauma and salivary changes, plays a significant etiological role in DRS [5]. Other denture-induced lesions, such as fibrous hyperplasia and papillary hyperplasia, are strongly associated with the age of the denture, improper fabrication, and lack of regular recall visits [6]. Several epidemiological studies have reported wide variations in the prevalence of denture-related oral lesions across different populations. A study on 1,000 elderly denture wearers reported a prevalence of 36%, with denture stomatitis (19%) and traumatic ulcers (11%) being the most common [7]. In another clinical series from Saudi Arabia, 20.5% of elderly patients presented with denture-related lesions, with fibrous hyperplasia (41.9%) being the most frequent [8]. In Indian populations, studies have reported an overall prevalence of oral mucosal lesions of around 50%, with denture stomatitis accounting for approximately 9% [9]. The etiology of these lesions is multifactorial. Local predisposing factors include continuous denture wear, poor hygiene, xerostomia, and ill-fitting dentures, whereas systemic factors such as diabetes, immunosuppression, and age-related mucosal atrophy further contribute to their occurrence [3,6]. Importantly, many of these risk factors are preventable or modifiable through patient education, prosthesis adjustment, and regular clinical follow-up [10]. With the demographic transition and rising proportion of elderly individuals in India and globally, the burden of denture-related mucosal lesions is expected to increase. Understanding the prevalence and characteristics of these lesions in local populations is crucial for prevention, early diagnosis, and management. Against this background, the present retrospective study was undertaken to assess the prevalence and distribution of denture-related oral mucosal lesions among elderly denture wearers attending a tertiary dental care center.

This retrospective observational study was carried out in the Department of Prosthodontics,, after receiving clearance from the Institutional Ethical Committee. The primary objective was to assess the prevalence and distribution of denture-related oral lesions among elderly patients. The study covered a period of five years. Study Population The study population consisted of elderly individuals aged 60 years and above who reported to the outpatient clinics and were wearing removable prostheses. Patients were included if they had been using complete or partial dentures for a minimum of six months and had complete demographic and clinical records available for review. Exclusion criteria included patients with a history of head and neck radiotherapy or chemotherapy, systemic diseases producing oral lesions not related to denture use, pre-existing malignant or potentially malignant conditions, and incomplete or illegible case records. Data Collection The medical records and case sheets of patients meeting the eligibility criteria were retrieved from the department archives. Data collected included demographic details such as age and gender, systemic medical history, and prosthesis-related variables. The type of prosthesis (complete denture or partial denture), arch involved, duration of denture use, and whether dentures were worn overnight were recorded. Information regarding denture hygiene practices, such as frequency and method of cleaning, was documented whenever available. Identification of Lesions Oral mucosal lesions associated with denture use were identified through clinical descriptions, diagnostic notes, and intraoral photographs available in the patient records. Lesions were categorized into denture stomatitis, traumatic ulcers, epulis fissuratum, angular cheilitis, and inflammatory papillary hyperplasia. The diagnostic process was validated by two examiners, one from prosthodontics and another from oral medicine, who independently reviewed the available data. Any discrepancies in diagnosis were resolved through mutual discussion to ensure accuracy and consistency in classification. Data Management All extracted data were systematically entered into a master sheet using Microsoft Excel. After cleaning and coding the data, it was exported for statistical analysis. Descriptive statistics, including frequency and percentage distribution, were calculated to summarize the prevalence of different denture-related lesions. Comparative analysis was conducted to assess associations between the prevalence of lesions and variables such as age group, gender, type of denture, duration of denture use, and overnight wearing habits. Chi-square test was applied for categorical variables, and a p-value of less than 0.05 was considered statistically significant. Ethical Considerations Patient confidentiality was maintained throughout the study by removing personal identifiers during data extraction. Only anonymized data were used for analysis. As this was a retrospective study based solely on record review, no patient interventions were performed, and informed consent was waived by the institutional ethics committee.

A total of 420 elderly denture wearers were included in the study after applying the inclusion and exclusion criteria. The mean age of the participants was 67.8 ± 6.2 years, with the majority belonging to the 60–69 years group. Females represented a slightly higher proportion of the study population compared to males. Distribution of Study Participants by Age and Gender Table 1 shows the demographic profile of the study participants. The majority (58.1%) were in the 60–69 years group, followed by 70–79 years (32.4%). Patients aged ≥80 years constituted 9.5% of the sample. Females accounted for 55.2% of the total sample. Table 1. Age and Gender Distribution of Study Participants Age group (years) Male (n=188) Female (n=232) Total (n=420) % of total 60–69 112 132 244 58.1% 70–79 61 75 136 32.4% ≥80 15 25 40 9.5% Prevalence of Denture-Related Oral Lesions Out of the total 420 participants, 154 patients (36.7%) exhibited at least one denture-related lesion. Denture stomatitis was the most common lesion (18.8%), followed by traumatic ulcer (7.6%), epulis fissuratum (4.8%), angular cheilitis (3.3%), and papillary hyperplasia (2.1%). Table 2. Distribution of Denture-Related Oral Lesions Lesion type Number of cases (n) Percentage (%) Denture stomatitis 79 18.8% Traumatic ulcer 32 7.6% Epulis fissuratum 20 4.8% Angular cheilitis 14 3.3% Papillary hyperplasia 9 2.1% Total 154 36.7% Association of Lesions with Type of Prosthesis Lesions were more frequent in complete denture wearers (42.1%) compared to partial denture wearers (28.4%). Denture stomatitis was significantly higher among complete denture users. Table 3. Association of Denture-Related Lesions with Prosthesis Type Type of denture Total patients (n) Patients with lesions (n) Prevalence (%) Complete dentures 245 103 42.1% Partial dentures 175 51 28.4% Total 420 154 36.7% Relationship Between Duration of Denture Use and Lesion Prevalence Patients using dentures for >10 years had the highest prevalence of lesions (54.7%), compared to those wearing dentures for 5–10 years (37.2%) and <5 years (22.8%). Table 4. Denture Lesions According to Duration of Denture Use Duration of denture use Total patients (n) Patients with lesions (n) Prevalence (%) <5 years 149 34 22.8% 5–10 years 177 66 37.2% >10 years 94 54 54.7% Total 420 154 36.7%

The present retrospective study investigated the prevalence and distribution of denture-related oral mucosal lesions among elderly denture wearers. The overall prevalence of lesions in this study was 36.7%, which falls within the broad range reported in literature (20–70%) [1]. This suggests that denture-related lesions remain a common clinical finding in geriatric populations, warranting attention from both clinicians and public health professionals. Comparison with Previous Studies The most common lesion observed in the present study was denture stomatitis (18.8%), followed by traumatic ulcers (7.6%), epulis fissuratum (4.8%), angular cheilitis (3.3%), and papillary hyperplasia (2.1%). Similar findings have been reported in international studies, where denture stomatitis accounts for the majority of denture-induced lesions [2]. A large survey in Brazil found denture stomatitis in 15–20% of elderly denture wearers, aligning closely with our results [3]. Studies in European populations have reported even higher rates, up to 35–40%, especially among patients who wore their dentures continuously without removal during sleep [4]. In contrast, a study conducted in Saudi Arabia found fibrous hyperplasia to be the most common lesion, accounting for nearly 42% of cases [5]. Differences between populations may be attributed to variations in prosthesis quality, patient awareness, hygiene practices, and clinical follow-up systems. In India, studies have reported a prevalence of denture-related lesions ranging from 25% to 45%, with denture stomatitis consistently being the most frequent diagnosis [6]. Our findings, therefore, reinforce the global trend while highlighting specific regional characteristics. Influence of Prosthesis Type This study found that complete denture wearers had a significantly higher prevalence of lesions (42.1%) compared to partial denture wearers (28.4%). The higher risk among complete denture wearers can be explained by the increased surface area of contact, greater potential for continuous microbial colonization, and longer wear periods [7]. Furthermore, complete dentures exert greater pressure on palatal and alveolar mucosa, predisposing to inflammatory conditions. Partial dentures, on the other hand, may induce localized trauma but often cover smaller mucosal areas. These observations align with earlier studies that also demonstrated a higher frequency of denture stomatitis in complete denture users [8]. Role of Duration of Denture Use An important finding was the strong association between longer duration of denture use and lesion prevalence. Patients using dentures for more than 10 years exhibited a lesion prevalence of 54.7%, compared to 22.8% among those with less than 5 years of use. This clearly highlights the impact of prosthesis aging, gradual loss of fit due to ridge resorption, and absence of timely relining or replacement [9]. Prolonged use of ill-fitting dentures leads to chronic irritation, which can manifest as stomatitis, hyperplasia, or ulceration. These results underscore the importance of regular recall visits and timely prosthesis replacement to prevent morbidity. Risk Factors and Pathogenesis The multifactorial etiology of denture-related lesions has been widely established. Mechanical trauma from ill-fitting dentures, continuous denture wear (especially during sleep), poor denture hygiene, and systemic conditions such as diabetes and xerostomia are key contributors [2,7]. In denture stomatitis, microbial colonization, particularly by Candida albicans, acts synergistically with mechanical factors to induce erythematous mucositis [3]. Traumatic ulcers and epulis fissuratum are directly linked to overextended borders and unpolished denture flanges, while angular cheilitis is often associated with reduced vertical dimension of occlusion and fungal superinfection [5]. The relatively low prevalence of papillary hyperplasia in this study (2.1%) may reflect differences in denture design and shorter duration of continuous use compared with populations where higher rates have been recorded [4]. Clinical and Public Health Implications The findings have significant clinical implications. First, the relatively high prevalence of lesions, particularly among complete denture wearers, underscores the need for periodic clinical examinations of elderly denture users. Routine check-ups would allow early detection and management of traumatic lesions, preventing progression to chronic hyperplastic changes or secondary infections. Second, patient education on denture hygiene practices and avoidance of nocturnal denture wearing should be emphasized as cost-effective preventive strategies [6]. Third, prosthesis maintenance through relining, rebasing, or timely replacement is essential to reduce chronic mucosal trauma. From a public health perspective, the increasing proportion of elderly individuals in India and globally means the burden of denture-related lesions will continue to rise [1]. Integrating oral health awareness programs into geriatric health care services could play a critical role in improving quality of life. Moreover, dental professionals must work collaboratively with geriatricians to manage systemic conditions such as diabetes and xerostomia, which exacerbate oral mucosal pathology [8]. Strengths and Limitations The strengths of this study include a relatively large sample size and a clear classification of lesions based on standardized diagnostic criteria. The retrospective design allowed for the evaluation of real-world clinical data without influencing patient behavior. However, certain limitations must be acknowledged. Being retrospective, the study relied on the accuracy and completeness of clinical records, and some risk factors such as denture hygiene methods or nocturnal wearing could not be consistently verified. In addition, microbiological confirmation of Candida colonization was not available, which could have provided more definitive insights into denture stomatitis cases. Finally, the study was conducted in a single institutional setting, which may limit generalizability. Future Directions Future studies should adopt a prospective design with standardized clinical and microbiological examinations to better establish causal associations. Multicentric studies across different regions of India would provide more comprehensive epidemiological data. Additionally, interventional studies assessing the impact of structured denture hygiene education and recall programs on lesion prevalence would be valuable [11-15].

In summary, this study demonstrated a prevalence of 36.7% for denture-related oral lesions among elderly denture wearers, with denture stomatitis being the most common lesion. Complete denture wearers and individuals with dentures older than 10 years were at significantly higher risk. These findings are consistent with global evidence and emphasize the need for regular clinical monitoring, patient education, and timely prosthesis maintenance to minimize the burden of denture-related mucosal lesions.

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