Introduction

Edentulism is defined as the loss of all the permanent teeth. This is due to a multi factorial process involving caries, periodontal health, trauma, oral cancer etc (The Journal of Prosthetic Dentistry, 2005). According to a report by the World Health Education in 2005, 26% of the inhabitants aged 65-69 years were completely edentulous (Petersen & Yamamoto, 2005). Maintenance of oral health and prevention of these oral diseases is associated with systemic health (Firoozmand, Almeida, & Cabral, 2001). It has been said that there is 1.82 times greater risk of having diabetes in edentulous patients than dentate patients (Felton, 2009).

Diabetes mellitus is associated with an imbalance in carbohydrate, protein and lipid levels and complications like retinopathy, nephropathy, neuropathy, macrovascular complications, impaired wound healing and periodontitis (Varon & Mack-Shipman, 2000; Vernillo, 2001). Patients who are completely edentulous often have complaints due to errors in denture fabrication or while recording impressions. Pre machined components and equipment generally tend to reduce the risk of mechanical complications (Ajay et al., 2017; Duraisamy et al., 2019). Patients complain of burning mouth sensation, dry lips, altered taste and denture stomatitis and ulceration (Moore, Guggenheimer, & Orchard, 2007). They have poor glycemic control because of the imbalance in insulin levels or absolute deficiency of insulin (Vitkov, Weitgasser, Hannig, Fuchs, & Krautgartner, 2003). There is a lack of adaptation and stability of the prosthesis because of the increase in the osteoclastic activity of bone tissue in the upper and lower jaw (Sennerby, Carlsson, Bergman, & Warfvinge, 1988). They are more at risk of osteoporosis and other bone related disorders as well (Klemetti, Collin, Forss, Markkanen, & Lassila, 1994). Aloe vera possesses moisturizing properties producing collagen and elastin fibres which allows regenerative changes to occur. It also helps in reducing inflammation (Subasree, Murthykumar, & Dhanraj, 2016). Apart from this, patients sometimes suffer with other systemic diseases along with diabetes mellitus.

Hypertension, asthma, hypothyroidism or hyperthyroidism, hematological disorders, immunological disorders are some systemic diseases which patients generally suffer from alongside diabetes mellitus (Heartwell, 1970; Selvan & Ganapathy, 2016; Vijayalakshmi & Ganapathy, 2016). Decrease in retention of the denture is due to lack of wettability, surface tension and muscular control (Ajay et al., 2017; Ashok, Nallaswamy, Begum, & Nesappan, 2014; Muddugangadhar, Sangur, Rudraprasad, Nandeeshwar, & Kumar, 2015). A very common sequel of complete denture wearers is the residual ridge resorption because of reduced blood supply and change in the functional stimulus of the bone tissue (Devaki, Manonmani, Balu, & Aravind, 2012). Furthermore, the prevalence of RRR is higher in women due to osteoporotic changes in the bone (Singhal et al., 2012). All these effects pave the way for poor oral hygiene, aesthetics with lack of stabilisation of occlusion and masticatory efficiency leading to failure of the complete denture. Other alternatives, like implants can be adopted as the scope for dental implants is increasing, and it overcomes major prosthetic complications. (Ganapathy, Kannan, & Venugopalan, 2017) Thus, it is very important to bring awareness (Ashok & Suvitha, 2016), acquire more knowledge and impart the same to the patients for proper maintenance of the denture and prevent complications which are systemically related.

The aim of the study was to assess the prevalence of diabetes mellitus along with age and gender analysis in complete denture patients. It is also to assess the susceptibility of other systemic diseases, along with diabetes mellitus among CD patients.

Materials and Methodology

Study Setting

This is a retrospective study regarding completely edentulous patients who have visited Saveetha Dental College and Hospitals in between June 2019- April 2020. The approval for this university setting study was obtained from the Institutional Ethics Board. The sample size for this study was 351 complete denture patients in which the sampling bias was minimised by verification with photographs. The study was reviewed by two reviewers and was cross-verified. Inclusion Criteria - Completely edentulous patients, patients with a complete denture. Exclusion Criteria- patients who weren't cooperative, incomplete record In the Record System.

Data Collection and Tabulation

The case records of 89,000 patients were retrieved and reviewed for the analysis. The data of these complete denture patients were analysed and tabulated. It included information/ parameters – Name of the patient, Age, Gender, diagnosis of Diabetes/ diabetes along with any other systemic diseases/ Non-Diabetic. The patients were grouped into 4 on the basis of age as - 30-45, 46-59, 60-75, above 75 years.

Statistical Analysis

After further verification of data by an external reviewer, it was imported to the SPSS software by IBM for statistical analysis. Percentages, mean, Standard deviation, frequency of parameters were employed in the analysis. Chi-square test was used to detect the significance between age, gender and diagnosis of diabetes/with other systemic disease. p-value less than 0.05 was considered to be statistically significant.

Results and Discussion

The data collected and imported to SPSS software was used for descriptive statistics. The total sample size of the patients was 351. Gender distribution revealed that 201 patients were male and 150 were females (Table 1). Out of total 351 complete denture patients, there were 93 patients who had diabetes mellitus out of which 18 patients suffered from diabetes along with other systemic diseases (Table 3). Maximum number of edentulous patients were seen in the age group 60-75 years (Table 2). Chi-square tests for association of age/gender with a diagnosis of diabetes showed no significance (p-value > 0.05)(Table 5; Table 4). It revealed that 48 were males and 45 were females and the most common age group was 60-75 among the people who had diabetes. The following are the tables and bar graphs.

Patients undergoing treatment for complete dentures always expect that comfort, function and esthetics will be restored. Harmonious appearance and efficiency are considered to be secondary when compared to comfort (Jain, Nallaswamy, & Ariga, 2019; Kannan & Venugopalan, 2018). The above results show association between certain parameters, its significant value and descriptive statistics showing frequency and percentages. It is observed that 26.5% of the complete denture patients gave a history of diabetes mellitus, as shown in Table 3. The proportion of patients who are completely edentulous are higher in men. This was in concordance with a study done previously (Samaila, Ajike, Ogunrinde, & Mohammed, 2013). Another study showed a contradicting result in men : women ratio of completely edentulous patients as 1:4 (Carr, Lucas, & Becker, 1993; Kotkin, 1985; Marcus, Joshi, Jones, & Morgano, 1996). The result of our study justifies and reasons out as men tend to lose their teeth more readily. This might be because of poor maintenance of oral hygiene, periodontal health, stress, habits like alcohol and smoking in males (Oliver & Tervonen, 1993; Palmer, 1988; Sakki, Knuuttila, Vimpari, & Hartikainen, 1995). Whereas, females are more conscious and concerned about their health and appearance. Removable prosthetic dentures are always prone to more plaque formation, which explains its need for high maintenance and care (Ganapathy, Sathyamoorthy, Ranganathan, & Murthykumar, 2016; Jyothi, Robin, Ganapathy, & Anandiselvaraj, 2017).

Figure 1 Grey colour denotes Male and Yellow denotes females. The graph shows that the prevalence of Male (57.3%) is more than Female (42.7%). X-axis denotes gender and Y-axis denotes the frequency of CD patients. Figure 2 Pink colour denotes patients in the age group 30-45 years, mustard colour denotes 46-59 years, light green colour denotes 60-75 years and orange colour denotes patients above 75 years of age group. The 60-75 years age group shows the highest prevalence of complete denture patients (53.8%) and least is 30-45 years and above 75 years age group (6%). X-axis denotes the Age (years) and Y-axis denotes the frequency of CD patients. Figure 3 Blue colour denotes non-diabetic patients, red colour denotes diabetic patients and dark green colour denotes patients who have diabetes mellitus along with other systemic disease. The graph shows that most of the patients (73.5% ) did not suffer from diabetes mellitus, 21.4% had diabetes mellitus and 5.1% had diabetes mellitus with other systemic disease. X-axis denotes the Diagnosis, Y-axis denotes the frequency of CD patients. Figure 4 Blue colour denotes non-diabetic CD patients, red colour denotes CD patients with diabetes mellitus and dark green colour denotes CD patients who have diabetes along with other systemic disease. Prevalence of non-diabetic and diabetic male CD patients was higher than the same female category. However, this is statistically not significant (Chi-square test; p-value - 0.290 ( > 0.05) not significant). X-axis denotes gender and Y-axis denotes the frequency of CD patients. Figure 5 Blue colour denotes non-diabetic patients, red colour denotes patients with diabetes mellitus and dark green colour denotes patients who have diabetes along with other systemic disease. The age group 60-75 years show a higher prevalence of diabetes mellitus (11.68%) and also with other systemic diseases(3.99%). The graph also shows a drastic decrease in the prevalence of diabetes(0.85%) in the age group of above 75 years. However, this is statistically not significant (Chi-square test; p-value - 0.207 ( > 0.05) not significant). X-axis denotes the different age groups - 30-45, 46-59, 60-75, above 75 years; Y-axis denotes the frequency of diabetes mellitus in complete denture patients.

The most common age group of high prevalence of diabetes mellitus was found to be 60-75 years. It was found that few of the patients suffered from other systemic diseases like hypertension, renal disorders, asthma, thyroid disorders along with diabetes mellitus. Prognosis of the treatment, occlusal instability, cost, kind of treatment offered, post-treatment maintenance are all influenced by the systemic status of the patient (Venugopalan, Ariga, Aggarwal, & Viswanath, 2014). Brunello et al also observed a higher prevalence in this age group with a mean of 68.7 years (Brunello & Mandikos, 1998). It is also seen that few young patients are completely edentulous, which possibly is because of maintenance of oral hygiene, diet control is not very consistent among them (Basha, Ganapathy, & Venugopalan, 2018). Figure 5; Figure 4 shows the association of age/gender with the disorder. Table 4 shows that there is no significant relationship between gender and diagnosis of diabetes mellitus (p-value > 0.05)

The ratio of prevalence of only diabetes between males and females was almost equal, but males were more in number of other systemic diseases along with diabetes mellitus. Evidence has been suggested that edentulous older men have 4.06 times greater risk of developing non insulin dependent diabetes mellitus regardless of their age or race (Cleary & Hutton, 1995). The association of age and disorder in Figure 5 shows that the prevalence of diabetes kept increasing as age increased from 30 to 60 years. 60-75 years of age group were found to be the most prone to diabetes and other systemic diseases as well. Older patients often find it difficult to adapt to new dentures because of xerostomia, atrophy of ridges and mucosa and other conditions associated (Marcus et al., 1996). Patients with insulin dependent diabetes mellitus and poorly controlled did not survive to an advanced age (Xie & Ainamo, 1999). This is in support of the study, which proves less prevalence of patients above 75 years.

In Table 3, shows the frequency and percentage distribution of diagnosis of Diabetes Mellitus or diabetes mellitus along with other systemic diseases. 26.5% of the complete denture patients are found to be diabetic.

In Table 4, shows the association between gender and diagnosis of diabetes mellitus - Chi-square test - statistically not significant - p-value > 0.05

In Table 5, shows the association of age and diagnosis of diabetes mellitus - Chi-square test - Insignificant relation (p-value > 0.05).

The limitations of the study include its small sample size, it is self-centered, and information was acquired retrospectively from patients case records. Therefore, it is a necessity to extend the research with a larger population and build more scope for more in future. Increased awareness on the risk of diabetes and various complications in edentulous or complete denture patients is required. Effective management and implementation to prevent complications and failure of complete dentures is the need!

Conclusion

Within the limitations of the present study, it is concluded that there is no significant correlation between age, gender and diabetes mellitus among complete denture patients. 26.5% of the completely edentulous patients were diabetic and few associated with other systemic diseases along with diabetes. The male prevalence of patients suffering from the disease was higher than the females by a small margin. The most affected age group is in the range of 60-75 years. More extensive research and awareness to reduce the risk of diabetes mellitus and its complications among complete denture patients should be encouraged.

Conflict of interest

The authors declare that they have no conflict of interest for this study.

Funding support

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