Management of Oral Sores from Ill-Fitting Dentures in Elderly Patients
The priority is immediate denture adjustment or replacement by a dental professional to eliminate the mechanical trauma causing the oral sores, as ill-fitting prostheses lead to chronic pain, infection, and significantly impaired quality of life in elderly patients. 1
Immediate Action Required
Dental evaluation and denture adjustment must be the first step, as the American Dental Association recommends having a dental team evaluate for sources of mechanical trauma, including ill-fitting dental prostheses, to manage oral mucosal lesions 2, 3. The evidence is clear that complex dental restorations in the elderly adversely affect quality of life when problems arise, and elderly patients face chronic infections and pain from prostheses that cause mechanical trauma 1.
Critical Considerations for Elderly Patients
- Avoid complex reconstructions in frail elderly patients, particularly those with cognitive impairment or limited dexterity, as they cannot perform adequate oral hygiene around difficult-to-clean prostheses 1
- Simpler removable dentures are preferable to complex fixed prostheses that require significant maintenance, even if aesthetically less ideal 1
- The failure of complex dental reconstructions in frail patients with chronic diseases (diabetes, metabolic syndrome, osteoporosis) can be catastrophic 1
Symptomatic Relief During Denture Adjustment Period
While awaiting or during denture adjustment, temporary pain relief can be provided:
- Topical benzocaine can be applied to affected areas up to 4 times daily for temporary pain relief from mouth and gum irritations 4
- Discontinue use if symptoms do not improve in 7 days or if irritation, pain, or redness persists or worsens 4
Essential Oral Hygiene Protocol
Implement rigorous oral hygiene measures immediately to prevent secondary infections, which are common in elderly patients with oral trauma:
- Brush twice daily with a soft toothbrush using the Bass or modified Bass method 2, 3
- Use alcohol-free mouthwash at least four times daily for approximately 1 minute to keep the oral mucosa clean 2, 3
- Maintain adequate hydration to keep oral mucosa moist and promote healing 2, 3
Common Pitfalls to Avoid
Do not delay dental referral - 65.3% of elderly hospitalized patients need direct oral hygiene assistance, and oral problems develop rapidly in this population 5. The prevalence of oral infections is extremely high in home-living elderly patients, with 71.1% having dentogenic infection foci and 96.2% having poor periodontal condition 6.
Watch for Candida superinfection - denture-related trauma creates an environment for chronic candidiasis, which develops under improperly fitting dentures 7. More edentulous patients with dentures have positive salivary yeast counts (84.4%) compared to dentate patients 6.
Monitor for malignant changes - ulcers, stomatitis, and hyperplasia can develop under improperly fitting dentures, and malignant changes can occur with chronic irritation 7.
Special Considerations for Frail Elderly
- Many elderly patients in assisted living facilities have limited access to dental care, making proactive management essential 1
- Decreased salivary flow from medications, cancer radiation, or diseases like Sjögren's syndrome exacerbates oral mucosal injury and impairs healing 1
- Surrogates may need to perform daily oral hygiene when dexterity and cognition are limited, as this becomes an impossible task for the patient alone 1