complications of denture wearing often remain under-recognized in routine care. In older adults, multimorbidity, polypharmacy, frailty and reduced access to dental services intersect with tooth loss, edentulism and prosthetic rehabilitation. These social-biological determinants influence denture use patterns (e.g., continuous or nocturnal wear), hygiene behaviours and clinic attendance, shaping the risk landscape for oral mucosal disease. Guidance from professional bodies highlights the need to anticipate geriatric-specific risks and to prioritize preventive and supportive care in this population [2,3]. Among denture wearers, the prototypical lesion is denture stomatitis (DS), a largely erythematous inflammatory process of the palatal mucosa under the denture base. Contemporary syntheses report DS prevalence typically between ≈20% and 60% across settings, reflecting heterogeneous populations and diagnostic thresholds; Candida biofilm, continuous wear and denture quality emerge as central drivers [4]. Diagnostic descriptors commonly reference Newton’s clinical classification (Types I–III), and angular cheilitis, traumatic ulceration, inflammatory papillary hyperplasia and epulis fissuratum frequently co occur, often mediated by mechanical irritation, hygiene deficits and salivary changes [5,6]. Risk factor studies consistently implicate denture fit and hygiene, the habit of sleeping with dentures, advanced denture age and specific host factors (e.g., diabetes, xerostomia). Cross-sectional analyses in clinical cohorts show markedly increased odds of DRML among overnight wearers and those with suboptimal prosthesis quality [7]. Nevertheless, prevalence estimates in the literature remain highly variable by geography and care level: in a Nigerian teaching hospital, DRML prevalence of ≈13% was reported among denture wearers [8], whereas a Gulf-region clinic reported ≈21% with denture-related fibrous hyperplasia common [9]; studies in other regions frequently report DS around a quarter to a half of complete denture wearers. Given this variability and the predominance of modifiable drivers, local data are valuable for service planning and counselling. We therefore undertook a retrospective review of elderly denture wearers attending a tertiary dental teaching hospital between 2019 and 2024 to (1) estimate the prevalence and spectrum of DRML; and (2) identify associated factors with a focus on modifiable behaviours and prosthesis-related characteristics.

Design, setting and ethical considerations We performed a single-centre retrospective chart review of consecutive patients aged ≥60 years who attended prosthodontic or geriatric dentistry clinic. The study adhered to the STROBE guidance for observational studies; the institutional review board approved the protocol with a waiver of informed consent for secondary use of de-identified data. Eligibility criteria Inclusion: (a) age ≥60 years; (b) current wearer of a removable complete denture (CD) and/or removable partial denture (RPD); and (c) complete baseline oral examination recorded by faculty supervised clinicians. Exclusion: implant supported prostheses; active head-and-neck radiotherapy; immunosuppression other than diabetes; insufficient records. Case definitions and data extraction Lesions were recorded when a clinician documented a diagnosis consistent with standard criteria: denture stomatitis (Newton Types I–III: petechial or generalized erythema, or papillary hyperplasia under the denture base), angular cheilitis (erythematous fissuring at commissures), traumatic ulceration (mechanical etiology in denture-bearing area), epulis fissuratum (inflammatory fibrous hyperplasia at over extended flange), and inflammatory papillary hyperplasia (pebbled palatal proliferation under the denture). Where present, co-occurrence of lesions was captured. Laboratory mycology was not required; diagnoses were clinical—consistent with routine practice and literature. We abstracted demographics; denture type (CD vs RPD); denture age (≤5 years vs >5 years); nocturnal wear (self-reported), dichotomized as “sleeps with denture most nights” vs “removes at night”; clinician-rated fit (good vs ill-fitting) based on pressure areas, retention and border extension; hygiene score (good/fair/poor) from standardized notes; comorbid diabetes mellitus (yes/no); smoking (current/former/never); and xerostomia (symptoms recorded). Outcomes Primary outcome: presence of any DRML (≥1 lesion). Secondary outcomes: prevalence by lesion type; multiple-lesion burden. Sample size and statistics All eligible charts within the time window were included (targeted administrative census). Categorical variables were summarized as counts (%) andcomparedbychi-square.Weestimated prevalencewith95%CIs.Factorswithp<0.10in univariate analyses and clinically relevant covariates entered a multivariable logistic regression for “anyDRML.”Model discrimination and calibrationwere describedwith pseudo-R² andHosmer–Lemeshowp-value. Analyses used conventional two-sidedα=0.05.

Sampledescription Weincluded1,000elderlydenturewearers(mean age69.2±6.8years;60–69y:53%;70–79y:36%; ≥80y:11%).Femalescomprised52%.Complete denturewearerswere61%, RPDwearers39%. Furthercharacteristicsappear inTable1. Overall prevalence of “any DRML” was 36.0% (95%CI 33.0–39.0). Among the lesions (non mutually exclusive; multiple lesions allowed), frequencies in the total sample were: denture stomatitis 19.0%(95%CI 16.6–21.4), traumatic ulcers 11.0%, angular cheilitis 9.0%, epulis fissuratum 7.0%, and inflammatory papillary hyperplasia3.5%.Oneormore lesionsoccurred in41.0%ofCDwearersvs28.2%ofRPDwearers (p<0.001). Among those with DRML (n=360), 27.8%had≥2lesiontypes. Table1.Samplecharacteristics(N=1,000) Characteristic n(%) Age60–69y 530(53.0) Age70–79y 360(36.0) Age≥80y 110(11.0) Femalesex 520(52.0) Denturetype:Complete 610(61.0) Denturetype:RPD 390(39.0) Dentureage:≤5y 450(45.0) Dentureage:>5y 550(55.0) Nocturnaldenturewear(yes) 420(42.0) Hygiene:Good/Fair/Poor 350(35.0)/270(27.0)/380(38.0) Clinician-ratedill-fitteddenture 300(30.0) Diabetesmellitus 280(28.0) Smoking:Current/Former/Never 220(22.0)/180(18.0)/600(60.0) Xerostomiasymptoms 260(26.0) Table2.Prevalenceoflesions(overallandbydenturetype) Lesion Totaln(%) CDn/N(%,N=610) RPDn/N(%,N=390) AnyDRML 360(36.0) 250/610(41.0) 110/390(28.2) Denturestomatitis 190(19.0) 135/610(22.1) 55/390(14.1) Traumaticulceration 110(11.0) 70/610(11.5) 40/390(10.3) Angularcheilitis 90(9.0) 60/610(9.8) 30/390(7.7) Epulisfissuratum 70(7.0) 50/610(8.2) 20/390(5.1) Inflammatorypapillaryhyperplasia 35(3.5) 30/610(4.9) 5/390(1.3) FactorsassociatedwithDRML Univariateanalyses(Table3)demonstratedhigher DRML prevalence among overnight wearers (50.0%vs 25.9%), ill-fittingdentures (60.0%vs 25.7%), poor hygiene (50.0% vs 27.4% in good/fair), denture age > 5 years (45.5%vs 24.4%), diabetes (42.9%vs33.3%), xerostomia (46.2%vs32.4%),andcompletedentures(41.0% vs28.2%;allp≤0.012exceptsmokingp=0.07and femalesexp=0.08). Table3.UnivariateassociationswithanyDRML(N=1,000) Factor WithDRMLn/N(%) WithoutDRMLn/N(%) OR(95%CI) p Nocturnaldenturewear(yesvsno) 210/420(50.0) 210/420(50.0) 2.87(2.20–3.74) <0.001 Dentureage>5y(vs≤5y) 250/550(45.5) 300/550(54.5) 2.58(1.98–3.36) <0.001 Hygienepoor(vsgood/fair) 190/380(50.0) 190/380(50.0) 2.65(2.03–3.45) <0.001 Ill-fitting(vsgoodfit) 180/300(60.0) 120/300(40.0) 4.33(3.27–5.73) <0.001 Diabetes(yesvsno) 120/280(42.9) 160/280(57.1) 1.50(1.15–1.95) 0.002 Xerostomia(yesvsno) 120/260(46.2) 140/260(53.8) 1.79(1.37–2.33) <0.001 Completedenture(vsRPD) 250/610(41.0) 360/610(59.0) 1.77(1.35–2.31) <0.001 Smoking(currentvsnot) 90/220(40.9) 130/220(59.1) 1.31(0.98–1.76) 0.07 Female(vsmale) 200/520(38.5) 320/520(61.5) 1.25(0.98–1.59) 0.08 Table4.MultivariablelogisticregressionforanyDRML(N=1,000) Variable AdjustedOR(95%CI) p Ill-fitting denture (yes) 3.10 (2.30–4.20) <0.001 Nocturnal denture wear (yes) 2.20 (1.70–2.90) <0.001 Poor hygiene (vs good/fair) 2.00 (1.55–2.58) <0.001 Denture age >5 y 1.70 (1.30–2.20) <0.001 Diabetes mellitus (yes) 1.30 (1.00–1.70) 0.045 Xerostomia (yes) 1.40 (1.08–1.86) 0.008 Complete denture (vs RPD) 1.40 (1.08–1.86) 0.012 Smoking (current) 1.10 (0.85–1.45) 0.48 Female sex 1.10 (0.88–1.40) Model statistics: Nagelkerke pseudo-R² = 0.19; Hosmer–Lemeshow p = 0.32

n this retrospective series of 1,000 elderly denture wearers, 36% had at least one denture-related oral mucosal lesion, with denture stomatitis the most frequent entity (19%), followed by traumatic ulcers (11%), angular cheilitis (9%), epulis fissuratum (7%) and inflammatory papillary hyperplasia (3.5%). These proportions align with reports from tertiary settings in South Africa (DRS ≈26%) [11] and elsewhere, though absolute frequencies differ across case definitions, prosthesis mixes and care pathways. 0.23 DS and angular cheilitis is widely recognized [15 17]. Nocturnal denture wear warrants special attention. Beyond its association with DS, prospective cohort data in very elderly community dwellers demonstrate that sleeping with dentures roughly doubles pneumonia risk [18]. Our adjusted estimate (aOR ≈ 2.2) for DRML complements this broader systemic risk narrative. Our adjusted analyses underscore modifiable drivers: mechanically ill-fitting dentures, nocturnal wear and poor denture hygiene together with older denture age were strongly and independently associated with DRML. This pattern accords with cross-sectional risk studies in Brazil [7] and broader geriatric oral disease surveys that connect prosthetic quality and hygiene with mucosal pathology [12]. The higher burden among complete denture wearers compared with RPD users likely reflects greater mucosal coverage, higher palatal biofilm load and longer wear duration findings also emphasized in edentulous cohorts [11]. Epulis fissuratum a reactive fibrous hyperplasia related to border over-extension and chronic flange trauma accounted for 7% of our sample. Although its prevalence varies, its mechanistic linkage to prosthesis fit is well-established [13]. Inflammatory papillary hyperplasia (3.5%) co localizes with chronic palatal irritation and candidal colonization, reinforcing the role of denture hygiene and overnight removal in prevention [11]. Host factors contributed as expected. Diabetes showed a modest independent association, reflecting impaired mucosal immunity and salivary alterations; xerostomia also remained significant after adjustment. These findings are consistent with pathophysiologic models linking DS to salivary flow, pH and biofilm ecology [4,14]. The role of Candida as an opportunistic pathogen in Geographically, prevalence differences across reports (≈13% in a Nigerian teaching hospital [8] vs ≈21% in a Gulf clinic [9]; higher in some South American and Asian cohorts [12]) likely reflect distinct case mixes, service access, prosthesis maintenance intervals, and diagnostic thresholds. Standardized recording (e.g., consistent Newton staging for DS) and inclusion of behavioural exposures would improve comparability. Clinical implications: Our data suggest three immediate, high-yield actions: (1) proactive fit assessment and timely reline/re-fabrication [13]; (2) structured hygiene protocols [19]; and (3) clear behavioural counselling to remove dentures overnight [18,20]. These align with global calls to integrate oral health into healthy ageing agendas [20-22].

In this 2019–2024 retrospective series of 1,000 elderly denture wearers, over one-third had denture-related oral mucosal lesions, with denture stomatitis most frequent. Lesions clustered with ill-fitting prostheses, nocturnal wear, poor hygiene and older denture age, alongside diabetes and xerostomia. These predominately modifiable exposures offer immediate targets for prevention: regular fit checks and timely reline/re-fabrication, daily mechanical plus chemical cleansing, and routine denture removal at night. Embedding these practices into geriatric denture care pathways can meaningfully reduce mucosal morbidity and improve oral health-related quality of life for older adults.

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