The aging population has led to an increased demand for oral healthcare services among the elderly population. The elderly are more prone to mucosal problems due to aging, missing teeth, various health complications, medications, decreased saliva production, and poor oral hygiene.1 The elderly can use removable dentures to compensate for missing teeth to maintain proper mouth functions like eating and speaking.2 These dentures may have adverse effects on the mucosa of the elderly if they fit poorly, are not properly cared for, or are worn for an extended period of time without being removed.3

Denture stomatitis is one of the most frequently reported denture-associated conditions. Other lesions include traumatic ulceration, angular cheilitis, frictional keratosis and denture-related fibrous hyperplasia.4 Previous studies among elderly populations have reported a higher frequency of oral mucosal lesions among denture wearers than non-wearers. A previous study by O’Gorman et al. (2024)5 conducted on 709 elderly dental patients reported a significant association between denture use and oral mucosal lesions. Denture-related lesions were observed in 44.2% of denture wearers, while denture stomatitis was among the most frequently observed conditions. The same study also suggested that duration of denture use, and nighttime wearing were relevant factors.

Various studies performed in diverse groups of the elderly have found that there was a considerable burden of lesions caused by dentures. Stomatitis and hyperplasia due to denture use were some of the most common lesions seen in institutionalized elderly groups, whereas poor denture hygiene and use of dentures at night were factors associated with more cases of denture stomatitis.5-7 In spite of the above information, the association between dentures and oral mucosal lesions can be population-specific based on various factors, which makes local information vital in finding the burden of such diseases. However, denture use alone may not explain the occurrence of mucosal lesions. Denture hygiene, duration of use, nighttime wearing, denture fitness and systemic factors may influence the development of these conditions.8,9

Therefore, this study was designed to determine the association between denture use and oral mucosal lesions among elderly patients.

An analytical cross-sectional study was conducted among 300 elderly patients aged 60 years and above attending a dental outpatient department. The ethical approval was obtained from the institution number (ADS-1077-33) dated 11/11/2024. Participants were recruited through consecutive sampling. Patients aged 60 years or above who were willing to participate and able to undergo an oral examination were included. Patients who declined participation, were unable to undergo clinical examination or had recent oral surgery affecting the oral mucosa were excluded. A self-structured questionnaire was used to collect information regarding age, sex, systemic diseases, tobacco use, xerostomia and denture-related characteristics. Participants were categorized as denture users or non-users. Among denture users, information was obtained regarding denture type, duration of use, denture hygiene, nighttime wearing and perceived denture fit. A systematic intraoral examination was performed under adequate illumination. The buccal and labial mucosa, gingiva, alveolar mucosa, palate, tongue, floor of the mouth and other relevant areas were examined. The primary outcome was the presence of at least one oral mucosal lesion. Lesions were clinically classified as denture stomatitis, traumatic ulceration, angular cheilitis, epulis fissuratum/denture-related hyperplasia, frictional keratosis and other lesions. Data were analyzed using SPSS version 26. Categorical variables were summarized using frequencies and percentages. The chi-square test was used to compare categorical variables. Multivariable logistic regression was performed to identify independent predictors of oral mucosal lesions. Odds ratios with 95% confidence intervals were reported. A p-value <0.05 was considered statistically significant.

A total of 300 elderly patients were included in the study. The mean age was 68.4 ± 6.7 years, ranging from 60 to 85 years. There were 162 (54%) males and 138 (46%) females. Among the participants, 180 (60.0%) were denture users, whereas 120 (40.0%) were non-denture users (Table 1).

Table 1. Participant demographics and clinical attributes

Oral mucosal lesions were identified in 126 (42%) participants. The prevalence of lesions was substantially higher among denture users (96/180, 53.3%) than non-denture users (30/120, 25.0%). This difference was statistically significant (χ² = 24.53, p < 0.001). Among denture users, denture stomatitis was the most frequently observed lesion, affecting 42 (23.3%) participants. Traumatic ulceration was observed in 24 (13.3%), angular cheilitis in 15 (8.3%), epulis fissuratum in 10 (5.6%), and frictional keratosis in 5 (2.8%) (Table 2).

Table 2. Distribution of oral mucosal lesions according to denture status

Poor denture hygiene was significantly associated with mucosal lesions. Among 55 participants with poor denture hygiene, 38 (69.1%) had oral mucosal lesions compared with 58 (46.4%) among 125 participants with adequate denture hygiene (p = 0.006). Nighttime denture wearing was also significantly associated with mucosal lesions. Among the 73 participants who reported wearing dentures during sleep, 48 (65.8%) had mucosal lesions compared with 48 (44.9%) among the 107 participants who removed their dentures at night (p = 0.009). Poor denture fit was another important finding. Among 65 participants with poorly fitting dentures, 45 (69.2%) had oral mucosal lesions compared with 51 (44.3%) among the 115 participants with adequately fitting dentures (p = 0.002). Duration of denture use was also associated with mucosal lesions. Participants who had used dentures for more than 10 years had the highest prevalence of lesions (28/42, 66.7%), followed by those using dentures for 5–10 years (38/70, 54.3%) and those using dentures for less than 5 years (30/68, 44.1%; p = 0.041) (Table 3).

Table 3. Denture-related factors associated with oral mucosal lesions

After adjustment for age, sex, tobacco use, diabetes and xerostomia, denture use remained independently associated with oral mucosal lesions. Denture users had approximately 2.8 times higher odds of having an oral mucosal lesion compared with non-users (Table 4).

Table 4. Multivariable logistic regression analysis

The present study demonstrated a significant association between denture use and oral mucosal lesions among elderly patients, with oral mucosal lesions identified in 53.3% of denture users compared with 25% of non-denture users (p<0.001). This finding is consistent with previous evidence demonstrating a substantially greater burden of oral mucosal lesions among denture wearers. A large sample study by Sartawi et al. (2022)10 involving elderly dental patients reported oral mucosal lesions in 68.4% of denture wearers compared with 19.2% of individuals without dentures, while denture-related lesions were observed in 44.2% of denture users. The slightly lower prevalence observed in the present study may be explained by differences in age distribution, denture characteristics, duration of use, oral hygiene practices, access to dental care and clinical diagnostic criteria. A study conducted among Indian elderly patients by Ankit et al. (2024)11 also reported a higher prevalence of oral mucosal conditions among denture wearers than non-wearers (62.7% vs. 28.5%), further supporting the association observed in the present study. Importantly, evidence from Pakistan also demonstrates a considerable burden of denture-associated lesions. A study conducted in Pakistan at Lahore Medical and Dental College by Rizvi et al. (2022)12 reported mucosal lesions in 60% of denture wearers, which is comparable to the 53.3% observed in the present study. However, the study reported traumatic ulcers as the most common lesion (45%), followed by hyperplasia (10%), denture stomatitis (3%) and angular cheilitis (2%). The difference in the distribution of lesions may reflect variations in the quality and age of dentures, duration of use, denture hygiene, patient characteristics and methods used for clinical diagnosis. Denture stomatitis was the most frequently observed lesion in the present study, affecting 23.3% of denture users. This finding agrees with several previous studies that have identified denture stomatitis as one of the predominant oral mucosal conditions among elderly denture wearers. A large study of elderly dental patients identified denture stomatitis as the most frequent denture-related lesion, while other studies have similarly demonstrated a substantial prevalence of inflammatory changes beneath dentures. However, the findings differ from the Pakistani study in which traumatic ulceration was considerably more common than denture stomatitis.12 Ankit et al. (2024)11 stated in his study that’s among elderly Indian denture wearers reported traumatic ulcers as the most frequent lesion, accounting for 22.6%, followed by denture stomatitis at 14.3% and angular cheilitis at 4.8%. These differences suggest that the pattern of oral mucosal lesions may vary between populations and may be influenced by denture design, prosthetic fit, duration of use, hygiene practices and individual susceptibility. In the present study, traumatic ulceration was the second most common lesion, affecting 13.3% of denture users, which remains consistent with previous reports showing that mechanical trauma is an important consequence of denture use. Repeated friction and pressure from unstable or poorly fitting dentures may produce localized mucosal injury and contribute to the development of traumatic ulcers. The present study also demonstrated a significant relationship between poor denture hygiene and oral mucosal lesions. Among participants with poor denture hygiene, 69.1% developed mucosal lesions compared with 46.4% of those with adequate hygiene (p=0.006). This finding is supported by previous study conducted by Guerra et al. (2026)13 demonstrating that inadequate denture hygiene is associated with a greater prevalence of denture stomatitis and other mucosal abnormalities. Poorly cleaned dentures provide a favorable environment for microbial biofilm accumulation, particularly Candida species, which may contribute to inflammatory changes beneath the denture. The association observed in the present study emphasizes that denture treatment should be accompanied by continuous oral and prosthetic hygiene education, particularly among elderly patients who may have reduced manual dexterity, visual impairment or limited understanding of denture-care procedures. Nighttime denture wearing was another important finding in the present study. Lesions were observed in 65.8% of participants who reported wearing their dentures during sleep compared with 44.9% of those who removed them at night (p=0.009). This finding is strongly supported by previous evidence. A study among elderly denture wearers in Nepal, reported by Neupane et al. (2026)14 that oral mucosal lesions in 35.6% of participants who wore dentures during sleep compared with only 8.4% among those who removed their dentures at night. Another study by Tudorici et al. (2026)15 examining removable prosthesis wearers found overnight prosthesis used to be significantly associated with oral mucosal lesions, with a particularly strong odds ratio for lesion development. Continuous wearing may expose the mucosa to prolonged mechanical pressure while simultaneously limiting tissue recovery and increasing microbial accumulation. The consistency of this finding across different populations suggests that nighttime denture wearing may represent a clinically important and potentially modifiable risk factor. Duration of denture use was also significantly associated with oral mucosal lesions in the present study. Participants who had used dentures for more than 10 years had the highest prevalence of lesions (66.7%), compared with 54.3% among those who had used dentures for 5–10 years and 44.1% among those with less than five years of denture use (p=0.041). This finding is consistent with previous research showing that longer duration of denture use is associated with an increased frequency of mucosal abnormalities. Long-term use may increase the likelihood of prosthetic deterioration, loss of adaptation and changes in the underlying oral tissues. A study of complete denture wearers conducted by Ghalwash et al. (2025) 16 found that individuals with denture stomatitis, traumatic ulcers and fibrous inflammatory hyperplasia had used their dentures for significantly longer periods than participants with clinically healthy mucosa. The present findings therefore support the importance of periodic evaluation, relining, adjustment or replacement of old dentures rather than if a prosthesis remains clinically satisfactory indefinitely. Poor denture fit was another significant factor, with mucosal lesions occurring in 69.2% of participants with poorly fitting dentures compared with 44.3% among those with adequately fitting dentures (p=0.002). This finding is clinically plausible because an unstable or poorly adapted denture can produce repeated friction, pressure and movement against the underlying mucosa. The resulting mechanical irritation may contribute particularly to traumatic ulcers and reactive lesions such as epulis fissuratum. Previous research conducted by Ghalwash et al. (2025) 16 has similarly identified prosthetic instability and poor denture-related conditions as important factors associated with oral mucosal lesions. The relatively strong association observed in the present study indicates that assessment of denture fit should be an integral component of routine follow-up, particularly in elderly patients with long-standing prostheses. The multivariable analysis further strengthened these findings. After adjustment for age, sex, tobacco use, diabetes and xerostomia, denture use remained independently associated with oral mucosal lesions, with denture users having approximately 2.8 times higher odds of developing a lesion than non-users (AOR=2.84, 95% CI: 1.69–4.77, p<0.001). Poor denture hygiene, nighttime wearing and poor denture fit also remained significant independent predictors. These findings are important because they indicate that the relationship between dentures and mucosal lesions cannot be explained entirely by differences in age, systemic disease or other patient characteristics. Nevertheless, the observed associations should not be interpreted as proof of causality because the cross-sectional design does not establish the temporal sequence between denture exposure and lesion development.

The most common mucosal lesion was denture stomatitis. Factors contributing to mucosal lesions include poor denture hygiene, use of dentures during sleep, longer period of denture use, and poor denture fitness. Proper denture hygiene, no unnecessary wearing during the night, and proper denture fitting will decrease the prevalence of denture-related oral mucosal lesions.

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