Wearing Dentures Overnight Tied to Pneumonia

Pneumonia and oral inflammation were more likely in older adults who slept in dentures

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Dentures can help the elderly maintain a normal lifestyle and diet in spite of age-related dental health problems. But the false teeth can also pose a risk for serious illness if proper oral hygiene isn’t followed.

Researchers in Japan found that elderly patients who slept with their dentures in had more than double the risk of developing pneumonia than those who removed dentures before bed.

The new study also linked overnight denture use with dental plaque, gum inflammation and other oral health issues.

"This study makes intuitive sense, because not only does the wearing of denture prostheses during sleep foster oral bacterial growth, but just as any other foreign body in the mouth, can also predispose to aspiration [breathing in] of saliva," said Mark Bornfeld, DDS, who has run a private dental practice in Brooklyn, NY since 1977 and is editor at the Queens County Academy of General Dentistry. "It is helpful to have this additional support for dentists’ standard admonishment to their denture patients that dentures should not be worn during sleep."

The researchers wrote that their study showed the importance of oral hygiene programs for pneumonia prevention in elderly people.

"These results suggest that simple denture care habits could reduce the risk of pneumonia in the community," they wrote.

According to Dr. Bornfeld, who was not involved in this study, "The directive to keep dentures out of the mouth during sleep is mostly intended to improve general oral hygiene and to reduce the incidence of proliferative inflammatory changes in the denture bearing tissues." Dr. Bornfeld explained that certain types of gum damage — such as epulis fissuratum and papillary hyperplasia — are known to result from round-the-clock denture wearing. He said that the risk of pneumonia is just as good of a reason to avoid wearing dentures through the night.

For this study, lead researcher Toshimitsu Iinuma, DDS, PhD, of the Nihon University School of Dentistry in Japan, and colleagues studied 524 patients who were 87.8 years old on average.

The seniors had an oral health exam and answered questions about dental hygiene. The study authors followed up yearly with the seniors until they were hospitalized for or died from pneumonia.

Pneumonia is a lung infection that affects breathing. Symptoms include cough, fever, chills and shortness of breath.

During the three-year follow-up, 20 patients died of pneumonia, and another 28 were hospitalized for it.

The study group included 453 denture wearers. Of those who wore dentures, 186 (40.8 percent) wore them during sleep.

Dr. Iinuma and colleagues found that overnight denture wearers had a 2.3 times higher risk of pneumonia than people who removed their dentures before sleep.

"Because pneumonia is such a prevalent issue in the elderly, I have little doubt that it is a concern for physicians," Dr. Bornfeld said. "I am unsure whether they would be generally aware of the role that nocturnal denture wearing might play as a cause."

In a companion editorial, Frauke Mueller, PhD, of the University of Geneva in Switzerland, wrote that oral hygiene is especially important for older people.

"When possible, denture wearing during the night should be discouraged in geriatric patients," Dr. Mueller wrote.

Dr. Bornfeld offered his tips for denture hygiene. "What's good for natural teeth is good for dentures," he said.

"There is no adequate substitute for daily brushing of all denture surfaces with a brush. Effervescent tablets are not nearly as effective at removing adherent bacterial plaque," Dr. Bornfeld said.

"Dentures should be kept submerged in fresh tap water while they’re out of the mouth to prevent warpage, which can happen if they’re allowed to dry out," he said. "Dentures may be periodically disinfected by soaking them overnight in liquid laundry chlorine bleach diluted one part to ten parts of water (avoid doing this more than once a month if the denture has metallic clasps, to avoid corrosion)."

"Finally," he said, "if tartar accumulates on the denture, it can be softened for easy removal with an overnight soak in white distilled vinegar (don’t get fancy with balsamic vinegar unless you like brown denture teeth)."

The study by Dr. Iinuma and colleagues was published online Oct. 7 in the Journal of Dental Research.

The Japan Society for the Promotion of Science, Nihon University School of Dentistry, the Japan Health Foundation for the Prevention of Chronic Disease and other public health organizations funded the research. The authors disclosed no conflicts of interest.

Review Date: 
October 7, 2014
Last Updated:
October 9, 2014