Functional Effectiveness of Removable Dentures in Patients with Dental Manifestations of Sensory Neuropathy Associated with Metabolic Disorders

Abstract

This study examines the specific dental manifestations of sensory peripheral neuropathy (SPN) and their impact on the parameters of stability, retention, and comfort when wearing dentures (DPN). It has been established that impaired sensory feedback due to neuropathy is a significant factor that reduces denture tolerance and increases the risk of functional dysfunction, especially in patients with poor metabolic control.
Objective: To identify manifestations of sensory peripheral neuropathy (SPN) in the oral cavity associated with metabolic disorders and to assess their impact on the functional efficiency of removable dentures in patients with type 2 diabetes mellitus (T2DM) and metabolic-associated steatosis of the liver (MASL).
Materials and methods: Forty-three patients aged 45–75 years with partial edentulism of Kennedy class I–II, who used dentures, were examined. The main group (A) consisted of patients with clinically confirmed MP and SPN: A1 — 16 patients with PD + T2DM + SPN; A2 — 15 patients with PD + MASL + SPN. The control group (B) included 12 patients with PD without diagnosed MP or SPN.
Objective examination methods: clinical examination, thermoreception analysis, discrimination sensitivity analysis, electro­myography.
Subjective examination methods: standardized OHIP-14 questionnaire (Oral Health Impact Profile; 14 questions, scale 0–4), and assessment of patient tolerance to the prosthesis using VAS (Visual Analog Scale; scale 0–10).
Results: The study showed that the manifestations of SPN in patients with T2DM and MASL had certain differences. In subgroup A1, SPN was manifested by temperature hyposensitivity and a high threshold of exteroception of the prosthetic bed (83% of patients), while in subgroup A2 it was manifested by glossodynia and temperature hypersensitivity (80%). In both subgroups, autonomic symptoms were observed: xerostomia (A1—92%, A2—60%), taste changes (A2—70%), which correlated with the degree of MP. In patients of group A, a significant reduction in the amplitude of biopotentials and asymmetry of the bioelectric activity of the masticatory muscles was observed compared to the control group. During chewing, significant differences in the magnitude and duration of chewing cycles and a decrease in the duration of rest periods were noted.
According to the OHIP-14 and VAS results, both subgroups of group A had significantly lower stability, retention, and comfort when wearing dentures compared to group B (foreign body sensation, insufficient control over dentures), despite objectively high-quality manufacturing. A strong inverse correlation was found between the threshold of mucosal pain sensitivity and subjective comfort when wearing dentures: the higher the threshold of sensitivity, the lower the tolerance (r = − 0.72, p < 0.01).
Conclusions: SPN associated with MP significantly impairs adaptation and reduces the functional efficiency of dentures, which negatively affects the quality of life and the success of orthopedic rehabilitation. Early diagnosis of SPN manifestations in the oral cavity may indicate IACS and T2DM and is key to effective treatment and dental prosthetics. The optimal option for such patients may be an orthopedic construction supported by implants, along with optimization of metabolic control and symptomatic therapy.