Asian Journal of Dental Sciences

The mucosa covering the edentulous residual ridge transmits masticatory load through a terminal microvascular bed that was never differentiated for that purpose, and its tolerance depends on how completely perfusion is restored between loading cycles. Prosthodontic research has treated denture-induced ischaemia as a local mechanical problem, while critical care medicine has independently established the oral mucosa as an accessible site for observing systemic microcirculatory failure. The two literatures describe the same tissue compartment yet have developed with little contact. This critical narrative review integrates them and evaluates what may defensibly be claimed about the vascular behaviour of denture-supporting tissues when mechanical loading and systemic circulatory compromise coincide. Literature was identified through structured searching of open scholarly indexes and citation registries, supplemented by backward and forward citation tracking, with all bibliographic records independently verified. Three findings emerge. Static compression and cyclic loading produce opposite perfusion responses, and the apparent contradiction in the experimental record resolves once loading duty cycle rather than peak interfacial pressure is treated as the operative variable. The injurious event is more plausibly repeated ischaemia followed by reperfusion than ischaemia alone, which reframes prosthesis design as a problem of recovery time rather than pressure minimisation. Systemic conditions that reduce capillary density or blunt vasodilator reserve, including diabetes mellitus, hypertension, chronic kidney disease, heart failure and vasospastic disorders, are well characterised in non-oral beds and demonstrable in oral mucosa, but the specific interaction between reduced reserve and prosthetic loading has almost never been examined directly. The evidence base is dominated by small single-centre studies using arbitrary perfusion units, short observation windows and dentate volunteers as surrogates for denture wearers. Diagnostic translation therefore remains premature. Priorities include standardised provocation protocols, cohort designs linking measured perfusion reserve to mucosal and osseous outcomes, and pragmatic evaluation in dependent and critically ill patients, in whom mucosal pressure injury is already a recognised and preventable harm.