The needs of denture-brushing in geriatrics: clinical aspects and perspectives

doi: 10.1111/j.1741‐2358.2011.00557.x
The needs of denture‐brushing in geriatrics: clinical aspects and perspectives Introduction: Oral and denture hygiene are often defective in particular with dependent persons such as geriatric subjects. The reasons are the lack of hygiene education of the subjects or those caring for them. Consequently, oral hygiene is often neglected, resulting in poor oral health and an increase in the presence of local or general infections. Objective: This paper is a report of brushing effectiveness on microbial biofilm deposits on dentures of subjects participating in a specific oral hygiene programme. Materials and methods: Thirty‐nine dentures of 30 subjects were assessed for 2 weeks following an educational brushing programme. Microbial biofilm was recovered using fluoresceine and then scanned and quantified by ‘Mesurim’ software three times: before study, after 1 and 2 weeks. Results: The repeated measurement procedures showed a decrease in the percentage of biofilm present (F = 15, p < 0.001) whatever the type of denture (partial or complete) and for all biomaterials. Conclusion: Regular denture‐brushing can improve local hygiene. Consequently, decreasing the biofilm surface can reduce the prevalence of oral pathogens, thereby contributing to the general prevention of the risks of infections such as pneumotisis.     

Self-reported oral hygiene habits among institutionalised elderly and their relationship to the condition of oral tissues in Taubaté, Brazil

Objectives: To record self‐reported hygiene habits, examine the oral conditions of a sample group of institutionalised elderly, and examine possible relationships between these habits and conditions. Design: Cross‐sectional. Setting: All the institutions for the elderly in Taubaté, Brazil. Subjects: The entire population of these institutionalised elderly people (n = 553). Intervention: The subjects were interviewed and underwent an oral examination. Main outcome measures: Oral hygiene habits, oral conditions and statistical relationships between habits and oral conditions were recorded. Results: The average age of the subjects who knew their age (n = 364) was 74.9 years (±12.9), and 64.7% of the sample group were females. Denture‐related stomatitis was found in 19.5%, impaired manual dexterity in 40%, dry mouth sensation in 36.3%, difficulty in performing oral hygiene in 20%, no oral hygiene‐related orientation in 54.1%, no periodic oral examinations in 59.5%, and no tongue cleaning in 68.3% was declared. Among dentate subjects, 73.3% had periodontal disease, 54.7% had caries, 26% reported no toothbrushing, and 7.3% reported flossing. Of the denture wearers, 7% did not brush their dentures. Denture‐related stomatitis showed a statistical relationship with impaired manual dexterity (p = 0.012) and an inverse statistical relationship with denture brushing frequency (p = 0.006). Periodontal disease showed an inverse relationship to flossing (p < 0.001) and tongue cleaning (p = 0.0026). Caries showed an inverse relationship with tooth‐brushing (p = 0.043), flossing (0.022), proper oral hygiene orientation (p = 0.041) and periodical check‐ups (p = 0.007). Conclusion: Oral hygiene practices in this sample group were found to be inadequate, and statistically significant relationships were verified between the lack of good oral hygiene practices and the deleterious oral conditions.     

Oral health in institutionalised elderly people in Oslo, Norway and its relationship with dependence and cognitive impairment

doi: 10.1111/j.1741‐2358.2011.00490.x
Oral health in institutionalised elderly people in Oslo, Norway and its relationship with dependence and cognitive impairment Objective: Investigating oral health’s relationship with dependency and cognitive state. Background: Oral hygiene is poor in the institutionalised elderly. There are problems regarding the oral care of residents having poor mobility or cognitive impairment. Material and methods: Cross‐sectional study involving 135 participants (mean age 85.7, SD 8.8 years) in two categories: nurses doing tooth cleaning and residents doing tooth cleaning. Those cleaned by nurses were categorised as co‐operative or unco‐operative. The oral hygiene status, presence of caries, retained roots and denture‐related stomatitis were recorded. Results: Of the participants, 70% had only natural teeth. The prevalence of caries was 28%. A significant correlation showed that having more teeth gave a poorer Simplified Oral Hygiene Index (OHI‐S) (p = 0.018). The number of retained roots increased with the severity of cognitive impairment (p < 0.05). Significant differences were found between nurses or residents doing the tooth cleaning on the OHI‐S (p = 0.05) and percentage of dental plaque (p = 0.003). Unco‐operative residents had poorer oral hygiene (p = 0.028), more caries (p = 0.008) and were more often moderate–severe cognitive impaired (p = 0.016). Conclusions: A high percentage of participants had unacceptable oral hygiene. Residents whose teeth were cleaned by the nurses had poorer oral hygiene. Unco‐operative residents had the worst oral hygiene and more caries.     

Oral health status in a group of the elderly population residing at home

doi: 10.1111/j.1741‐2358.2011.00556.x Oral health status in a group of the elderly population residing at home Objectives: To determine the oral health status and treatment needs of subjects aged 65 years and older residing in different districts of Ankara. Materials and methods: A total of 1300 patients, 751 females and 549 males, age 65 and over with a mean age of 72.8 ± 6.34 were included in this study. The subjects were visited at home and toothbrushing habits, visiting the dentist, tooth loss, denture needs were questioned and body mass index values were recorded. Results: 52.5% of the subjects were completely edentulous, 83.3% subjects reported wearing a removable denture. Females had a higher total tooth loss frequency when compared to males (p < 0.05). Total tooth loss between 65 and 69 ages was 47.3%, and increased to 62.4% among those aged 75 and over (p < 0.05). 16.2% of the subjects had not visited a dentist in the last 10 years, and only 3% visited a dentist for control check‐ups; no gender‐based difference was observed as to the frequency of dental visits (P > 0.05). No significant relationship was found between tooth loss and BMI values (P > 0.05). 46.3% of the subjects had chewing problems. Conclusions: The subjects included in this study showed high tooth loss frequency and poor oral hygiene habits. Education regarding maintenance of oral hygiene and regular dental check up should be stressed for the elderly.     

Number of teeth in relation to oral health behaviour in dentate elderly patients in Lithuania

Aim: To describe oral self‐care practices and the use of dental services among dentate elderly patients attending public dental service in Kédainiai, Lithuania, and relate these parameters to the number of remaining teeth. Design: Cross‐sectional questionnaire study. Setting: Two public dental offices in Kédainiai, Lithuania. Participants: Dentate patients aged 60+. Methods: A self‐administered questionnaire covering oral hygiene practices, use of sugar, utilisation of dental services, and number of teeth. Age, gender, and education served as background factors. Results: In all, 174 dentate elderly people responded, their mean age being 69.2 years (CI 95% 68.2–70.2) and mean number of teeth reported 16.2 (CI 95% 15.4–17.1). Of these respondents, 30% reported that they brushed their teeth twice daily and 57% that they always used fluoridated tooth paste. Having 21+ teeth was strongly associated (p < 0.001) with these habits, with brushing in the evening, and with enrolment in higher education, but not with gender. After controlling for various self‐care and background factors, frequent tooth brushing remained as the only significant factor in the logistic regression model (OR 2.0, CI 95% 1.2–3.3, p = 0.01) to explain subjects’ retention of 21+ teeth. Conclusions: Elderly Lithuanians’ oral self‐care is far from meeting recommendations. To preserve their natural teeth, dentate elderly people should improve their oral self‐care practices, in particular as regards tooth brushing. To reach that goal, all efforts by the community and dental profession are welcomed.     

Denture contamination by yeasts in the elderly

Objectives: The aim of this study was to investigate yeast carriage in healthy denture wearers by swabbing and to evaluate the effect of denture hygiene habits. Materials and methods: Denture wearers (n = 87) without evidence of denture stomatitis or any other oral disease were investigated by separately swabbing the fitting surface of the upper denture and the corresponding palatal mucosa in contact with the appliance. In a group of volunteers, a gel without any active compound was spread on the palatal side of the denture once in every morning for 2 weeks. Results: Screening showed Candida colonisation of upper prosthesis in 75.9% of individuals. The most frequent species isolated were Candida albicans (77.9% of the positive cultures), Candida glabrata (44.1%) and Candida tropicalis (19.1%). Carriage of more than one yeast species was found in 48.5% of the contaminated dentures. There was a statistically significant association between denture contamination and palatal mucosa colonisation (chi‐squared test: p < 0.0001). Repeated swabbings after 1 week as well as during a weekly follow‐up for 1 month confirmed the denture contamination and its degree of severity. A daily gel application produced a yeast‐count decrease to 10% of the initial value after 2 weeks (chi‐squared test: p = 0.0134 and p = 0.2841 for prosthesis and palatal mucosa, respectively). Conclusion: This study documented the reliability of oral swabbing when investigating yeast carriage in healthy denture wearers. Moreover, just a diagnostic tool, sampling upper dentures for Candida could be the opportunity to verify the patient’s compliance to hygiene advice.     

The clinical evaluation of the oral status in Alzheimer-type dementia patients

doi: 10.1111/j.1741‐2358.2010.00401.x
The clinical evaluation of the oral status in Alzheimer‐type dementia patients Background: To evaluate the oral health status in patients with Alzheimer dementia (AD), and the association of the disease severity with the oral findings. Methods: The study was conducted on the study group (31 AD patients) and the control group (47 healthy volunteers) from the Neurology Department of the Institute. Cognitive status was evaluated with the MMSE scoring system. Oral parameters, such as decaying, missing, filled teeth (DMFT) index and teeth present (PT) were evaluated in the patients. Oral hygiene status, denture status and mucosal lesions, including denture‐induced stomatitis were also investigated. Results: The study was conducted on the study group (31 AD patients) and the control group (47 healthy volunteers). Tooth brushing and denture cleaning were irregular in 22 of 31 (70%) patients with AD. The ratio of the subjects who forgot to remove their denture during the night was significantly higher in the study group than in the control group (p < 0.001). In this study, decreased cognitive functions in AD patients have been demonstrated to result in a deterioration of denture care and increased denture‐related mucosal lesions. Conclusions: These findings were considered due to decreased denture care including the non‐removal of the denture in the night in the patients with decreased cognitive functions.     

Oral health and treatment needs of the long-term hospitalised elderly

Objectives: To determine the oral health and treatment needs of the long‐term hospitalised elderly. Setting: The Laakso long‐term hospital, Helsinki, Finland. Design: A cross‐sectional study with clinical oral examinations. Subjects: All long‐term patients (n = 260) aged 60 and older. Main outcome measures: Edentulousness, presence and hygiene of dentures, mucosal findings, number of teeth, functioning teeth and tooth remnants, level of dental hygiene, and need for operative treatment. Results: Subjects’ mean age was 83.3 years (SD = 8.1); 42% were edentulous, 45% of women and 33% of men (p = 0.12). With no gender difference, 41% had removable dentures, but one in four were considered to be in need of repair or replacement. Denture hygiene was good in 19%, moderate in 44%, and poor in 37%, and for men worse than for women (p = 0.02). Stomatitis was found in 25%, and angular cheilitis in 28% of the denture wearers. The dentate subjects had on average 12.4 (SD = 8.6) teeth with a clear difference by age (p = 0.03), but no difference by gender. Dental hygiene was considered poor. Of the dentate subjects, 37% were in need of restorations, 51% of periodontal therapy and 42% of extractions. Conclusions: Oral cleanliness should be improved with regards to dentures and teeth. More attention should be focused on dental care of the long‐term hospitalised elderly.     

Postural impairments in Parkinson’s disease are not associated with changes in circadian rhythms changes

ABSTRACT

Parkinson’s disease (PD) is a progressive neurodegenerative disease, with a worldwide incidence of 1% in individuals >60 years of age. Its primary characteristics include postural impairments and changes in circadian rhythms. The authors investigated the association between postural impairment and changes in circadian rhythms in 24 PD subjects diagnosed with stages 1 to 3 on the Hoehn-Yard (HY) scale and regularly used dopaminergic medication for at least 1 year (experimental group – EG) and 24 healthy elderly individuals without a history of neurological impairment as the control group (CG). Static balance tests using a force plate were performed, and activity/rest rhythm, according to the relative amplitude of L5 and M10 values, was monitored for seven consecutive days using actimetry. The results indicated differences in posturographic indicators of mediolateral displacement (ML) [EG, 4.71 ± 0.85 mm; CG, 2.79 ± 0.53 mm (p < .0001)] and anteroposterior displacement of the center of pressure (COP) [EG, 5.61 ± 2.43 mm; CG, 8.23 ± 1.72 mm (< 0.0001)], ML velocity of the COP [EG, 2.39 ± 0.83 mm/s; CG, 1.40 ± 0.18 mm/s (p < .0001)], and total distance of the COP in the tandem stance condition [EG, 227.6 ± 75 mm; CG, 53.4 ± 6.1 mm (p < .0001)] between the EG and CG. There was no correlation between relative amplitude and posturographic data for the EG. Postural impairments were verified in comparing the EG and CG; however, there was no association between posturographic indicators and activity/rest rhythm.     

Complete denture hygiene and nocturnal wearing habits among patients attending the Prosthodontic Department in a Dental University in Brazil

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2010.00369.x Complete denture hygiene and nocturnal wearing habits among patients attending the Prosthodontic Department in a Dental University in Brazil Objective: The aim of this study was to evaluate the overnight wearing and cleaning habits of complete denture wearers. Background: Successful complete denture treatment can be achieved when the patients are motivated and aware of appropriate denture wear and hygiene. Materials and methods: A sample of 224 complete denture wearers (162 women) aged 37–89 years was studied. Inclusion criteria comprised edentulous subjects who had received their new complete dentures between 2000 and 2005 in the Dental Clinic of the Araçatuba and Araraquara Dental School, São Paulo State University. Ethical approval was sought and granted. Subjects were interviewed using questions related to overnight denture wearing and denture cleaning habits. Possible statistical relationships among some of items were analysed by the chi‐square test at 5% significance level. Results: Of the patients, 55.8% removed their dentures during the overnight period and 88% did this every day. Among them, 66.4% removed both dentures. Most of the patients used brushing with toothpaste (105 patients – 46.87%) as a cleaning method. More than a half of the subjects (63.4%) showed biofilm and calculus on their dentures. Conclusion: The patients need instructions and motivation concerning denture hygienic and denture removal overnight.     

Effect evaluation of a supervised versus non‐supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial

doi: 10.1111/j.1741‐2358.2010.00418.x
Effect evaluation of a supervised versus non‐supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial Objective: To compare a supervised versus a non‐supervised implementation of an oral health care guideline in Flanders (Belgium). Background: The key factor in realising good oral health is daily oral hygiene care. In 2007, the Dutch guideline ‘Oral health care in care homes for elderly people’ was developed to improve oral health of institutionalised elderly. Materials and Methods: A random sample of 12 nursing homes was randomly allocated to the intervention or the control group. Representative samples of 30 residents in each home were monitored during a 6‐month study period. The intervention included a supervised implementation of the guideline. Results: At the 6‐month follow‐up, only a small but statistically significant (p = 0.002) beneficial effect (0.32) of the intervention was observed for denture plaque after adjustment for baseline value and the random effect of the institution. In the linear mixed regression models, including a random institution effect, difference in denture plaque level was no longer statistically significant at the 5% level. Conclusion: Only denture hygiene has been improved by the supervised implementation, although with lower benefits than presumed. Factors on institutional level, difficult to assess quantitatively, may play an important role in the final result.     

Domestic use of a disclosing solution for denture hygiene: a randomised trial

doi:10.1111/j.1741‐2358.2009.00309.x
Domestic use of a disclosing solution for denture hygiene: a randomised trial Objectives: The purpose of this study was to investigate the effect of the domestic use of a disclosing agent for denture hygiene. Materials and methods: Completely edentulous participants wearing maxillary dentures were randomly assigned to one of the three intervention groups: (1) Follow‐up only (control; n = 12); (2) Oral and denture hygiene instructions (n = 10); (3) Instructions associated with the home use of a disclosing agent (1% neutral red; n = 10). Biofilm coverage area (%) over internal and external surfaces of the maxillary denture was assessed at baseline and after 14 and 90 days. Data were evaluated by generalised estimating equations based on score tests (α = 0.05). Results: The participants presented low changes for areas of biofilm coverage (14 days (%): internal: GI = 1.4 ± 0.9; GII = 1.5 ± 1.3; GIII = ?0.4 ± 0.9; external: GI = 1.4 ± 1.5; GII = 1.5 ± 1.4; GIII = ?0.4 ± 0.9; 90 days (%): internal: GI = 2.0 ± 0.9; GII = 2.2 ± 1.4; GIII = 0.3 ± 1.0; external: GI = 2.1 ± 1.4; GII = 2.2 ± 1.5; GIII = 0.3 ± 0.9). Changes were similar for the three groups (p = 0.293) and were not influenced by the test time (p = 0.218). Conclusion: It can be concluded that the home use of a disclosing agent for denture hygiene does not improve the removal of the biofilm, particularly for patients with adequate oral hygiene habits.     

Candida albicans biofilm formation on soft denture liners and efficacy of cleaning protocols

doi: 10.1111/j.1741‐2358.2011.00485.x
Candida albicans biofilm formation on soft denture liners and efficacy of cleaning protocols Objective: The aim of this study was to investigate Candida albicans biofilm formation on denture liners and to analyse the efficacy of cleaning protocols. Material and methods: Specimens were prepared from four silicone‐based soft denture liners. After artificial ageing and surface free energy determination, specimens were incubated with saliva (2 h) and Candida albicans ATCC 10231 for either short‐ (2.5 h) or long‐term (24 h) biofilm formation. Adherent cells were determined either after incubation of specimens with Candida albicans or after treatment with different denture cleaning protocols. Statistical analysis was performed using one‐way anova and the Games–Howell test (α = 0.05). Results: For both short‐ and long‐term biofilm formation, similar amounts of Candida albicans cells were found on the surface of the different liners (p = 0.295 and 0.178, respectively). For both short‐ and long‐term biofilm formation, the highest cleaning efficacy was observed for sodium hypochlorite (NaOCl; p < 0.01). The efficacy of the chemical denture cleaner in removing long‐term Candida albicans biofilms was significantly lower than the efficacy of removal by brushing (p < 0.001). Conclusion: Different silicone‐based soft denture liners yield similar Candida albicans biofilm formation on their surface. The highest efficacy for the removal of Candida albicans biofilms was identified for NaOCl. Chemical denture cleaners appear to have rather low efficacy to remove mature Candida albicans biofilms.     

General health, dental status and perceived dental treatment needs of an elderly population in Istanbul

doi: 10.1111/j.1741‐2358.2010.00363.x
General health, dental status and perceived dental treatment needs of an elderly population in Istanbul Background: Comprehensive data on the oral health status and dental treatment needs of the elderly population in Turkey are deficient. Objectives: This pilot study determined the general and dental health status, perceived medical and dental treatment needs of an elderly population dwelling in residential homes in Istanbul. Method: Subjects at three different residential homes, namely one belonging to the state and two supported by foundations in Istanbul (N=121, female: 63 and male: 58) were involved in this study. A detailed questionnaire was prepared and dental examinations were conducted. Information was collected related to age, education levels, financial status, current physical functional status, general health, mental health, previous dental history, current dental status, oral hygiene practices and denture hygiene of these elderly people. The prevalence of edentulism, the presence and type of dental prostheses, dental and denture status and denture cleanliness were further evaluated. Results: The three most prevalent reported general health problems were associated with genito‐urinary problems (24%) followed by cardiovascular (18%) and respiratory problems (14%) varying significantly between genders, with males suffering more from cardiovascular problems than females (p < 0.05). Females showed significantly higher gastrointestinal and orthopaedic problems than males (p < 0.05). Females were more frequently edentulous than males but denture hygiene was significantly better in females than in males (p < 0.05). Brushing frequency did not significantly increase denture hygiene (p = 0.6). More than one‐third of the subjects had not been to the dentist within the previous 5–10 years, mainly due to lack of demand, followed by the cost of the dental care and fear. More than two‐thirds of denture‐wearing subjects wore their dentures only during eating. Conclusions: There was significant perceived dental treatment and care need for the sample population of elderly studied.     

Bacteriocin-producing strain of Enterococcus faecium EK 13 with probiotic character and its application in the digestive tract of rabbits

Enterococcus faecium EK 13 is a bacteriocin-enterocin A producing strain with probiotic properties. In this study its colonization, stability and effect on microflora in rabbits was studied as well as its influence on zootechnical parameters. Fifty rabbits of both sexes (HYPLUS, 30-day old; after weaning) were divided into control (CG) and experimental (EG) groups. They were fed a standard diet. Moreover, 25 rabbits in EG were fed daily (for 4 weeks) 15 g (separate doses ∼1.6 g) of lyophilized EK13 strain (rifampicin resistant variant — rif^R; 10⁹ cfu/g) dissolved in drinking water. After cessation of EK13 (rif^R) strain application, the rabbits in both groups were fed a standard diet for the next 2 weeks. Sampling was performed in double on day 0 (at the beginning of experiment), weekly during EK13 (rif^R) strain application as well as on week 1 and 2 after cessation of EK13 (rif^R) strain application. The counts of EK13 (rif^R) strain reached 7.1 ± 2.6 log₁₀ cfu/g after 4 weeks and even on week 2 after its cessation the counts 5.6 ± 2.3 log₁₀ cfu/g were determined. The total counts of enterococci in the rabbits were already increased in EG comparing with CG (p < 0.05); even 2 weeks after EK13 (rif^R) strain cessation, their counts in EG were 7.2 ± 2.6 log₁₀ cfu/g (p < 0.001). Enterococci in CG reached at the same time the value 3.7 ± 2.6 log₁₀ cfu/g. The counts of E. coli were significantly reduced in EG during 4 weeks (p < 0.05, p < 0.001). Even 2 weeks after EK13 (rif^R) strain cessation significant difference in E. coli counts between CG and EG was detected (p < 0.001). Enterobacteria in EG were significantly reduced (p < 0.001). Average daily gain in EG was 41.0 ± 3.83 in comparison to CG (40.6 ± 3.72); it means almost the same; although rabbits in EG showed higher feed intake per kg of gain than rabbits in CG. Preliminary results demonstrated that EK13 is a perspective probiotic candidate for rabbits. Presented at the Second Probiotic Conference, Košice, 15–19 September 2004, Slovakia.     

Prevalence of temporomandibular disorders in a population of complete denture wearers

doi: 10.1111/j.1741‐2358.2011.00574.x
Prevalence of temporomandibular disorders in a population of complete denture wearers Background: Complete tooth loss among the elderly is still frequent in developing countries and the incidence of temporomandibular disorders (TMD) is a common finding in complete denture wearers. Objectives: The aim of this study was to evaluate the prevalence of temporomandibular disorders (TMD) in a population of complete denture wearers. Materials and Methods: The data were collected by four examiners for the diagnosis of use and need for complete dentures followed by the World Health Organization standards and interviews for TMD signs and symptoms evaluation. Exploratory variables included demographic, socio‐economic status and TMD prevalence. Results: The prevalence of TMD among denture wearers was 55.12%. Chi‐squared test showed no statistical difference between subjects with or without TMD for gender, geographical location and skin colour (p < 0.05). The number of subjects with TMD increased as the period of complete denture wear increased, although no statistical difference between groups were found (p < 0.05). Conclusions: There is a need of educational programmes aiming at the importance of health care and periodical change of a complete denture, and strategies with a preventive approach to quality general dental care.     

In vitro and clinical evaluation of specific dentifrices for complete denture hygiene

Objectives: To study the physical properties of two experimental dentifrices for complete denture hygiene, their effect on denture biofilm removal and antimicrobial properties by means of a clinical trial. Materials and methods: The experimental dentifrices comprised two compositions. One was based on the addition of 1% chloramine T (D1) and the other on the presence of 0.01% fluorosurfactant (D2). Measurements of density, pH, consistency, rheological features and abrasiveness were conducted. Sixty complete denture wearers were randomly assigned to three groups and were instructed to brush their dentures with a specific toothbrush: (1) Water (control); (2) D1; or (3) D2. Each method was used for 21 days. Denture biofilm was disclosed by a 1% neutral red solution and quantified by means of digital photos taken from the internal surface. Microbiological assessment was conducted to quantify Candida sp. and mutans streptococci. Data were evaluated by one‐way anova and Tukey HSD, or Kruskal–Wallis (α = 0.05). Results: Both dentifrices decreased biofilm coverage when compared with the control group. D1 was the most efficacious treatment to reduce mutans streptococci, whereas D2 showed an intermediate outcome (anova , p < 0.040). No treatment influenced Candida albicans or non‐albicans species (Kruskal–Wallis, p = 0.163 and 0.746, respectively). Conclusion: It can be concluded that brushing complete dentures with the experimental dentifrices tested could be effective for the removal of denture biofilm.     

Comparative analysis of biofilm levels in complete upper and lower dentures after brushing associated with specific denture paste and neutral soap

Objectives: The objective of this study was to compare and correlate biofilm levels in complete upper and lower prosthesis after brushing, associated with specific paste and soap, by means of computerised methodology. Materials and methods: Forty‐five complete denture wearers were selected and instructed to brush their prostheses (Soft Oral B 40) three times a day for 3 weeks with water (Control), specific paste for complete dentures (Corega Brite) (Experiment 1) and neutral soap (Experiment 2). The study was based on a cross‐over model and a wash‐out period was not included. For biofilm quantification, the internal surfaces were dyed (neutral red 1%), photographed (Canon EOS Digital) and the disclosed biofilm was measured with the Image Tool 2.0 software. The products were assessed by means of a questionnaire regarding their hygiene properties and acceptance. Results: The variance analysis indicated that the lower prostheses exhibited a mean biofilm percentage, significantly higher than the upper prostheses and that brushing with paste (Experiment 1) was more effective than soap (Experiment 2) and, in turn, this was more effective than water (Control). There was a high biofilm correlation (Pearson correlation) between both prostheses. Both products were well accepted by the patients, but the most favoured one was the paste. Conclusions: This was effective in controlling the biofilm and can be used preventatively in the maintenance of oral health by wearers of complete dentures. This is important where the lower prosthesis can harbour microorganisms which may act as a reservoir for other areas of the mouth and thus enhance the importance of proper hygiene.     

Oral health‐related quality of life in hospitalised stroke patients

doi:10.1111/j.1741‐2358.2009.00330.x
Oral health‐related quality of life in hospitalised stroke patients Objective: The aim of this study was to test the hypothesis that impairment of orofacial function following stroke affects the patients’ oral health‐related quality of life (OHRQoL). Material and methods: From the University Hospitals of Geneva, 31 stroke patients (18 men, 13 women, mean age 69.0 ± 12.7 years) with unilateral facial and limb palsy were recruited (patient group, PG). In the study, the Oral Health Impact Profile (OHIP)‐EDENT was utilised to assess OHRQoL. Further examinations comprised a test of masticatory efficiency and lip force, stroke severity National Institute of Health Stroke Scale and dental state. The control group (CG) consisted of 24 subjects with similar age, gender and dental state. Results: The PG mean OHIP‐EDENT sum score was 18.8 ± 15.5 and proved higher than one of the CG, indicating a lower OHRQoL in the PG (p < 0.01). The score of the sub‐domains ‘functional limitation’ and ‘physical pain’ were significantly higher in PG (p < 0.03 and p < 0.02, respectively). The masticatory efficiency was significantly lower in the PG (p < 0.0001) and was associated with the OHIP‐EDENT sum score and its sub‐domains, except for ‘physical disability’. This effect was not present in the CG. Conclusion: The OHRQoL is significantly reduced in hospitalised stroke patients whereby functional impairment seems predominant when compared with psychological and psycho‐social aspects.