Correlation between factors associated with the removable partial dentures use and Candida spp. in saliva

doi: 10.1111/j.1741‐2358.2010.00390.x
Correlation between factors associated with the removable partial dentures use and Candida spp. in saliva Objectives: To correlate the presence and number of Candida spp. in the saliva of wearers of removable partial dentures retained with precision attachments with the proportion of metal/acrylic resin present in the dentures. Methods: Saliva samples from 40 removable partial denture wearers (test) and one paired sample of individuals, non‐wearers of any type of removable denture (control) were collected, seeded, and the colony forming units of Candida counted and identified. The metal/acrylic resin proportion of each denture was quantified, using silicone plates pressed over each denture. Results: Candida spp. was found in the saliva of 80% of the individuals in the test group and 65% of the control, with C. albicans being the most prevalent species. The test group presented with the highest number of colony forming units of Candida per ml of saliva, and there was weak correlation between this number and the metal and resin area of the denture (Pearson’s coefficient of correlation). Greater prevalence and a higher number of colony forming units of Candida per ml of saliva occurred in removable partial denture wearers (p = 0.04) with a weak positive correlation between the metal and resin area and the number of colony forming units of Candida per ml of saliva. However, this correlation was more significant for the area of resin.     

In vivo assessment of the effect of an adhesive for complete dentures on colonisation of Candida species

doi: 10.1111/j.1741‐2358.2009.00345.x
In vivo assessment of the effect of an adhesive for complete dentures on colonisation of Candida species Objective: Denture adhesives have long been recognised by denture wearers as a useful adjunct to denture retention and stability. The objective of the present study was to evaluate, in vivo, the effect of a denture adhesive on oral quantities of Candida species by determination of absolute counts of colony‐forming units (CFU) per ml of saliva of individuals who use this denture adhesive for a period of 14 days. Materials and methods: Twenty‐four individuals were randomised in two equal groups of 12 (test and control), with the individuals of the test group using the adhesive for 14 days. Samples of saliva were collected from all individuals on days 0 (initial), 7 and 14. Aliquots of saliva were diluted and plated in duplicate on Sabouraud dextrose agar with chloramphenicol and incubated for 37°C for 48 h, the CFU/ml were counted in the individuals of each group and the data of each group were compared at the different time periods and analysed statistically by the non‐parametric Mann‐Whitney U‐test (α ≤ 5%). Results: There were no statistically significant differences between the test and control groups during the test periods. Conclusion: Within of the limitations of this study, the data suggested that the denture adhesive tested did not significantly alter the oral microbiota during the 14‐day trial period.     

Effervescent tablets and ultrasonic devices against Candida and mutans streptococci in denture biofilm

doi: 10.1111/j.1741‐2358.2010.00378.x Effervescent tablets and ultrasonic devices against Candida and mutans streptococci in denture biofilm Objective: To evaluate the antimicrobial action of effervescent tablets and ultrasound on Candida spp. and mutans streptococci from denture biofilm. Background: It is not uncommon for edentulous patients to be elderly and find it difficult to brush their dentures. Hence, auxiliary methods are required for cleansing dentures as well as treating oral infections. Materials and methods: Seventy‐seven complete denture wearers were randomly assigned into four groups: (A) Brushing with water (control); (B) Effervescent tablets; (C) Ultrasonic device (Ultrasonic Cleaner, model 2840 D); (D) Effervescent tablets and ultrasonic device. All groups brushed their dentures with a specific brush and water, three times a day, before applying their treatments. Denture biofilm was collected at baseline and after 21 days. The samples were collected by brushing the dentures with saline and the detached microbial cells were quantified by plating. Counts [log (CFU+1) ml^?1] of total aerobes, Candida spp. and mutans streptococci were compared by one‐way anova or Kruskal–Wallis test (α = 0.05). Results: No significant difference was found among the methods from C. albicans (p = 0.76), C. tropicalis (p = 0.94) and C. glabrata (p = 0.80). Lower counts were found for methods B and D when compared with the other methods against mutans streptococci (p < 0.001). Method B showed lower total aerobic counts than A, whereas C and D showed intermediate results (p = 0.011). Conclusion: The effervescent tablets significantly reduced mutans streptococci and total aerobes from denture biofilm. However, they was not as effective against C. albicans. Ultrasonic cleansing presented a discrete antimicrobial effect and was less effective than the tablets for complete denture disinfection.     

Prevalence and Antifungal Susceptibility of Yeasts Obtained from the Oral Cavity of Elderly Individuals

Infections caused by Candida yeasts are common in elderly individuals. Seventy-five isolates of Candida spp. were obtained from saliva samples of 136 institutionalized elderly individuals resident in six retirement homes of Belo Horizonte, Brazil. Forty-seven isolates (62.66%) were identified as Candida albicans, 15 (20%) as C. tropicalis, 7 (9.33%) as C. glabrata, 4 (5.33) as C. parapsilosis, and 2 (2.67%) as C. guilliermondii. Among the 136 elderly individuals studied, 49 (36%) were male and 87 (64%) were female. Ages ranged from 60 to 90 years old. Sixty-three (46.3%) of the institutionalized individuals were denture wearers and, among them, 53 (84.1%) carried Candida yeasts in the oral cavity. Forty-four subjects presented lesions in the oral mucosa and among these, 36 (82%), had positive culture for Candida spp. The samples were tested for the in vitro susceptibility to amphotericin B, itraconazole, fluconazole and 5-flucytosin, and great variations were observed in the minimum inhibitory concentrations (MIC) of these drugs according to the species.     

Colonisation of the oral cavity by periodontopathic bacteria in complete denture wearers

doi: 10.1111/j.1741‐2358.2011.00506.x Colonisation of the oral cavity by periodontopathic bacteria in complete denture wearers Objective: The purpose of this study was to investigate colonisation by periodontopathic bacteria and the sites of colonisation in elderly upper and lower complete denture wearers. We also investigated the relationship between level of oral hygiene and colonisation by periodontopathic bacteria. Materials and methods: Forty edentulous and 37 dentate volunteers participated in this study. Samples were collected from whole saliva, and levels of Aggregatibacter actinomycetemcomitans, Prevotella intermedia, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia and Fusobacterium nucleatum were determined by PCR Invader technology. Detection of these species on oral mucosal and denture surfaces was performed by PCR. Fisher’s exact test was used for the statistical analysis. Cluster analysis was employed to investigate trends in the periodontopathic bacteria flora in each sampling area. Results: Detection rates of periodontopathic bacteria in whole saliva were lower under edentulous conditions than under dentulous conditions, except for A. actinomycetemcomitans and F. nucleatum (p < 0.01). Detection rate of F. nucleatum was the highest in all areas. A positive correlation was observed between DNA quantification of P. gingivalis and number of Candida species in saliva. Cluster analysis of the test species identified two clusters. Tongue‐coating status was associated with the detection rate of all periodontopathic bacteria investigated, and denture plaque status was associated with the detection rate of T. denticola and F. nucleatum. Conclusion: Results indicate the presence of periodontopathic bacteria under edentulous conditions and that the status of oral hygiene of the mucosal or denture surfaces affects colonisation by T. denticola and F. nucleatum.     

Salivary immunity in elderly individuals presented with Candida-related denture stomatitis

doi: 10.1111/j.1741‐2358.2011.00476.x
Salivary immunity in elderly individuals presented with Candida‐related denture stomatitis Objectives: Elderly individuals with Candida‐related denture stomatitis (DS) present with a reduced defence against Candida albicans. This study evaluated levels of antimicrobial mediators in the elderly DS saliva and salivary neutrophils’ activation characteristics compared with elderly and young without DS. Methods: Salivary peroxidases (SPO) and elastase activities (ELA), nitric oxide (NO), transforming growth factor beta (TGF‐β), IL‐6 and CCL3 production were determined in saliva from elderly with or without DS, and young control individuals. TLR4, CXCR1, CD11b, CD16 and CD32 expression on salivary neutrophils were evaluated. Correlations between number and apoptosis rate of salivary neutrophils, enzymatic activities and cytokine levels were determined. Results: Elderly DS individuals exhibited the lowest SPO and ELA activities. Also, the activity of both enzymes was low in elderly without DS. Although both elderly groups showed higher salivary NO and TGF‐β levels compared to young control groups, elderly DS presented the highest salivary NO, TGF‐β, IL‐6 and CCL3 levels. Decreased percentages of salivary TLR4⁺ and CD16⁺ neutrophils were detected in both elderly groups. Although these damages could influence the establishment and persistence of DS, the highest levels of salivary IL‐6 and CCL3 in elderly DS could be preventing more serious complications.     

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.     

In vitro antiseptic properties of an ammonium compound combined with denture base acrylic resin

Background: Denture base acrylic resin is easily colonised by oral endogenous bacteria and Candida spp., and eventually by extra‐oral species such as Staphylococcus spp., Pseudomonadaceae or members of Enterobacteriaceae. This microbial reservoir can be responsive for denture related stomatitis and aspiration pneumonia, a life‐threatening infection especially in geriatric patients. However, the oral and denture hygiene of dependant elderly individuals is extremely poor. Objective: This in vitro study aimed to determine the per cent of a quaternary ammonium compound heat‐polymerised in acrylic resin necessary to obtain denture base displaying antiseptic properties. Design: Acrylic resin discs containing 2–50% ammonium polymer (Poly 202063A; 0% control) were soaked in artificial saliva for 4 weeks. Resin discs were incubated for 24 hours with Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa [37°C, brain–heart infusion (BHI) broth and phosphate‐buffered saline (PBS) buffer] and Candida albicans (30°C, Schaedler broth), in 15 ml (168 discs) and 600 μl (168 discs) of inoculum. Microbial growth was verified at t 0 hours and t 24 hours. Data were recorded as the mean of three colony forming unit (CFU) numerations. The borderline of antimicrobial effect was determined at 0.1% viable cells. Results: In 600 μl of PBS inoculum, resin specimens had a bactericidal effect (E. coli and S. aureus: 2%; P. aeruginosa: 10%) and a fungicidal effect (C. albicans: 50%). Long‐term stability and toxicity in vivo studies are now required. Conclusion: A 2% quaternary ammonium compound polymerised with a denture acrylic resin displayed antiseptic properties after a 4‐week soaking period in artificial saliva. Such antiseptic denture base could help geriatric patients to improve their oral health.     

The relationships between oral status, physical and mental health, nutritional status and diet type in elderly Japanese women with dementia

Objectives: To suggest methods for maintaining an adequate nutritional status for elderly patients with dementia by evaluating the relationships between oral status, physical and mental health, and feeding conditions. Background: Feeding difficulties in dementia patients are related to food intake, and failure to eat may be associated with weight loss in long‐term care facilities. The relationship between compromised oral function and diet is still unclear. Materials and methods: A cross‐sectional study of 94 elderly women with dementia (mean age 89.6 ± 5.6 years) from a nursing home was undertaken to investigate their oral, physical and mental and nutritional status. Results: There were significant differences in serum albumin (p = 0.0284), N‐ADL (p = 0.0005), NM scale (p = 0.0004) and HDS‐R (p = 0.0004) between denture wearers and non‐denture wearers. However, there were no significant differences in body mass index between denture wearers and non‐denture wearers. Conclusion: A suitable type of diet and assistance with feeding could maintain the nutritional status of elderly patients with dementia if they are still feeding themselves. The nutritional support team will benefit from the participation of a dentist.     

Susceptibility of <Emphasis Type="Italic">Candida</Emphasis> biofilms to histatin 5 and fluconazole

Candida-associated denture stomatitis has a high rate of recurrence. Candida biofilms formed on denture acrylic are more resistant to antifungals than planktonic yeasts. Histatins, a family of basic peptides secreted by the major salivary glands in humans, especially histatin 5, possess significant antifungal properties. We examined antifungal activities of histatin 5 against planktonic or biofilm Candida albicans and Candida glabrata. Candida biofilms were developed on poly(methyl methacrylate) discs and treated with histatin 5 (0.01–100 μM) or fluconazole (1–200 μM). The metabolic activity of the biofilms was measured by the XTT reduction assay. The fungicidal activity of histatin 5 against planktonic Candida was tested by microdilution plate assay. Biofilm and planktonic C. albicans GDH18, UTR-14 and 6122/06 were highly susceptible to histatin 5, with 50% RMA (concentration of the agent causing 50% reduction in the metabolic activity; biofilm) of 4.6 ± 2.2, 6.9 ± 3.7 and 1.7 ± 1.5 μM, and IC₅₀ (planktonic cells) of 3.0 ± 0.5, 2.6 ± 0.1 and 4.8 ± 0.5, respectively. Biofilms of C. glabrata GDH1407 and 6115/06 were less susceptible to histatin 5, with 50% RMA of 31.2 ± 4.8 and 62.5 ± 0.7 μM, respectively. Planktonic C. glabrata was insensitive to histatin 5 (IC₅₀ > 100 μM). Biofilm-associated Candida was highly resistant to fluconazole in the range 1–200 μM; e.g. at 100 μM only ~20% inhibition was observed for C. albicans, and ~30% inhibition for C. glabrata. These results indicate that histatin 5 exhibits antifungal activity against biofilms of C. albicans and C. glabrata developed on denture acrylic. C. glabrata is significantly less sensitive to histatin 5 than C. albicans.     

Effect of ill-fitting dentures on the swallowing duration in patients using polygraphy

doi: 10.1111/j.1741‐2358.2011.00536.x Effect of ill‐fitting dentures on the swallowing duration in patients using polygraphy Background: Surface electromyography (SEMG) has been widely used in the recent years to study swallowing physiology, offering a valid and reliable tool for identifying normal swallowing. The goal of our study was to assess the contribution of denture fitness in the age‐related increase of swallowing duration. Methods: Twenty denture wearers and 20 dentate individuals were analysed using SEMG and a computerised kinesiography of mandibular movement. Three spontaneous saliva swallowings were recorded for each patient with both their old and new prostheses. Three spontaneous saliva swallowings were recorded for each dentate person in two different recording sessions. Results: Old prosthesis mean swallowing time was 1.84 (SD ± 0.85) seconds while the new well‐fitting prostheses needed a 1.28 (SD ± 0.55) (p = 0.0009) swallowing time. The difference in swallowing time was significant (p = 0.01) between dentate subjects and individuals wearing an old prosthesis. No significant difference was found between dentate subjects and the same prosthesis wearers when a new well‐fitting prosthesis was worn. Conclusion: Data presented in this work suggest that part of the increased duration of swallowing showed by elderly and healthy people is because of incorrect an dental prosthesis. Prolongation of swallowing duration in the elderly population could be reconsidered in the light of the quality of dental device worn by the aged population.     

Oral mucosal lesions in denture wearers

doi:10.1111/j.1741‐2358.2009.00289.x
Oral mucosal lesions in denture wearers Objective: To determine the prevalence of oral mucosal lesions (OMLs) and denture‐related mucosal lesions (DMLs) in denture wearers and to co‐relate the prevalence with age, gender, type of denture and any systemic conditions. Materials and methods: Dental records of 380 denture wearers were retrospectively reviewed for OMLs and DMLs. Results: We found 45% of the denture wearers had DMLs and 60.8% had OMLs not related to denture wearing. Although the prevalence of DMLs was higher in complete denture wearers than in partial denture wearers (49% vs. 42.2%), this difference was not significant. The most common DMLs were traumatic ulcer (19.5%) and denture‐induced stomatitis (18.1%). When analysed by type, traumatic ulcer, denture hyperplasia, frictional keratosis and candidiasis were more common in complete denture wearers, whereas denture‐induced stomatitis was more common in partial denture wearers. Frictional keratosis was more common in men than in women. The prevalence of OMLs not related to denture wearing was higher in complete denture wearers than in partial denture wearers, and the most common OML was fissured tongue (27.6%). No association between DMLs and systemic conditions or xerostomic drugs was noted. Conclusion: No differences in the prevalence of DMLs in association with denture type were found. The prevalence of OMLs not related to denture wearing was higher in complete denture wearers than in partial denture wearers. This difference was affected by age, and the data were similar to the findings observed in the elderly.     

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.     

A 2-year study of Candida-associated denture stomatitis treatment in aged care subjects

Objective: To test the efficacy of two methods of treatment for denture stomatitis in aged care institutions. Background data: Candida‐associated denture stomatitis has been associated with a lack of denture hygiene. Materials and methods: Sixty subjects with denture stomatitis were randomly divided into three groups: sodium hypochlorite denture soak, microwaving and control. Both methods of treatment were carried out on a nightly basis for 1 week, excepting the control group. Standardised photographs of the palate and microbial samples of palate, upper and lower dentures were taken before and after treatment. Results: Both hypochlorite and microwave irradiation significantly reduced the numbers of Candida and aerobic bacteria on both dentures and both methods significantly reduced Candida on the palate. However, palatal aerobic bacteria were not significantly reduced by either method and the controls showed insignificant changes at all three sites for both Candida and aerobes. Conclusion: While both methods of denture disinfection were successful, except for the counts of palatal aerobic bacteria, three independent observers of the clinical photographs had difficulty in identifying the controls but were more successful with the treatments. The raters also showed that there was no difference between both methods of disinfection and this agreed with the microbiological analysis.     

Clinical and microbiological efficacy of three different treatment methods in the management of denture stomatitis

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2009.00354.x
Clinical and microbiological efficacy of three different treatment methods in the management of denture stomatitis Objective: This study evaluated. the effect of mouthrinses and tissue conditioner on the clinical findings and microbial flora of 60 patients with Newton’s type II denture stomatitis (N2DS) Background: Denture stomatitis is a common problem in complete denture wearers. Materials and methods: Sixty patients with N2DS were included in this study and divided into three groups. Two groups of patients were instructed to rinse their mouth with the designated mouthrinses DioxiDent and Corsodyl twice daily for 1 min and to soak their dentures overnight in these solutions for 15 days. For the third group, tissue conditioner was placed in each of 20 patients’ existing maxillary dentures. Patients were evaluated both clinically and microbiologically at baseline and after 15 days. Palatal swabs and smears were taken from each patient before and after treatment and these samples were examined mycologically. The difference between Candida colonisation before and after treatment and the differences between pre‐treatment and post‐treatment clinical findings were assessed. Results: DioxiDent and Corsodyl showed an improvement in palatal inflammation and a decrease in Candida colonisation compared to Visco‐gel. Conclusions: The effectiveness of topical chlorine dioxide and chlorhexidine gluconate in the management of N2DS was demonstrated.     

Determining <Emphasis Type="Italic">Candida</Emphasis> spp. Incidence in Denture Wearers

The aim of this study was to determine Candida spp. incidence in the oral cavity of denture wearers and characterize predisposing factors in denture-related stomatitis (DRS). Three groups of denture wearers and a control group were evaluated for DRS according to Newton’s classification. The amount of yeast in saliva and the presence of yeast on mucosal surfaces were determined by phenotyping methods, and the impact of some risk factors on candidal carriage was evaluated. The development of DRS is most common in complete prosthesis users. When the count of yeast in saliva is ≥400 cfu/ml, the frequency of DRS is increased. In individuals who develop DRS, the most frequently encountered species that was identified as C. albicans. Prosthetic hygiene was related to the intensity of candidal growth and the development of DRS. C. albicans live as saprophyte in the oral cavity. But, it is capable of causing infection if there are predisposing conditions related to the host. Usage of removable prosthesis may cause these microorganisms to gain pathogenicity.     

Prevalence and antifungal drug sensitivity of non‐albicans Candida in oral rinse samples of self‐caring elderly

doi: 10.1111/j.1741‐2358.2010.00407.x
Prevalence and antifungal drug sensitivity of non‐albicans Candida in oral rinse samples of self‐caring elderly Aim: To assess the prevalence and antifungal drug sensitivity of non‐albicans Candida (NAC) species in elderly outpatients. Materials and methods: We investigated oral rinse samples of 194 self‐caring elderly population (mean age 83 years) with emphasis on background factors for harbouring NAC. Susceptibility of Candida species to antifungal drugs was determined using standard methodology. Multiple logistic regression analysis was performed taking positive NAC count as the dependent variable and a number of known Candida risk factors as independent variables. Results: Prevalence of candidal carriage of the population was 78.4%, of which 0.5% of the subjects were NAC positive. Candida dubliniensis was the most prevalent NAC species, followed by Candida glabrata and Candida parapsilosis. The NAC positive elderly were more often edentulous with dental prostheses or had fewer teeth than Candida albicans‐positive or yeast‐negative subjects. Dental caries slightly increased the risk for having NAC strains (odds ratio 1.08), whilst greater age appeared to lower the risk (odds ratio 0.77). Candida species were susceptible to the commonly used antifungal agents in general, but with considerable variation among species. Occasionally, some NAC exhibited lower antifungal susceptibility. Conclusion: The possibility of oral reservoirs of NAC strains which are resistant to common antifungals should be noted in elderly outpatients.     

Nocturnal masseter electromyographic activity of complete denture wearers

doi: 10.1111/j.1741‐2358.2011.00528.x Nocturnal masseter electromyographic activity of complete denture wearers Objective: Collection of normative data on activity patterns of the masseter during sleep in elderly denture wearers by portable electromyography (EMG) recorders. Background: Complete denture wearers might suffer from orofacial pain caused by myoarthropathies of the masticatory system. Indeed, denture instability may precipitate parafunctional habits and consequently muscle soreness and/or temporomandibular pain. Materials and methods: We collected normative masseter EMG data during sleep in 15 complete denture wearers (five women, 10 men, 56–88 years) by portable recorders in their natural environment. Activity periods (AP) were signal portions including subthreshold intervals ≤5 s. Signal amplitude was expressed in per cent of maximum voluntary contraction (%MVC). For this reason, maximum bite force was assessed. Twenty age‐matched dentate controls were also recorded for the maximum bite force. Results: We found 157.2 ± 86.5 AP per night, i.e. 24.0 ± 12.2 AP/h. Mean amplitude was 15.1 ± 4.3%MVC. AP lasted 6.8 ± 4.1 s, and their time integral was 126.3 ± 112.5%MVC?s. Maximum bite force was 116.8 ± 69.6 N in the edentulous, significantly lower than in controls (344.8 ± 150.4 N). Conclusions: Healthy complete denture wearers showed intermittent periods of nocturnal masseter activity of very low intensity and short duration.     

Effect of amine fluoride–stannous fluoride preparations on oral yeasts in the elderly: a randomised placebo‐controlled trial

Objectives: Oral yeast infections are an emerging problem among medically compromised and frail elderly. Antifungal drug resistance is also increasing because of an increase in non‐albicans Candida strains in these populations. We therefore set out to study, in the randomised‐controlled trial setting if the use of a topical amine fluoride–stannous fluoride combination (AmF–SnF₂) could control oral Candida growth in the elderly. The hypothesis was based on earlier findings showing that in vitro this combination had antifungal efficacy. Methods: A total of 194 nursing home residents were randomised to receive either the test mouth rinse and toothpaste or a placebo twice daily for 8 months. Of these, 136 completed the trial. Saliva samples were taken using the oral rinse method, cultivated and the strain level identified with routine microbial methods. Compliance and use of preparations was assessed by a nurse. Results: Significantly at the end of the trial, less mucosal lesions were observed in the test group in comparison to controls. Total bacterial count decreased in both the groups during the trial. Candida albicans was the most prevalent strain detected both at baseline and 8 months later. Only a few subjects carried non‐albicans strains. The AmF–SnF₂ did not significantly affect mean oral Candida counts, but median Candida counts were reduced in the AmF–SnF₂ group while an increase was seen in the placebo group. However, the differences observed were not statistically significant. Compliance among the regular elderly users slightly increased during the trial for both the groups. Conclusion: The number of subjects with high Candida counts decreased in the AmF–SnF₂ group. Hence, the fluoride combination might be useful as a support therapy for oral candidiasis. Prevalence of non‐albicans Candida strains was low in this population.