Relationship between salivary histatin 5 levels and Candida CFU counts in healthy elderly

Objectives: Few epidemiological studies have confirmed the antifungal activity of histatin 5 in saliva against Candida species. The purpose of this study was to examine the relationship between concentrations of histatin 5 and the number of cultivable Candida in saliva samples from elderly. Methods: Whole saliva samples were obtained from 124 elderly people, 65 years or older, living in a rural community. The concentrations of histatin 5 in saliva samples were determined by the enzyme‐linked immunosorbent assay (ELISA) using a monoclonal antibody. Total colony‐forming units (CFUs) were counted on a selective medium for Candida. Multiple linear regression analysis was performed to determine the independent contribution of explanatory variables to Candida CFUs using age, sex, histatin 5 concentration and type of denture prosthesis as independent variables. Results: Saliva samples from 104 subjects (84%) were candidal colony‐positive. The youngest group (65–69 years old) showed significantly smaller Candida CFU counts than those in the older group. The mean Candida CFU count of denture wearers was significantly higher than that of non‐denture wearers. Significantly negative associations were found between Candida CFU counts and histatin 5 level in the oldest group (p < 0.05) and in the full‐denture wearers (p < 0.01). Multiple linear regression analysis revealed that Candida CFU counts were mostly associated with type of dentures, followed by histatin 5 concentration. Conclusion: Possible activity of histatin 5 against Candida in whole saliva of elderly people was epidemiologically confirmed. The area covered by the prostheses was a strong factor associated with the Candida CFU count.     

Knowledge of prosthodontic treatment among denture-wearers and non-denture-wearers attending a dental institute in India: a survey report

Objective: Knowledge of subjects regarding prosthodontic treatment may play a role in their acceptance of the prostheses. The purpose of this survey was to assess the knowledge of prosthodontic treatment among the denture‐wearers and non‐denture‐wearers reporting to the Institute of Dental Sciences, Belgaum. Methods: A self‐designed closed‐ended questionnaire containing 14 questions was designed. Four‐hundred and nineteen subjects aged between 25 and 65 years were surveyed over a period of 2 months. Collected data were statistically analysed using chi‐squared test at a significance level of p < 0.05. Results: From the 419 subjects surveyed, 140 subjects (33.4%) were dentate and 279 subjects (66.6%) were edentulous either in the maxillary, mandibular or both arches. Among the 279 edentulous subjects, 143 (51.3%) did not use any kind of prosthesis. There was a statistically significant difference in knowledge regarding the replacement of teeth by artificial means, the number of visits required for the provision of a complete denture, problems with dentures among subjects using and not using them (p < 0.001) whereas no significant difference was found among the subjects regarding aesthetics with dentures and socializing with friends. Conclusion: Attempts should be made to raise the level of knowledge of both denture‐wearers and non‐denture‐wearers reporting to the Institute for any dental treatment.     

The influence of age and denture wear on the size of edentulous structures

Objectives : This study was designed to evaluate the influence of age and denture use on the size of arches and residual ridges in edentulous patients. Design : At two nursing homes, maxillary and mandibular stone casts of 302 fully edentulous patients were utilized to measure the size of the arches and residual ridges, according to age and use of complete dentures. Age cohorts were divided into three groups; 60–69, 70–79, and 80–89 years old. Two hundred and forty‐nine denture wearers used complete dentures for at least 2 years before examinations. Fifty‐three non‐denture users had never worn removable prostheses. Chi‐square analysis (p<0.05) was used to establish the possible relations between the linear values and the size indexes of the ridges and arches and the two examined parameters: age and denture wear. Results : Young old patients possessed edentulous structures that were not significantly larger than elderly old patients in both the maxilla and the mandible. Non‐denture users had significantly bigger arches and ridges in both edentulous jaws than denture users. Conclusions : Young old, non‐denture users tended to have bigger residual edentulous tissues compared to elderly old patients who used complete dentures.     

Radiographic evaluation of alveolar ridge heights of dentate and edentulous patients

doi: 10.1111/j.1741‐2358.2010.00391.x Radiographic evaluation of alveolar ridge heights of dentate and edentulous patients Objective: To evaluate the reduction of residual alveolar ridge height on panoramic radiographs and the differences between denture wearers and non‐denture wearers. Materials and methods: The study consisted of 147 individuals (74 men and 73 women) [50 were denture wearers and 50 non‐denture wearers (examination groups) and 47 of them were dentate (control group)]. Individuals having diseases impacting on bone were excluded. Vertical measurements were made at 15 sites (central incisors, first premolars and molars at the left and right of both jaws and the distance between the zygoma/orbit). MANOVA (multi‐variate analysis of variation) was used for the statistical analysis of the results. Results: There were significant differences between the alveolar ridge heights of dentate and edentulous groups (p < 0.001). Between the denture wearer and the non‐denture wearer groups, there was significant difference in the lower jaw (p < 0.001), but no significant difference in the upper jaw (p = 0.635). There were also differences between men and women (p < 0.005) and upper and lower jaws at every measurement sites (p < 0.01). Conclusion: Reduction in residual alveolar ridge height was in close relation with gender, denture usage and edentulousness.     

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.     

Biofilm formation of Candida albicans on the surface of a soft denture‐lining material

Background: Soft denture lining‐materials are more susceptible to microbial adhesion than hard denture base acrylic resin. Poor oral hygiene and Candida albicans infection are common among elderly denture wearers as these patients usually have difficulty in keeping them clean. Purpose: To evaluate the influence of the oral hygiene methods on the formation of a biofilm over a soft denture‐lining material. Material and methods: Twenty volunteers were randomly separated into two groups: G1 and G2. Ten volunteers performed daily hygiene of the prostheses with a soft toothbrush and toothpaste. The G2 performed a treatment identical to G1 but also immersed the prostheses in sodium hypochlorite 0.5% for 20 min, once a week. Quantification of the mean score values of biofilm formation at different times were statistically analysed using analysis of variance and Tukey’s test (α = 0.05). Results: G1 (0.65 ± 0.52) showed the lowest mean score values of biofilm formation. There was statistical difference between G1 and G2. The highest mean score values were found at 6 weeks (1.3 ± 1.08) and were statistically different from other times. Conclusion: The oral hygiene methods had a significant effect in the formation of the biofilm over a soft denture‐lining material.     

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 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.     

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.     

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.     

A preliminary assessment of intra-oral lubricating systems for dry mouth patients

Objective: To provide extended intra-oral delivery of a saliva substitute. Intervention: Three different types of prostheses containing saliva substitute were designed and assessed: a two-part device resembling a mandibular complete denture sealed by cobalt-samerium magnets, a one-part clear resin device for the edentate patients and a flexible mouth guard type of appliance containing a lubricant releasing bubble for the dentate patients. Setting: A teaching hospital Oral Medicine and Rheumatology Clinic. Subjects: 8 edentate and 3 dentate Sjogren Syndrome sufferers. Outcome measures: Subjective dryness after a week of wearing the lubricating appliance. Results: The majority of the subjects wore the appliances for 6–12 hours during each 24 hours. The initial dryness severity diminished after wearing the lubricating prosthesis. The patients preferred to wear the appliance at night. Conclusion: All criteria were fulfilled on designing a saliva substitute lubricating appliance and some of the subjects have worn this prosthesis successfully for up to 3 years. Particular benefit was obtained by night-time wear.     

Unnoticed swallowing of a unilateral removable partial denture

doi: 10.1111/j.1741‐2358.2011.00621.x Unnoticed swallowing of a unilateral removable partial denture Objective: This paper presents a case report about an unnoticed swallowing of a partial denture impacted in the esophagus in a 74‐year old man without serious complications. Background data: Dental prostheses (removable/fixed dental prostheses or fragments of dentures) appear to constitute a significant proportion of swallowed of impacted foreign bodies in the orolaryngopharynx. Conclusion: This case emphazises that is advisable to contraindicate this type of unilateral removable partial denture to replace teeth as temporary or definitive dental prosthesis.     

Examination of denture-cleaning methods based on the quantity of microorganisms adhering to a denture

doi: 10.1111/j.1741‐2358.2011.00461.x Examination of denture‐cleaning methods based on the quantity of microorganisms adhering to a denture Objectives: To investigate effective denture‐cleaning methods, we examined the relationships between the quantity of microorganisms adhering to dentures and the use of a denture brush and the frequency of use of a denture cleanser. Subjects and Methods: Denture plaque was collected from the mucosal surface of the examined dentures, which were 142 and 80 upper and lower complete dentures, respectively, worn by 96 outpatients (mean age: 71.9 years) of a university hospital and 41 nursing home residents (mean age: 84.8 years). The collected microorganisms were counted in terms of isolated representative colonies that were cultured and identified using standard methods. The use of a denture brush, the frequency of use, and the type and soaking time of denture cleansers as denture‐cleaning methods were surveyed. Results: The quantity of microorganisms was significantly lower in dentures of denture brush users than in those of non‐users in the outpatients (p < 0.01, Mann–Whitney U test). The quantity of microorganisms was significantly lower in the dentures of outpatients who used a denture cleanser daily or 3–4 times a week than in those who used one once or less per month and in the dentures of nursing home residents who used one daily than in those who used one at other frequencies (p < 0.05, Kruskal–Wallis test, followed by Dunn’s Multiple Comparison test). Conclusion: Within the limitations of this study, it was concluded that the use of a denture brush and daily use of denture cleanser should be recommended to complete dentures wearers as denture‐cleaning methods that effectively reduce the quantity of microorganisms adhering to dentures.     

Nutritional status, dietary intake and oral quality of life in elderly complete denture wearers

doi: 10.1111/j.1741‐2358.2011.00545.x Nutritional status, dietary intake and oral quality of life in elderly complete denture wearers Background and objective: The prevalence of malnutrition increases with age because of many factors. Edentulousness leads to the avoidance of many types of foods. The aim of this study was to determine whether elderly complete denture wearers have a higher risk of malnutrition than dentate controls. Material and methods: A Mini‐Nutritional Assessment (MNA) and a 3‐day dietary record were compiled for a group of fully dentates (21 women and 29 men; mean age 70.1 ± 6.1) and for a group of complete denture wearers (31 women and 16 men; mean age 70.1 ± 8.1). Socio‐demographic data and scores on the General Oral Health Assessment Index (GOHAI) questionnaire were collected. Results: Inter‐group comparison of MNA scores showed that more subjects in the edentulous group (21.3%) risked malnutrition than in the dentate group (0%). The variability of the MNA could be explained for 22% by dental status, 7% by loneliness and 4% by the GOHAI score (regression analysis). Both groups had insufficient energy intakes and deficits in vitamins and micronutrients; moreover, edentulous subjects had lower intakes than dentate subjects. Conclusion: The use of conventional dentures increases the risk of malnutrition in the elderly.     

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.     

Maxillary complete denture movement during chewing in mandibular removable partial denture wearers

Objectives: To evaluate the pattern of maxillary complete denture movement during chewing for free‐end removable partial dentures (RPD) wearers, compared to maxillary and mandibular complete denture wearers. Materials and methods: Eighteen edentulous participants (group I) and 10 volunteers with bilateral posterior edentulous mandibles (group II) comprised the sample. Measures of mean denture movement and its variability were obtained by a kinesiographic instrument K6‐I Diagnostic System, during the mastication of bread and a polysulphide block. Data were analysed using two‐way anova (α = 0.05). Results: Upper movement during chewing was significantly lower for group II, regardless of the test food. The test food did not influence the vertical or lateral position of the denture bases, but more anterior dislocation was found when polysulphide blocks were chewed. Group II presented lower intra‐individual variability for the vertical axis. Vertical displacement was also more precise with bread as a test food. Conclusion: It can be concluded that mandibular free‐end RPD wearers show smaller and more precise movements than mandibular complete denture wearers.     

In vivo biofilm formation on a soft denture liner in elderly patients with controlled diabetes

doi: 10.1111/j.1741‐2358.2010.00428.x In vivo biofilm formation on a soft denture liner in elderly patients with controlled diabetes Objectives: This in vivo study evaluated the influence of controlled diabetes on biofilm formation on a soft denture liner in elderly patients. Background: Soft denture lining materials are more susceptible to microbial colonisation than denture base acrylic resins. Especially in the elderly, several predisposing factors may accumulate leading to an increased probability of biofilm development that may result in candidiasis, a significant clinical oral disease. Materials and methods: Volunteers wearing complete dentures were divided into two groups (n = 20): diabetic patients with controlled glycaemia, and healthy patients. In both groups, a silicone‐based soft liner was placed in a recess created at the base of the maxillary dentures. Subjects cleaned the prosthesis three times a day. Biofilm formed on the liner was quantified at various time points (baseline, two, four and six weeks). Data were analysed by two‐way repeated measures anova and Tukey’s test (α = 0.05). Results: There was no statistical difference in biofilm formation for any of the time points between controlled diabetes patients and healthy patients. Conclusion: The results suggest that the control of diabetes in elderly patients provides the same levels of biofilm formation when compared to healthy individuals.     

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.     

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.