The role of candidal histolytic enzymes on denture-induced stomatitis in patients living in retirement homes

Material and methods: Fifty nine elders wearing complete dentures and living in retirement homes in Curitiba (southern Brazil), were divided into two groups: group #1, 26 patients with denture‐induced stomatitis and group #2, 33 patients without denture‐induced stomatitis. The two groups were evaluated in relation to the degree of denture‐induced stomatitis, salivary fungal loads, and secretion of some histolytic enzymes. Results: Patients from group #1 showed higher degrees of colonisation by Candida albicans (p = 0.031). Candida krusei, Candida tropicalis, and Candida parapsilosis were also isolated, but there were no differences between the groups (p > 0.05). Secretory aspartyl protease (Sap) and chondroitinase did not show significant differences among the isolated Candida spp. in the two groups. Phospholipase secretion rates were higher among the strains of C. albicans from group #2 (p = 0.036). The same behaviour was not detected for non‐albicans Candida species. Conclusions: The results could infer that differences in the secretion rates of candidal histolytic enzymes should not be imputed as imperative for the progress of denture‐induced stomatitis.     

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.     

Treatment protocol for denture stomatitis,prior to anatomical molding

doi: 10.1111/j.1741‐2358.2012.00661.x Treatment protocol for denture stomatitis, prior to anatomical molding Background: Microorganisms of the genus Candida have been recovered from complete dentures made of acrylic resin, with high numbers of colony forming units and species diversity, which can act as infectious agents causing chronic atrophic candidiasis (denture stomatitis). Objective: The objective of this paper is present a treatment protocol for chronic atrophic candidiasis (denture stomatitis). Materials and Methods: The work describes three cases of totally edentulous patients presenting palate stomatitis who were submitted for treatment associating denture rebasing with chemically‐activated acrylic resin, night immersion in 2.5% sodium hypochlorite and use of topical antifungals for two weeks. Results: In all cases, remission of the inflammatory process occurred. Conclusion: The proposed treatment protocol proved to be to be effective.     

Denture-related stomatitis managed with tissue conditioner and hard autopolymerising reline material

doi: 10.1111/j.1741–2358.2010.00398.x
Denture related stomatitis managed with tissue conditioner and hard autopolymerising reline material. Objective: To compare the response of denture‐related stomatitis (DS) under management with a tissue conditioner (TC) and autopolymerising hard reline material (AHRM). Background data: Denture‐related stomatitis affects up to 75% of denture wearers; not wearing the denture at night, using TC or prescribing topical or systemic antifungal agents could reduce its incidence. Materials and methods: This was a double‐blind study consisting of 44 participants with DS who wear denture; they were randomly divided into two unmatched groups according to the material used for the management of DS. The TC was replaced weekly, and the AHRM was placed at the beginning of the study and was not changed for 4 weeks. A dentist performed an initial and a weekly clinical diagnosis for DS; the clinical situation was recorded by means of photographs for each week. Results: Both TC and AHRM were effective in the management of DS. Significant differences were found in the DS resolution time (p < 0.001), taking longer for the TC. Conclusions: Both the tissue conditioner and AHRM are effective for the management of DS, but AHRM requires less time for recovery and as a result fewer appointments are required for the patient.     

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 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.     

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.     

Effect of denture adhesive on the micro-organisms in vivo

doi: 10.1111/j.1741‐2358.2010.00381.x Effect of denture adhesive on the micro‐organisms in vivo Background: Denture adhesives increase the retention and stability of dentures in edentulous patients, especially in cases where salivary flow is impaired or in the management of traumatised oral mucosa. Objectives: The effect of a denture adhesive on the oral flora at different time intervals. Method: Thirty denture‐wearing patients were involved in this study. While half of the group received a denture adhesive, the other half did not. At baseline, 1 and 2 months after delivering the dentures, smear samples were obtained from the saliva, palate and the dentures. Candida albicans, Candida krusei, Candida glabrata, Candida spp., Staphylococcus aureus, Moraxella catarrhalis, α‐haemolytic streptococci, β‐haemolytic streptococci, Pneumococcus aureus, S. anginosus, S. intermedius, S. constellatus, S. sanguis, S. gordonii, S. mitis, S. mutans, S. salivarius, and yeasts were investigated. The data were statistically analysed using anova and repeated measures. Results: Most types of the micro‐organisms were not seen and could not be analysed statistically except α‐haemolytic streptococci and C. albicans. No statistically significant difference was found for α‐haemolytic streptococci and C. albicans in saliva, palate and the denture at all time intervals. Conclusions: Prolonged use of the denture adhesive tested up to 2 months did not yield to increase in micro‐organisms of the oral flora.     

Factors affecting the distribution and prevalence of oral mucosal lesions in complete denture wearers

Gerodontology 2010; doi: 10.1111/j.1741‐2358.2009.00351.x
Factors affecting the distribution and prevalence of oral mucosal lesions in complete denture wearers Objective: To determine the frequency of the oral lesions related to gender, age, the length of time of denture usage, education level and economic status. Methods: The 153 patients with old complete dentures (CD) were asked to participate in the investigation. The subjects (76 male and 77 female) were 37–85 years of age with a mean age of 61.8 ± 9.8 years. Education, economic status and age factors were estimated in subgroups. The data obtained were evaluated by one‐way anova , Mann–Whitney U‐test, Kruskal–Wallis test, Student’s t‐test and chi‐squared test. The level of statistical significance was set at p < 0.05. Results: The patients who had denture stomatitis and traumatic ulcers were statistically significantly older than the ones who did not have these lesions (p < 0.05). Based on the length of denture usage, patients who had a flabby ridge, fibrous inflammatory hyperplasia, traumatic ulcers (p < 0.01) and denture stomatitis (p < 0.05) were using their dentures statistically significantly longer than the ones who had healthy tissues. Conclusions: The CD wearers should be advised to visit their dentist regularly to prevent oral mucosal lesions due to the changing supporting tissues during the length of denture usage and to improve their quality of life.     

Distribution and phospholipase activity of Candida species in different denture stomatitis types

The aim of this study was to evaluate the correlation between frequency and phospholipase activity of Candida species and denture stomatitis according to Newton’s classification. Seventy-five complete denture wearers were evaluated for the presence of yeasts on the palatal mucosa by culture method. In addition, the number of yeast isolates producing phospholipase and amount of this enzyme were determined using egg yolk agar plate method. According to Newton’s classification, 25 denture wearers were with healthy palatal mucosa while 50 were with any types of denture stomatitis. The frequency of yeasts was linked to whether subjects had Type II or Type III, but not Type I denture stomatitis. Candida albicans was the most frequently isolated species in denture wearers with and without clinical signs of denture stomatitis and it was the only species produced phospholipase. Although the amount of phospholipase produced by the C. albicans isolates from denture wearers in control and Type II and III DS groups was not significantly different, there was statistically significant difference in the number of C. albicans isolates producing phospholipase between patients with and without clinical signs of DS.     

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.     

Complete denture wearing and fractures among edentulous patients treated in university clinics

doi: 10.1111/j.1741‐2358.2011.00551.x
Complete denture wearing and fractures among edentulous patients treated in university clinics Objective: The prevalence of wearing and fracture of complete dentures was evaluated among edentulous patients treated in two dental schools in Brazil. Background: Acceptance and wearing of complete dentures are related to adaptive behaviour of edentulous patients. However, one reason that could interfere with the wearing dentures is their potential to fracture, which is still a common complication in denture rehabilitation practice. Material and methods: Two hundred and twenty‐four edentulous patients rehabilitated with complete dentures from 2000 to 2005 in Araçatuba and Araraquara Dental School, University of State of São Paulo, were assessed in 2006 and 2007 to answer a questionnaire about wearing and fracture of their dentures. Statistical analysis were performed using Epi Info software and chi‐squared test to compare maxillary and mandibular data (α = 0.05). Results: Almost 26% of the patients did not wear their dentures, and among the remainder, the majority wore the maxillary denture. About 30% of the dentures were fractured, with higher prevalence in the maxillary arch (p = 0.003). Conclusions: Discontinuation of wearing dentures was quite high, especially considering the treatment which was carried out in university clinics. Prevalence of fractures was also high, greater for the maxillary denture, and was one of the main reasons for non‐wearing of complete dentures.     

The prevalence of denture stomatitis and its predisposing conditions in an older Greek population

doi:10.1111/j.1741‐2358.2009.00359.x
The prevalence of denture stomatitis and its predisposing conditions in an older Greek population Background: Pathology related to complete denture‐wearing will remain an important issue because of an increase in the ageing population. Objective: To investigate the prevalence and the risk factors for denture‐related stomatitis in the edentulous maxilla of older patients with a maxillary complete denture. Material and methods: One hundred and six patients treated in the Department of Prosthodontics of the Athens Dental School were interviewed and clinically examined. The results were analysed using chi‐square tests and multiple logistic regression. Results: Denture stomatitis was recorded in 39.6% of the sample (pinpoint hyperaemia: 17%, diffuse erythema: 16%, papillary hyperplasia: 6.6%). Chi‐square tests recorded significant associations between denture stomatitis and the continuous use of dentures (particularly the diffuse erythema type), the increased duration of denture experience and the poor retention of the maxillary denture. Other significant associations were recorded between the increased age of the current denture and pinpoint hyperaemia, and the reduced frequency of denture cleaning and papillary hyperplasia. Multiple logistic analysis revealed that the most important risk factor for denture stomatitis was the continuous use of the denture. Conclusion: The prevalence of denture stomatitis was high in denture users. Although many predisposing conditions were recorded, the most important risk factor was the continuous use of the denture. Therefore, appropriate advice on denture maintenance should be provided.     

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.     

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.     

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.     

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.     

Antimicrobial activity of denture adhesive associated with Equisetum giganteum- and Punica granatum-enriched fractions against Candida albicans biofilms on acrylic resin surfaces

Candida biofilms adhere to the internal surface of removable dentures, which is an etiological factor in the pathogenesis of denture stomatitis (DS). Adhesive materials are used at the base of maxillary complete dentures to improve their retention and chewing qualities. This article reports the antimicrobial activity of the enriched fractions of Equisetum giganteum and Punica granatum incorporated into a denture adhesive against C. albicans biofilm. The biofilms were induced on the surface of heat-cured acrylic resin specimens that were previously treated with a mixture of adhesive/herb extracts. The antimicrobial activity was evaluated by CFU counts, XTT reduction, and SEM and CLSM analysis. Both herb extracts amplified the anti-biofilm action of the adhesive on the acrylic resin by up to 12 h. Therefore, when these extracts were combined with COREGA®, they played a collaborative and innovative role in biofilm control and can be considered alternatives for temporary use in the treatment and/or prevention of DS.